Longevity Science Cannot Ignore Eating Disorders
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. However, we rarely talk about them.
If we are serious about improving healthy lifespan, we cannot keep ignoring them.
The Long Shadow We Don’t See
Eating disorders are often framed as adolescent struggles—phases that people “grow out of.”
However, recovery does not erase the biological consequences of eating disorders early in life.
Restriction and inadequate nourishment can reduce gray matter volume in the brain, affecting cognition, mood regulation, and concentration. Electrolyte imbalances, especially those caused by purging, can disrupt the heart’s electrical system causing rhythm disturbances. Even after behaviors stop, the cardiovascular system may carry the imprint of that strain.
Adolescence and young adulthood are also critical windows for building peak bone mass. Restriction, hormonal disruption, and low body weight during these formative years impair bone development at the very time it should be strongest. Many individuals never regain the bone density they otherwise would have achieved.
A person who struggled at sixteen may enter midlife with osteopenia or osteoporosis, fragile bones, and an increased fracture risk. Hip fractures in older adulthood carry significant morbidity and mortality—often marking the beginning of a cascade of decline and loss of independent living.
The impact is not limited to the skeletal and cardiovascular systems. Chronic vomiting erodes tooth enamel, sometimes irreversibly. The immune system may weaken, increasing vulnerability to illness and the development of other disorders and diseases. And hormonal disruption can impair reproductive health, contributing to irregular cycles, fertility challenges, and pregnancy complications.
What once appeared temporary can quietly shape aging for life. They are medical illnesses with long shadows.
The Top 5 Misconceptions About Eating Disorders
Misconceptions are one of the greatest barriers to recognition.
Myth #1: You Have to Be Underweight to Have an Eating Disorder
You don’t.
Many individuals with eating disorders are at a “normal” weight. Some are in larger bodies. Some look physically strong. Even anorexia nervosa, which includes low body weight as part of its diagnostic criteria, has a related diagnosis: atypical anorexia nervosa. In atypical anorexia, individuals meet all the psychological and behavioral criteria for anorexia, but their weight remains within or even above the normal range despite significant weight loss.
Severity is not determined by body size. When we rely on weight alone, people are overlooked and undertreated.
Myth #2: Eating Disorders Are Just Anorexia and Bulimia
When most people hear “eating disorder,” they likely think of extreme thinness or self-induced vomiting.
In reality, the most common eating disorder is not anorexia or bulimia, but binge-eating disorder.
Binge-Eating Disorder
Binge-eating disorder involves recurrent episodes of eating unusually large amounts of food in a short period of time, accompanied by a sense of loss of control and marked distress. There are no compensatory behaviors like vomiting or excessive exercise afterward. It is the most common eating disorder. Nearly 47% of people with eating disorders have binge-eating disorder, and lifetime prevalence estimates suggest it affects approximately 3.5% of women and 2% of men.
Bulimia Nervosa
Bulimia involves recurrent binge-eating episodes followed by compensatory behaviors to prevent weight gain. Purging does not just mean vomiting. It can include misuse of laxatives, fasting, or excessive exercise. Bulimia affects approximately 1.5% of women and 0.5% of men during their lifetime.
Anorexia Nervosa
Anorexia is characterized by restriction of food intake leading to low body weight, intense fear of weight gain, and distortion in body perception. It is the least common of these three major diagnoses, affecting approximately 0.9% of women and 0.3% of men throughout their life.
Myth #3: Eating Disorders Fit Neatly Into One Box
Eating disorders are not static diagnoses. They often shift.
- Restriction can evolve into bingeing.
- Bingeing can be followed by purging.
- Purging may take the form of vomiting at one stage and excessive exercise at another.
- Periods of apparent “control” can alternate with periods of loss of control.
A person may move between patterns over months, or even years, and still have a severe, life-threatening illness.
That was my experience.
Because I did not fit neatly into one category, I convinced myself it “wasn’t serious enough.” I expected reassurance. Instead, I was diagnosed with a severe eating disorder requiring intensive coordinated care.
Diagnostic fluidity does not mean mild illness. In fact, it often indicates that the illness has become longstanding and deeply ingrained.
Myth #4: Binge Eating Is Laziness or Lack of Self-Control
Although binge-eating disorder is the most common eating disorder, it is often the most dismissed or under-recognized.
Binge eating is not gluttony. It is not a weakness. And it is definitely not laziness.
Binge-eating disorder involves measurable differences in brain circuits related to reward processing, impulse regulation, and stress response. These patterns are shaped by a combination of genetic vulnerability, psychological factors, and environmental influences.
Certain personality traits can also increase vulnerability. High levels of perfectionism—especially rigid, all-or-nothing thinking and harsh self-criticism—are common. When eating becomes governed by strict rules, even a minor deviation can trigger intense guilt or shame. That emotional distress can, in turn, fuel binge episodes. What appears from the outside as “overindulgence” and “lack of control” is often part of a cycle driven by rigidity and self-judgment.
Importantly, binge-eating disorder is treatable, like anorexia or bulimia. Evidence-based therapies, such as cognitive behavioral therapy, have strong clinical support. Nutritional counseling and, in some cases, medication can also be helpful.
When we frame binge eating as a failure of willpower, we obscure the biology and psychology involved. And when we replace judgment with understanding, people are far more likely to receive the treatment they deserve.
Myth #5: You Would Know If You Had One
Many people think: “It’s probably not me” or “I’m just trying to be healthy.”
I thought that too.
When I was bingeing, I told myself I just needed more discipline.
When I was restricting, I felt proud of how “healthy” and controlled I was.
I could avoid sugar at a friend’s birthday when others couldn’t.
I could exercise every single day, including holidays, when others rested.
It felt like willpower, but it wasn’t. Only after receiving help, did I realize how wrong I was.
Because diet culture has been normalized within society, we often applaud behaviors that appear disciplined or healthy, even when they are extreme.
Of course, not everyone who declines dessert is struggling. But when rigid rules, shame, or fear are driving the behavior, that is not wellness.
If You Recognize Yourself — Don’t Ignore It
If any part of this feels familiar, do not dismiss it, even if you think: “it’s probably not that bad.”
Start with:
- A primary care physician who understands eating disorders*
- A licensed therapist who specializes in eating disorders
- A psychiatrist or registered dietitian with eating disorder expertise
If you’re concerned about someone else, approach gently and in private. Focus on how they’re feeling rather than what they’re eating or how they look. Listen without judgment and encourage professional support in a non-pressuring way.
Eating disorders are treatable at any age.
*Ensuring the health practitioners are specialized in eating disorders is essential for proper recovery.
A Final Thought
At the Buck Institute, we study the mechanisms of aging. But aging is not only molecular. If someone lives longer but carries decades of distress around food, or suffers fractures from untreated early-life restriction, we have not truly extended healthy lifespan. Healthy aging must also include mental health.
If you learned something new from this, or if it touched on something for you, please share it. Send it to a friend. Repost it. Start a conversation.
This is how stigma shifts and change begins.
With care and compassion, Sierra