Eating disorders impact more than 1.1 million people in Australia, representing 4.5% of the population. These disorders include binge eating disorder, bulimia nervosa, and anorexia nervosa.

Meanwhile, more than 4.1 million people (18.9%) are affected by body dissatisfaction, a major risk factor for some types of eating disorders.

But what image comes to mind first when you think of someone with an eating disorder or body image concerns? Is it a teenage girl? If so, you’re definitely not alone. This is often the image we see in popular media.

Eating disorders and body image concerns are most common in teenage girls, but their prevalence in adults, particularly in women, aged in their 30s, 40s and 50s, is actually close behind.

So what might be going on with girls and women in these particular age groups to create this heightened risk?

The 3 ‘P’s

We can consider women’s risk periods for body image issues and eating disorders as the three “P”s: puberty (teenagers), pregnancy (30s) and perimenopause and menopause (40s, 50s).

A recent report from The Butterfly Foundation showed the three highest prevalence groups for body image concerns are teenage girls aged 15–17 (39.9%), women aged 55–64 (35.7%) and women aged 35–44 (32.6%).

We acknowledge there’s a wide age range for when girls and women will go through these phases of life. For example, a small proportion of women will experience premature menopause before 40, and not all women will become pregnant.

Variations in the way eating disorder symptoms are measured across different studies can make it difficult to draw direct comparisons, but here’s a snapshot of what the evidence tells us.

Puberty

In a review of studies looking at children aged six to adolescents aged 18, 30% of girls in this age group reported disordered eating, compared to 17% of boys. Rates of disordered eating were higher as children got older.

Pregnancy

During pregnancy, eating disorder prevalence is estimated at 7.5%. Almost 70% of women are dissatisfied with their body weight and figure in the post-partum period.

Perimenopause

It’s estimated more than 73% of midlife women aged 42–52 are unsatisfied with their body weight. However, only a portion of these women would have been going through the menopause transition at the time of this study.

The prevalence of eating disorders is around 3.5% in women over 40 and 1–2% in men at the same stage.

So what’s going on?

Although we’re not sure of the exact mechanisms underlying eating disorder and body dissatisfaction risk during the three “P”s, it’s likely a combination of factors are at play.

These life stages involve significant reproductive hormonal changes (for example, fluctuations in oestrogen and progesterone) which can lead to increases in appetite or binge eating and changes in body composition. These changes can result in concerns about body weight and shape.

These stages can also represent a major change in identity and self-perception. A girl going through puberty may be concerned about turning into an “adult woman” and changes in attitudes of those around her, such as unwanted sexual attention.

Pregnancy obviously comes with significant body size and shape changes. Pregnant women may also feel their body is no longer their own.

While social pressures to be thin can stop during pregnancy, social expectations arguably return after birth, demanding women “bounce back” to their pre-pregnancy shape and size quickly.

Women going through menopause commonly express concerns about a loss of identity. In combination with changes in body composition and a perception their appearance is departing from youthful beauty ideals, this can intensify body dissatisfaction and increase the risk of eating disorders.

These periods of life can each also be incredibly stressful, both physically and psychologically.

For example, a girl going through puberty may be facing more adult responsibilities and stress at school. A pregnant woman could be taking care of a family while balancing work and other demands. A woman going through menopause could potentially be taking care of multiple generations (teenage children, ageing parents) while navigating the complexities of mid-life.

Research has shown interpersonal problems and stressors can increase the risk of eating disorders.

We need to do better

Unfortunately most of the policy and research attention currently seems to be focused on preventing and treating eating disorders in adolescents rather than adults. There also appears to be a lack of understanding among health professionals about these issues in older women.

In research I (Gemma) led with women who had experienced an eating disorder during menopause, participants expressed frustration with the lack of services that catered to people facing an eating disorder during this life stage. Participants also commonly said health professionals lacked education and training about eating disorders during menopause.

We need to increase awareness among health professionals and the general public about the fact eating disorders and body image concerns can affect women of any age – not just teenage girls. This will hopefully empower more women to seek help without stigma, and enable better support and treatment.

Jaycee Fuller from Bond University contributed to this article.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. For concerns around eating disorders or body image visit the Butterfly Foundation website or call the national helpline on 1800 33 4673.

