Disordered Eating, Eating Disorders, and Body Image in Midlife and Older Women.

PURPOSE OF REVIEW: We review the evidence for the reported increase in disordered eating and body image disturbance occurring in women in middle age and later life. We describe the contributing factors that relate to the unique experience of eating disorders (EDs) at midlife and beyond. We review evidence for several key factors in this observation, specifically the bio-psycho-social and relational components of later life EDs. We present treatment considerations, screening tools for evaluation, and treatment recommendations for this special population suffering with EDs. RECENT FINDINGS: Eating disorder symptoms and body image preoccupation have been identified in increasing numbers of women over age 50. Reports indicate that women are seeking treatment for chronic, recurrent, or late onset EDs. However, health care providers generally have not screened for these conditions, and often pursue other medical diagnoses. Age does not immunize women from body image preoccupation, weight and shape concerns, disordered eating, and eating disorders.

Eating disorders: A 25-year perspective.

I founded Eating Disorders: The Journal of Treatment & Prevention 25 years ago, and its character, reputation, and success are highly attributable to Arnold Andersen, John Foreyt, and Margo Maine, the three original senior editors, whose perspectives follow in this article. Having made the decision to retire from the journal, I asked the senior editors to transition to the emeritus board along with me, which I explain further in my own Last Word, "Goodbye, Eating Disorders," in this volume (Cohn, 2017). Over our 25 years of collaboration, the senior editors have acquired unique insights into the evolution of the eating disorders field; so, I asked them to contribute retrospective essays in which they also look forward within their primary areas of expertise-presented here in alphabetical order. - Leigh Cohn, Editor-in-Chief.

The legacy of hope summit: a consensus-based initiative and report on eating disorders in the U.S. and recommendations for the path forward.

BACKGROUND: Several unsuccessful attempts have been made to reach a cross-disciplinary consensus on issues fundamental to the field of eating disorders in the United States (U.S.). In January 2020, 25 prominent clinicians, academicians, researchers, persons with lived experience, and thought leaders in the U.S. eating disorders community gathered at the Legacy of Hope Summit to try again. This paper articulates the points on which they reached a consensus. It also: (1) outlines strategies for implementing those recommendations; (2) identifies likely obstacles to their implementation; and (3) charts a course for successfully navigating and overcoming those challenges. METHODS: Iterative and consensual processes were employed throughout the Summit and the development of this manuscript. RESULTS: The conclusion of the Summit culminated in several consensus points, including: (1) Eating disorder outcomes and prevention efforts can be improved by implementing creative health education initiatives that focus on societal perceptions, early detection, and timely, effective intervention; (2) Such initiatives should be geared toward parents/guardians, families, other caretakers, and frontline healthcare providers in order to maximize impact; (3) Those afflicted with eating disorders, their loved ones, and the eating disorders community as a whole would benefit from greater accessibility to affordable, quality care, as well as greater transparency and accountability on the part of in-hospital, residential, and outpatient health care providers with respect to their qualifications, methodologies, and standardized outcomes; (4) Those with lived experience with eating disorders, their loved ones, health care providers, and the eating disorders community as a whole, also would benefit from the establishment and maintenance of treatment program accreditation, professional credentialing, and treatment type and levels of care guidelines; and (5) The establishment and implementation of effective, empirically/evidence-based standards of care requires research across a diverse range of populations, adequate private and government funding, and the free exchange of ideas and information among all who share a commitment to understanding, treating, and, ultimately, markedly diminishing the negative impact of eating disorders. CONCLUSIONS: Widespread uptake and implementation of these recommendations has the potential to unify and advance the eating disorders field and ultimately improve the lives of those affected. A cross-disciplinary group of eating disorder professionals, thought leaders, and persons with lived experience have come together and reached a consensus on issues that are fundamental to the battle against the life-threatening and life-altering illnesses that are eating spectrum disorders. Those issues include: (1) the need for early detection, intervention, prevention, and evidenced-based standards of care; (2) the critical need to make specialized care more accessible and affordable to all those in need; (3) the importance of developing uniform, evidenced-based standards of care; (4) the need for funding and conducting eating spectrum disorder research; and (5) the indispensability of advocacy, education, and legislation where these illnesses are concerned. During the consensus process, the authors also arrived at strategies for implementing their recommendations, identified likely obstacles to their implementation, and charted a course for successfully navigating and overcoming those challenges. Above all else, the authors demonstrated that consensus in the field of eating spectrum disorders is possible and achievable and, in doing so, lit a torch of hope that is certain to light the path forward for years to come.

The risks of a quick fix: a case against mandatory body mass index reporting laws.

As the United States addresses obesity, a number of state legislatures are considering laws that require schools to track and report students' body mass index (BMI), a measurement of body weight (weight/height2). This article describes the state level activity on mandatory BMI reporting, offers numerous arguments against this practice, and suggests an alternative approach to promoting health in youth. Mandatory BMI reporting laws place a new and inappropriate responsibility on the schools. Proponents of such laws imply that BMI reporting will have positive outcomes, yet there is virtually no independent research to support this assumption. The authors argue that these laws could do significant harm, including an increased risk for children to develop eating disorder symptoms.