Search:
Menopause Live - IMS Updates
InFocus

Date of release: 15 December, 2014

Restrained eating in menopausal women

Few data exist about restrained eating behavior in postmenopausal women. A recently published paper reports on an online survey in women aged between 40 and 66 years [1]. Overall, about 5000 e-mail invitations were sent, of which 1101 potential participants started to fill out the questionnaire. The drop-out rate (participants who did not fill out the questionnaire completely) was 40.2%. A further 88 women were excluded because of pre-set criteria. Eating behavior was assessed with the Eating Disorder Examination-Questionnaire (EDE-Q) in premenopausal (n = 318, mean age 46 years) and postmenopausal women (n = 250, mean age 55 years). The mean body mass index (BMI) for both groups was around 23.5 ± 4 kg/m2. All participants rated their self-esteem using the Rosenberg Self-Esteem Scale (RSE) and reported their weight, height, waist circumference, and hip circumference. Meaningful restrained eating was defined according to the periods of going without food during waking hours on average three or more times per week in order to influence weight or shape. For example, repeated food avoidance during 8 hours was considered extreme dietary restraint. 15.7% of all participants showed clinically meaningful scores on restrained eating. Postmenopausal women showed significantly higher scores on the EDE-Q subscale of restrained eating as compared to premenopausal women, but, when controlling for BMI, this finding was no longer significant. Further exploratory analyses suggested that particularly low or high self-esteem levels were associated with restrained eating. Self-esteem might have served as a mediator between menopausal status and restrained eating; however, results of these additional analyses were inconsistent.

Comment

The interaction between eating behaviors, body shape/weight and self-esteem is very complex, although the underlying rationale for dietary restraint seems easy to understand. The current study by Drobnjak and colleagues [1] focused on relatively young postmenopausal women with normal weight. They found that restrained eating is not uncommon within this population. Furthermore, compared to premenopausal women, postmenopausal women reported a decreased self-esteem and higher levels of restrained eating, although these associations became insignificant after adjusting for BMI and age. In an effort to control body weight, many women diet or adopt a restrained approach to eating. In a survey of dietary attitudes and body image (1071 postmenopausal women aged 45–75 years), 53% of the sample reported current dieting [2]. Among dieters, BMI was 4.1 (3.6–4.6) kg/m2 higher than among non-dieters. In contrast, BMI of restrained eaters was 1.0 (-1.6 to -0.5) kg/m2 lower than in unrestrained eaters. Thus 'keeping a diet' and dietary restraint are not equivalent. In normal-weight groups, restrained eating and BMI seem to be positively associated. Based on their study results in a group composed of parents and offspring, de Lauzon-Guillain and colleagues suggested that restrained eating may actually be a self-initiated attempt to restrict food intake for the purpose of weight control in subjects who are 'over-eaters' and prone to put on weight [3]. 
 
In younger women, several studies have shown that decreased self-esteem is a risk factor for developing disordered eating behavior, but results in middle-aged women have been inconsistent. The U-shaped relationship found in Drobnjak's study [1] suggests that low as well as high self-esteem might be associated with restrained eating, although the findings were more robust for the former. In modern times, a lean body shape is considered the ideal one. Therefore, if the goal of restrained eating is to lose weight, which is expected to lead to improved self-esteem, then the association between restrained eating and self-esteem can be easily explained. On the other hand, many individuals experience varying degrees of dissatisfaction with their appearance but relatively few individuals place such importance on shape/weight that it has an effect on their self-esteem. In those who react to their shape/weight by exceptional dietary measures, a psychological or cognitive impairment should be suspected [4]. Population-based studies in the United States and Europe have reported reduced risk for eating disorders as women mature, but late onset of dieting mal-behaviors, with or without a relevant past history may occur. Mid-life women report greater disordered eating behaviors and concerns, including drive for thinness and disinhibited eating, compared with older women [4]. 
 
To conclude, dieting and eating behaviors are influenced by various biological, psychological and sociocultural factors. The menopause-related hormonal, bodily and emotional changes may have some effect as well.

Amos Pines
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    References

  1. Drobnjak S, Atsiz S, Ditzen B, Tuschen-Caffier B, Ehlert U. Restrained eating and self-esteem in premenopausal and postmenopausal women. J Eat Disord 2014;2:23
    http://www.ncbi.nlm.nih.gov/pubmed/25349697

  2. Rideout CA, Barr SI. "Restrained eating" vs "trying to lose weight": how are they associated with body weight and tendency to overeat among postmenopausal women? J Am Diet Assoc 2009;109:890-3
    http://www.ncbi.nlm.nih.gov/pubmed/19394476

  3. de Lauzon-Guillain B, Basdevant A, Romon M, Karlsson J, Borys JM, Charles MA; FLVS Study Group. Is restrained eating a risk factor for weight gain in a general population? Am J Clin Nutr 2006;83:132-8
    http://www.ncbi.nlm.nih.gov/pubmed/16400061

  4. Gagne DA, Von Holle A, Brownley KA, et al. Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. Int J Eat Disord 2012;45:832-44
    http://www.ncbi.nlm.nih.gov/pubmed/22729743