In an era where medical science continuously strives for precision and comprehensive care, a new eye-opening study highlights a critical blind spot in primary healthcare: the pervasive presence of gendered ageism in the management of eating disorders. Researchers Kohestani, Otto, and Köttl published their groundbreaking findings in the International Journal for Equity in Health, exposing how age-based and gender bias systematically leads to the overlooking and undertreatment of eating disorders, particularly in older adults. This revelation shakes the foundation of existing primary care paradigms and calls for an urgent recalibration of clinical approaches to ensure equity, accuracy, and humane treatment for all demographics.
Eating disorders, traditionally perceived as ailments predominant among young women, carry a stigma and stereotype that deeply influence clinical decision-making. Such biases skew the assessment and care provided in primary healthcare settings. According to Kohestani and colleagues, this entrenched stereotype contributes significantly to the underdiagnosis of eating disorders in older populations, especially among men and women beyond their third decade of life. The researchers argue that this misperception results in a constellation of systemic oversights—ranging from failure to recognize symptoms to inadequate referrals and interventions—thus marginalizing an entire demographic vulnerable to these complex psychiatric and physiological conditions.
Ageism, a form of discrimination based on age, amplifies the invisibility of eating disorders among older adults. When compounded with gender biases—such as the preconceived notion that eating disorders primarily affect adolescent girls and young women—primary care professionals often fail to consider the possibility of eating disorders in older patients. This “double bias” leads to a critical gap in healthcare delivery that not only jeopardizes the physical health of patients but also exacerbates psychological distress, given that untreated or unrecognized eating disorders can precipitate severe comorbidities and even mortality. The study’s detailed analysis underscores how this intersectional discrimination breaches core principles of equity and inclusiveness in health.
From a clinical perspective, one of the most troubling implications of Kohestani et al.’s work is the systemic failure in primary care settings to integrate comprehensive screening protocols that account for age and gender diversities. Standardized tools and clinical guidelines for eating disorder diagnosis often lack sensitivity to atypical presentations common in older adults or men. This clinical blind spot is compounded by a lack of training and awareness among primary care practitioners, many of whom might prioritize other age-related health concerns over eating disorders, unconsciously deprioritizing mental health symptoms perceived as less critical or less likely in older age brackets.
Moreover, the study highlights biological and psychosocial nuances that complicate the detection and treatment of eating disorders in older populations. For instance, physiological changes due to aging—such as altered metabolism, changes in body composition, or chronic illnesses—can mask or mimic symptoms of eating disorders, leading to misattribution or diagnostic overshadowing. Psychosocial factors, including isolation, stigma, and diminished social supports, further obscure the clinical picture. As Kohestani and team vividly describe, this multifaceted complexity demands a more nuanced and tailored approach in primary care diagnostics, calling for interdisciplinary collaboration between geriatricians, psychiatrists, dietitians, and mental health specialists.
Another crucial dimension exposed by this research is the gendered nature of ageism within eating disorder care. While female patients often exhibit more recognized symptomatology, the condition’s manifestation in men can be markedly different, less stereotypical, and thus more easily dismissed. The societal invisibility of men suffering from eating disorders, coupled with ageist biases, effectively silences a segment of the population who may be enduring profound suffering in secret. This gendered blind spot inhibits equitable treatment and healthy prognoses, emphasizing the need for primary care providers to deconstruct gender stereotypes actively.
Kohestani and colleagues further illuminate how health system structures and policies unwittingly perpetuate this disparity. Many primary care pathways are optimized for younger populations, neglecting the need for specialized protocols that address eating disorders within older adults. Insurance coverage, referral systems, and mental health resources often fall short in accommodating the unique needs and complexities presented by older gender-diverse patients. The researchers call for policy reforms that embed equitable access to diagnosis, counseling, and intervention services, ensuring that older adults receive the standard of care that their conditions warrant.
