The clock strikes 12pm and it is time for lunch.
For many, this is a regular moment to recharge, enjoy a meal and perhaps share a laugh with colleagues or friends. But for someone living with an eating disorder, this moment can bring intense anxiety, guilt and shame.
Despite thinking about food all day, the "voice" in their head might tell them they don't deserve to eat or that eating will ruin their sense of control. In a society that equates thinness with happiness, there is an endless pursuit of being "thin enough", a finish line that never seems to exist.
Eating disorders are often misunderstood, with many assuming they are merely about food or the desire to be thin.
But as Dr Felicity Marcus, a specialist psychiatrist with expertise in eating disorders and adolescent psychiatry, explains: "The biggest misconception with eating disorders is that their illness is about avoidance of food and wanting to be thin. Very often, this is not the case. The food is rather a symptom of much more complex issues."
Beyond the food: the iceberg effect
Imagine an iceberg floating in the ocean. The visible tip of the iceberg represents the eating disorder's symptoms restricting food, binge eating or purging.
However, beneath the surface lies the bulk of the iceberg, hidden from view. This is where the deeper emotional and psychological struggles reside. These underlying factors such as trauma, anxiety, depression or a need for control are often the driving forces behind the eating disorder.
For some, eating disorders serve a purpose. In chaotic or unpredictable environments, controlling food intake becomes a form of security and reassurance. It’s not about the food itself but what the eating disorder represents control, coping or even self-punishment.
Eating disorders are most prevalent among children and teenagers. A 2023 study published in the "Journal of the American Medical Association of Pediatrics" revealed that 1 in 5 children and adolescents worldwide engage in disordered eating behaviours. Girls, older adolescents and those with higher body mass are particularly vulnerable.
South Africa is not immune to this growing problem. While no comprehensive studies are measuring the prevalence of diagnosable eating disorders like anorexia nervosa or bulimia nervosa in the country, existing research paints a worrying picture.
Around 1 in 6 South African girls exhibit attitudes and behaviours that suggest a potential eating disorder, and nearly half (45.3%) of teenagers report being "highly dissatisfied" with their bodies. This dissatisfaction often becomes the breeding ground for disordered eating patterns.
Challenge of treatment in South Africa
One of the biggest challenges in addressing eating disorders in South Africa is the lack of specialised services. Treatment options include inpatient hospitalisation and outpatient care but access to these services remains limited.
While some private and government psychiatric facilities offer inpatient care, most patients rely on outpatient services and individual practitioners, such as dieticians, psychologists and psychiatrists.
Treatment must be individualised, considering factors such as the severity of the disorder, the patient’s weight, their home environment and their willingness to recover.
However, as Dr. Marcus emphasises: "There is no one medication or single professional who can treat an eating disorder. A team approach is always best due to the complexity and nature of the illness."
How to recognise the systems of eating disorders
Many people recognise the signs of an eating disorder but feel unsure about how to approach the topic. It’s important to remember that eating disorders are not just about food they are often symptoms of deeper emotional distress.
Here are some practical tips for approaching someone you’re concerned about:
1. Approach without judgment: Avoid making assumptions or passing judgment. Instead, approach the individual with empathy and care.
2. Choose the right time and place: Find a moment when the person feels safe and comfortable. Avoid discussing the issue before or after meals, as this can heighten their anxiety.
3. Use gentle, open-ended questions: Start with phrases like, "I’m worried about you," or, "I’ve noticed you’ve been struggling lately. Would you like to talk about how you’re feeling?"
4. Avoid focusing solely on food: While food behaviours may be the most visible symptoms, it’s essential to address the emotional struggles beneath the surface.
5. Provide support and care: Let them know you care about their emotional well-being and are there to support them, no matter what.
6. Don’t take defensiveness personally: It’s common for people with eating disorders to deny their struggles or become defensive. Remember, the eating disorder may serve a purpose for them and they may not be ready to let it go.
In South Africa, stigma and misinformation about eating disorders often prevent individuals from seeking help. Many people believe that eating disorders only affect wealthy, young white women a stereotype that excludes countless others who suffer in silence.
Eating disorders are not a choice, nor are they a simple matter of "just eating." They are deeply rooted in emotional and psychological struggles that require professional intervention and a supportive network.
If you or someone you know is struggling with an eating disorder, reach out to a trusted healthcare professional or organisation. Early intervention can save lives.
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