Gemma Sharp, Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, The University of Queensland; Amy Burton, Lecturer in Clinical Psychology, University of Technology Sydney, and Megan Lee, Assistant Professor, Psychology, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This week the World Health Organization (WHO) released new guidelines recommending people switch the regular salt they use at home for substitutes containing less sodium.

But what exactly are these salt alternatives? And why is the WHO recommending this? Let’s take a look.

A new solution to an old problem

Advice to eat less salt (sodium chloride) is not new. It has been part of international and Australian guidelines for decades. This is because evidence clearly shows the sodium in salt can harm our health when we eat too much of it.

Excess sodium increases the risk of high blood pressure, which affects millions of Australians (around one in three adults). High blood pressure (hypertension) in turn increases the risk of heart disease, stroke and kidney disease, among other conditions.

The WHO estimates 1.9 million deaths globally each year can be attributed to eating too much salt.

The WHO recommends consuming no more than 2g of sodium daily. However people eat on average more than double this, around 4.3g a day.

In 2013, WHO member states committed to reducing population sodium intake by 30% by 2025. But cutting salt intake has proved very hard. Most countries, including Australia, will not meet the WHO’s goal for reducing sodium intake by 2025. The WHO has since set the same target for 2030.

The difficulty is that eating less salt means accepting a less salty taste. It also requires changes to established ways of preparing food. This has proved too much to ask of people making food at home, and too much for the food industry.

Enter potassium-enriched salt

The main lower-sodium salt substitute is called potassium-enriched salt. This is salt where some of the sodium chloride has been replaced with potassium chloride.

Potassium is an essential mineral, playing a key role in all the body’s functions. The high potassium content of fresh fruit and vegetables is one of the main reasons they’re so good for you. While people are eating more sodium than they should, many don’t get enough potassium.

The WHO recommends a daily potassium intake of 3.5g, but on the whole, people in most countries consume significantly less than this.

Potassium-enriched salt benefits our health by cutting the amount of sodium we consume, and increasing the amount of potassium in our diets. Both help to lower blood pressure.

Switching regular salt for potassium-enriched salt has been shown to reduce the risk of heart disease, stroke and premature death in large trials around the world.

Modelling studies have projected that population-wide switches to potassium-enriched salt use would prevent hundreds of thousands of deaths from cardiovascular disease (such as heart attack and stroke) each year in China and India alone.

The key advantage of switching rather than cutting salt intake is that potassium-enriched salt can be used as a direct one-for-one swap for regular salt. It looks the same, works for seasoning and in recipes, and most people don’t notice any important difference in taste.

In the largest trial of potassium-enriched salt to date, more than 90% of people were still using the product after five years.

Making the switch: some challenges

If fully implemented, this could be one of the most consequential pieces of advice the WHO has ever provided.

Millions of strokes and heart attacks could be prevented worldwide each year with a simple switch to the way we prepare foods. But there are some obstacles to overcome before we get to this point.

First, it will be important to balance the benefits and the risks. For example, people with advanced kidney disease don’t handle potassium well and so these products are not suitable for them. This is only a small proportion of the population, but we need to ensure potassium-enriched salt products are labelled with appropriate warnings.

A key challenge will be making potassium-enriched salt more affordable and accessible. Potassium chloride is more expensive to produce than sodium chloride, and at present, potassium-enriched salt is mostly sold as a niche health product at a premium price.

If you’re looking for it, salt substitutes may also be called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.

A review published in 2021 found low sodium salts were marketed in only 47 countries, mostly high-income ones. Prices ranged from the same as regular salt to almost 15 times higher.

An expanded supply chain that produces much more food-grade potassium chloride will be needed to enable wider availability of the product. And we’ll need to see potassium-enriched salt on the shelves next to regular salt so it’s easy for people to find.

In countries like Australia, about 80% of the salt we eat comes from processed foods. The WHO guideline falls short by not explicitly prioritising a switch for the salt used in food manufacturing.

Stakeholders working with government to encourage food industry uptake will be essential for maximising the health benefits.

Xiaoyue (Luna) Xu, Scientia Lecturer, School of Population Health, UNSW Sydney and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health

This article is republished from The Conversation under a Creative Commons license. Read the original article.