Behind the clinical and systemic factors, there lies a profound ethical imperative underscored by this study: the fundamental right of every patient—regardless of age or gender—to receive unbiased, compassionate, and effective healthcare. The invisibility cloaked by ageism and gender norms is not simply a clinical oversight but a breach of ethical standards that underpin modern medicine. Kohestani et al.’s work serves as a clarion call to healthcare systems globally to reevaluate their approach towards mental health and eating disorders, demanding a paradigm shift that honors every patient’s intrinsic worth and dignity.
Additionally, this study propels a vital conversation about the sociocultural forces that shape perceptions of eating disorders. Media portrayal, public health discourse, and cultural stereotypes heavily influence both patients’ self-awareness and clinicians’ diagnostic vigilance. The entrenched narrative that eating disorders predominantly affect a young, white, female demographic obscures the real epidemiological pattern, which is far more diverse and widespread across age and gender lines. Addressing these misconceptions requires coordinated efforts in public health education and awareness campaigns, as well as ongoing professional development for healthcare providers.
The research also emphasizes the importance of utilizing data-driven interventions and machine learning tools that could assist primary care practitioners in identifying subtle and atypical presentations of eating disorders across diverse patient populations. Technological advancements integrated with clinical heuristics hold promise to overcome entrenched biases and provide personalized, evidence-based care pathways. Kohestani et al. suggest that harnessing such innovations might be pivotal in bridging the current diagnostic and treatment gaps, revolutionizing primary care management practices.
From a psychological perspective, the study sheds light on the often-overlooked emotional toll that ageism and gender bias impart on patients suffering from eating disorders. Feelings of invisibility, invalidation, and marginalization can deepen the clinical severity and complicate recovery trajectories. The primary care environment, often the first contact point in the healthcare system, can either exacerbate or alleviate this psychological burden. Therefore, training healthcare workers in empathetic communication and bias reduction becomes as essential as clinical skill enhancement to foster trust and improve health outcomes.
Importantly, the study calls for longitudinal research initiatives to track clinical outcomes for men and older adults with eating disorders, which remain underrepresented in existing literature. Kohestani and colleagues highlight that without robust cohort studies and intervention trials inclusive of diverse age and gender groups, the healthcare system will continue to operate with outdated assumptions. Such data acquisition is critical to refine evidence-based guidelines, ensuring adaptations that meet the evolving demographic and epidemiological realities of eating disorders.
Another profound insight from this research is its relevance to global health equity. The phenomenon of gendered ageism in eating disorder management may be exacerbated in lower-resource settings or cultures with rigid gender roles and pronounced age hierarchies. The study urges international health agencies and governments to prioritize equity-focused research and policy development, thereby tackling disparities that transcend borders and foster universal health coverage that is truly inclusive.
Ultimately, this landmark study by Kohestani, Otto, and Köttl paints a complex portrait of how entrenched social biases invisibilize significant segments of the population suffering from eating disorders, undermining effective primary care delivery. Addressing these barriers requires a holistic transformation encompassing clinical practice, medical education, health policy, societal awareness, and research innovation. Only through such concerted efforts can the global healthcare system hope to restore fairness and efficacy in the fight against eating disorders, ensuring no patient is neglected or underserved due to ageist or gendered prejudices.
In conclusion, “Overlooked and undertreated: gendered ageism in primary care management of eating disorders” emerges as a critical contribution exposing the urgent need for reformed healthcare frameworks—ones that transcend stereotypes and prioritize equity and individualized care. Its implications ripple across clinical, social, ethical, and policy domains, setting a new agenda for the future of eating disorder management. For practitioners, policymakers, researchers, and advocates alike, this research inspires renewed commitment to dismantling bias and advancing justice in healthcare for all ages and genders.
Article Title:
Overlooked and undertreated: gendered ageism in primary care management of eating disorders.
Article References:
Kohestani, T., Otto, P. & Köttl, H. Overlooked and undertreated: gendered ageism in primary care management of eating disorders. Int J Equity Health 24, 358 (2025). https://doi.org/10.1186/s12939-025-02702-0
DOI: https://doi.org/10.1186/s12939-025-02702-0
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