Unpacking eating disorder risk and resilience during menopause: a biopsychosocial perspective

Midlife may represent a developmentally vulnerable period for eating disorders (ED) due to the biopsychosocial factors associated with menopause that influence risk and resilience. In this cross-sectional study, we utilized CloudResearch, a leading research participant sourcing platform to recruit, prescreen, and generate a diverse and nationally representative sample of women between the ages of 40 and 65 (n = 467), who voluntarily completed a fully online survey administered through Qualtrics, a web-based survey platform. We examined two conceptually driven, multifactorial models to determine the differential influences of biologic (ie, age, menopause stage, menopause symptoms), psychological (ie, body image, self-perceptions of aging and menopause) and social (ie, social support and strain) on healthy eating and eating pathology, and specific ED behaviors (ie, caloric restriction, binging, purging). Two multivariate linear regression models were tested. We found that ED risk is elevated by higher body dissatisfaction and reduced by being in perimenopause or postmenopause as compared to premenopause. Resilience (ie, intuitive eating) was elevated by positive perceptions of aging and diminished by higher levels of body dissatisfaction, greater bothersomeness of menopause symptoms, and social support. Binging and purging were elevated by greater bothersomeness of menopause symptoms and greater body dissatisfaction. Dietary restraint was reduced by social relationship strains. This study replicates previous research on the important role of menopause symptoms and body image for ED risk. This study is the first to examine factors related to resilient outcomes and specifically the role of self-perceptions of menopause, aging, and social support as mechanisms to affect adjustment to menopause and promote healthy aging.