Longevity Science Cannot Ignore Eating Disorders

Blog Author: Sierra Lore, PhD candidate, Verdin lab

I have spent years researching and writing about longevity science. Yet this is the first time I am publicly writing about eating disorders. It is uncomfortable to share, so for a long time, I chose not to. But silence protects stigma, and stigma delays care.

Eating disorders have the highest mortality rate of any psychiatric illness. Still, we rarely talk about them — especially in older adults.

They are often framed as adolescent struggles that people “grow out of.” But recovery does not erase the biological consequences. Restriction and inadequate nourishment can reduce gray matter volume, affecting cognition, mood regulation, and concentration. Electrolyte imbalances caused by purging can disrupt the heart’s electrical system, and even after behaviors stop, the cardiovascular system may carry that imprint.

Adolescence is also a critical window for building peak bone mass. Restriction, hormonal disruption, and low body weight during these years impair bone development when it should be strongest. Many individuals never regain the density they otherwise would have achieved, entering midlife with osteopenia or osteoporosis and increased fracture risk. Hip fractures in older adulthood often mark the beginning of functional decline and loss of independence.

The effects extend beyond bone and heart health. Chronic vomiting erodes tooth enamel, the immune system may weaken, and hormonal disruption can impair reproductive health and fertility.

What once appeared temporary can quietly shape aging for life. Eating disorders are medical illnesses with long shadows.

The Top 5 Misconceptions About Eating Disorders

Misconceptions remain one of the greatest barriers to recognition — especially in older adults.

Myth #1: You Have to Be Underweight to Have an Eating Disorder
You don’t. Many individuals are at a “normal” weight or in larger bodies. Atypical anorexia includes the psychological and behavioral features of anorexia without low body weight. Severity is not determined by body size, and reliance on weight alone leads to missed diagnoses.

Myth #2: Eating Disorders Are Just Anorexia and Bulimia
The most common eating disorder is binge-eating disorder — recurrent episodes of eating large amounts of food accompanied by loss of control and distress, without compensatory behaviors. Nearly half of people with eating disorders have binge-eating disorder.

Myth #3: Eating Disorders Fit Neatly Into One Box
They often shift. Restriction can evolve into bingeing; bingeing can be followed by purging or excessive exercise. Patterns change over time, yet the illness remains serious. Because I did not fit one category, I convinced myself it wasn’t serious — until I was diagnosed with a severe eating disorder requiring coordinated care.

Myth #4: Binge Eating Is Laziness or Lack of Self-Control
It is neither. Binge-eating disorder involves differences in brain circuits related to reward, impulse regulation, and stress response, shaped by genetics, psychology, and environment. Framing it as willpower obscures the biology and delays care.

Myth #5: You Would Know If You Had One
Many people assume, “It’s probably not me.” I did too. Restriction felt disciplined. Exercise felt virtuous. Avoiding foods felt like control. Only after receiving help did I realize how wrong I was. Diet culture often rewards behaviors that may actually signal risk.

If any of this feels familiar, do not dismiss it — even if you think it’s “not that bad.” You may want to speak with a primary care clinician familiar with eating disorders, a therapist, psychiatrist, or registered dietitian with specialized expertise.

If you are concerned about someone else, approach gently and privately. Focus on how they feel rather than what they eat or how they look. Listen without judgment and encourage professional support. Eating disorders are treatable at any age.