Increased Appetite in Elderly Women: Causes and Clinical Approach
Increased appetite in elderly women is uncommon and warrants investigation for underlying pathology, as the normal aging process typically causes decreased appetite (anorexia of aging), not increased appetite. 1, 2
Understanding the Normal Aging Pattern
The physiological norm in elderly individuals is decreased appetite and reduced food intake, not increased appetite 1, 2:
- Aging naturally causes alterations in olfaction and gustatory sensation that reduce appetite and dietary intake 1
- Increased levels and effectiveness of cholecystokinin (CCK) and peptide YY (PYY) contribute to early satiation and the anorexia of aging 2, 3
- Central feeding drive (both opioid and neuropeptide Y effects) declines with age 2
- Many medications commonly used by older adults contribute to decreased appetite 1
Pathological Causes to Investigate
When an elderly woman presents with increased appetite, consider these specific etiologies:
Endocrine Disorders
- Uncontrolled diabetes mellitus - hyperglycemia causes osmotic diuresis and cellular starvation despite adequate food intake, triggering compensatory hyperphagia 1
- Hyperthyroidism - increased metabolic rate drives increased appetite
- Cushing's syndrome - excess cortisol increases appetite and causes central weight gain
Psychiatric Conditions
- Depression with atypical features - can present with increased appetite rather than the typical anorexia 2, 4
- Binge-eating disorder or bulimia nervosa - these can persist or develop in older women and are increasingly recognized in this population 5
- Dementia with disinhibition - particularly frontotemporal dementia can cause loss of satiety signals and compulsive eating
Medication Effects
- Corticosteroids - commonly prescribed for inflammatory conditions, directly stimulate appetite 1
- Antipsychotics (particularly olanzapine, quetiapine) - cause metabolic changes and increased appetite
- Mirtazapine - prescribed for depression, has appetite stimulation as a primary side effect with mean weight gain of 1.9 kg at 3 months 6, 7
- Megestrol acetate - if prescribed for other indications, causes appetite stimulation 7
Neurological Causes
- Hypothalamic lesions - tumors or other structural lesions affecting satiety centers
- Post-stroke changes - particularly affecting appetite regulation centers
Diagnostic Approach
Obtain fasting glucose and HbA1c immediately to rule out diabetes, as this is the most common and immediately treatable cause of pathological increased appetite in elderly women 1:
- Check thyroid function (TSH, free T4) to exclude hyperthyroidism
- Review all medications systematically for appetite-stimulating effects, particularly corticosteroids, antipsychotics, and mirtazapine 1, 7
- Screen for depression using validated tools (PHQ-9 or GDS), as atypical depression can present with increased appetite 4
- Assess cognitive function to identify dementia with disinhibited eating behaviors
- Measure morning cortisol if Cushing's syndrome is suspected based on clinical features
Critical Clinical Pitfalls
Do not assume increased appetite is benign or a sign of "good health" in an elderly woman - this represents a deviation from normal aging physiology and requires investigation 1, 2:
- Weight gain in elderly women, even when appetite is increased, may mask sarcopenia - body composition changes can hide muscle loss behind fat accumulation 1
- Uncontrolled diabetes in elderly patients is associated with increased morbidity, mortality, and functional decline - early detection and treatment are critical 1
- Eating disorders in older women are increasingly recognized but often missed - they carry high morbidity and mortality and should not be dismissed as vanity or dismissed due to age 5
Management Priorities
Address the underlying cause rather than the symptom:
- For diabetes: initiate appropriate glucose-lowering therapy with careful attention to hypoglycemia risk in elderly patients 1
- For medication-induced appetite increase: consider dose reduction or alternative agents if the increased appetite is causing problematic weight gain or metabolic complications 7
- For psychiatric causes: treat the underlying depression or eating disorder with appropriate psychotherapy and pharmacotherapy 5
- For dementia with disinhibition: implement environmental modifications and structured meal timing rather than restricting access to food
Monitor body composition, not just weight - increased appetite leading to weight gain may worsen sarcopenic obesity, functional decline, and metabolic complications 1.