Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women

Abstract

Objectives The objective of our study was to evaluate the association between the transition to menopause, body dissatisfaction, and abnormal eating habits (restrained eating, binge eating, and orthorexia nervosa) in a sample of middle-aged Lebanese women. Methods A cross-sectional study conducted between July 2019 and January 2020 enrolled 1001 women aged 40 years and above from all Lebanese governorates. Data were collected by face-to-face interviews with all participants. The Body dissatisfaction subscale of the Eating Disorder Inventory‑second version was used to assess body dissatisfaction, whereas the Binge Eating Scale, Dutch Restrained Eating Scale, ORTO-15, Dusseldorf Orthorexia Scale (DOS), and Teruel Orthorexia Scale (TOS) were used to assess eating disorders (binge eating, restrained eating and orthorexia nervosa respectively. Multivariable analysis of covariance (MANCOVA) was used to compare multiple measures among the three menopausal phases, after adjustment over potential confounding variables (age, monthly income, body mass index, marital status, education level, and body dissatisfaction). Results Postmenopause was significantly associated with more orthorexia nervosa tendencies (lower ORTO-15 scores) than premenopause (β = − 1.87; p = 0.022). Perimenopause was associated with more binge eating (β = 1.56; p = 0.031), and less orthorexia nervosa (as measured by the DOS) than premenopause, with this association tending to significance (β = − 1.10; p = 0.051). Furthermore, higher body dissatisfaction was significantly associated with higher restrained eating (β = 0.02; p < 0.001), binge eating (β = 0.48; p < 0.001), and orthorexia nervosa as measured by ORTO-15 (β = − 0.17; p < 0.001) and TOS (β = 0.08; p = 0.002), but not DOS. Conclusion Our study showed that menopausal stages are associated with some disordered eating behaviors (binge eating and orthorexia nervosa) among middle-aged women. Those results may serve as a first step towards spreading awareness among women within this age group regarding eating attitudes. Moreover, healthcare professionals should screen for the presence of disordered eating during those women’s routine visits to the clinics.

Associations between menopause and body image: A systematic review

“…When excluding the previously mentioned micro-longitudinal pilot study which only included 8 participants, 64 the sample size of eligible studies ranged from n = 67 90 to n = 1001, 80 with an average of 387 participants (SD = 291). As presented in Table 1, the age range required for inclusion was generally between 40 and 65 years.…”

“…Nonetheless, they did not find significant differences when using scores from the EDI body dissatisfaction subscale ( p ⩾ .05) or the level of satisfaction with weight ( p ⩾ .05). 99 Khalil et al 80 found that body dissatisfaction was higher in perimenopausal ( p = .002) and postmenopausal ( p = .003) women compared to premenopausal women, while Gümüşsoy et al 82 found higher levels of body dissatisfaction in the postmenopausal group compared to the perimenopausal group ( p < .001). McLaren et al 67 also found that menopausal status at age 54 years was significantly associated with weight esteem ( p = .016).…”

“…Six studies reported no relationship between menopausal stages and body image, 65,73,79,84,97,99 while six studies found some significant relationship. 65,73,79,84,97,99 Two studies reported that certain body dissatisfaction measures were greater in perimenopausal women compared to pre- and postmenopausal women, 5,99 one study found higher body dissatisfaction in both peri- and postmenopausal women compared to premenopausal women, 80 one study found higher body dissatisfaction during postmenopause compared to perimenopause, 82 and two studies reported that postmenopausal women seemed to be more satisfied with their body image than other menopausal status groups. 67,76 Although convenient for conducting research, the use of menopausal stages based solely on self-reported menstruation history has been criticized, as the commonly used WHO definitions of pre-, peri-, and postmenopause have no hormonal biomarkers and are based on an arbitrary number of months spent in a certain state (e.g.…”

“…2,65,69,73,76,93,99 Most studies (n = 10) employed tools designed for the assessment of body image specifically, 5,65,67,69,76,82,84,85,90,93 such as the Body Image Scale, 87 the Body Shape Figure Scale, 66 the BSQ, 72 the Body Cathexis Scale, 83 Mendelson's Body-Esteem Scale, 68 Fisher's Body Image Questionnaire, 95 the Body Esteem Scale, 92 the Appearance-Related Picture Self-Appraisal Form, 77 and the Appearance Self-Appraisal Scale. 78 Seven studies used body-image-related subscales that were included in questionnaires designed to assess eating disorder symptomatology, 64,69,73,79,80,97,99 such as the Bulimia Test-Revised (BULIT-R), 98 the Eating Pathology Symptom Inventory (EPSI), 96 the EDI, 70 the Eating Disorder Examination Questionnaire (EDE-Q), 74 and modified questions from the Diagnostic Survey for Eating Disorders (DSED). 71 The complete list of tools used in each study is available in Table 1.…”

Menopause, weight, and metabolic health – considerations for a patient centered, multidisciplinary approach

“…Careful attention must be given to review any medications, as many drugs can cause weight gain, such as nonhormonal treatments for hot flashes including gabapentin and selective serotonin reuptake inhibitors. In addition to cancer screening, proper screening for mental health conditions including anxiety, depression, and disordered eating, specifically orthorexia and binge eating disorder, is also recommended [17]. Based on screening results, referring to a mental health provider may also be needed.…”