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Eating disorders are often seen as a ‘lifestyle’ choice, but they are serious illnesses that have a severe impact on a person’s health and everyday life, and can often be fatal. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating.1

Exact figures of eating disorders throughout the country are difficult to pinpoint due to the limited research that has been conducted. Raising awareness of eating disorders affecting South Africans – through World Food Day (16 October) and National Obesity Week (15 – 19 October) – aims to increase research and improve treatment options.

“Eating disorders do not discriminate,” says Lauren Aron, a social worker at Akeso Montrose Manor. “They are complex mental health disorders that can affect anyone, regardless of age, sex or race, and are influenced by many factors. Although the exact cause of eating disorders is unknown, it is generally believed that a combination of biological, psychological and environmental factors contribute to the development of these illnesses.”

Anorexia nervosa

According to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, to be diagnosed as having anorexia nervosa a person must display a persistent restriction of food intake leading to significantly low body weight; a fear of gaining weight or of becoming fat even though their weight may be significantly low; and have a distorted view of their body weight or shape; or a persistent lack of recognition of the seriousness of their current low body weight.1

“People who have suffered from anorexia chronically have also experienced some degree of gastrointestinal distress, including severe bloating, constipation and indigestion,” says Aron. “Chronic dehydration and malnutrition can drastically affect other vital organs, including the heart, liver, and kidneys.”

Bulimia nervosa

Bulimia nervosa is defined as a cycle of binging and purging.1 To be diagnosed as having bulimia nervosa, a person must display recurrent episodes of binge eating. These episodes are characterised by eating an amount of food that is definitely larger than most people would eat during a similar period of time, and a feeling that one cannot stop eating or control what or how much one is eating.
“This repeated inappropriate compensatory behaviour prevents weight gain, and includes self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting, or excessive exercise,” says Aron.

Physically, a person dealing with bulimia may suffer with chronic dehydration from purging, diuretic and laxative use. “Over the long term, this can lead to cardiovascular complications from electrolyte imbalance, blood pressure abnormalities, kidney failure and more,” says Aron. “A person who is chronically binging and purging will also tend to suffer gastrointestinal distress, like indigestion, constipation, diarrhoea and heartburn.”

Binge eating disorder

The DSM-5 criteria indicate that a person with binge eating disorder displays similar behaviour to people with bulimia nervosa, eating a significantly larger than normal amount of food in a short period of time, and has a sense of lack of control over eating during the episode.1

“Binge eaters eat much more rapidly than normal, they eat until uncomfortably full, and they eat large amounts of food when they are not feeling hungry,” Aron says. “They eat alone because of feeling embarrassed by how they are eating, they feel disgusted with themselves and guilty, and they are very distressed about binge eating.  Unlike bulimia nervosa, binge eaters do not purge to compensate for overeating. The disorder is less common but much more severe than overeating, and it generally occurs along with other psychological problems.”

Aron adds that people who binge eat repeatedly are at increased risk for heart disease, gastrointestinal distress, diabetes and more, particularly when they continue with this behaviour over longer periods of time. Binge eaters may also experience increased struggles with body image, low self-esteem, and suicidal ideations as the disease continues.
She says that the “drive for thinness” that is portrayed by the media and ongoing diet fads can affect people with eating disorders negatively, but these disorders are also multi-dimensional.

“Diet trends cannot influence someone to have an eating disorder because eating disorders have biological, environmental and psychological factors that come together to create this mental illness. But someone with an eating disorder who, for example, goes on a low-carb or banting diet will often exacerbate their illness and their drive for thinness, whereas someone who does not have an eating disorder can go on a diet and use it in a healthy manner.”

What you can do to help

If you are concerned about a friend or family member, there are things you can do to help.

“People with eating disorders find it difficult to accept compliments,” Aron says. “They transform comments about looking healthy or good as looking fat or putting on weight. It’s advisable to steer away from comments about appearance. If you must, rather comment on more neutral features such as eyes, hair, or an item of clothing. Asking the person how they are feeling and listening to them is very important. Offer your support and let the person know that you are available to talk but don’t force them into talking or ask numerous questions.”

Aron notes that meal times have probably been stressful in the past and may have involved arguments and tension. It is important to remember that it is the sole responsibility of the person with the eating disorder, and not your responsibility, to eat their food. Nagging or coercing is not helpful or productive. If you notice that food has not been eaten or was eaten with difficulty, wait until the meal has been cleared away to discuss it.

At home, you may encourage the person to take measures to help them get better. “These may include taking down full-length mirrors, getting rid of bathroom scales, discarding of fashion magazines, removing pictures of themselves or others at an ‘ideal’ weight, throwing away clothes that no longer fit but are being kept for when they are thinner.”

How are eating disorders treated?

The complex nature of eating disorders make them extremely difficult to treat. “Short-term treatment, like individual consultations with a psychologist or dietician and outpatient programs are rarely successful, due to the lack of supervision during meals and other emotional crises,” Aron explains. “Most people suffering from restrictive diets are proud of their low weight and their ability to follow their strict diet; they lack the motivation and willingness for treatment.  Family and close friends also play a vital role in the success rate for people in recovery. They should not be treated in isolation, as family involvement radically increases support and chances for recovery in the future.”

In South Africa, the general practitioner is often the first point of contact and will refer the patient to a psychiatrist, dietician or psychotherapist for further evaluation.  Most local tertiary institutions have counsellors that can screen for mental health conditions. However, eating disorders are often overlooked until much later when some drastic changes in weight are noticed. Unfortunately, in the case of bulimia, unhealthy purging methods, like the use of laxatives, often persist without any noticeable changes in weight. 

“Most eating disorder patients also present with symptoms of depression or anxiety, which is usually the reason why they seek professional help,” Aron adds.

The average in-patient treatment can range from eight weeks up to several months. Local medical schemes do not accommodate such prolonged treatment, which forces patients to seek treatment privately. This limits accessibility of treatment to higher income households.

Eating Disorders South Africa (EDSA) hosts weekly support groups for individuals over the age of 18 who are struggling with anorexia nervosa or bulimia nervosa. Email [email protected] for more information.
Anorexia, Bulimia Anonymous hosts support and outpatient eating disorder programmes. For more information, visit aba12steps.org.

RecoverySpace.org is an online resource for those struggling with eating disorders throughout South Africa. This includes local articles and referrals to treatment centres throughout the country,

Eating disorder statistics2

• It is estimated that 1.0% to 4.2% of women have suffered from anorexia in their lifetime.
• Anorexia has the highest fatality rate of any mental illness.
• It is estimated that 4% of anorexic individuals die from complications of the disease.
• It is estimated that up to 4% of females in the US will have bulimia during their lifetime, and that 3.9% of these bulimic individuals will die as a result of the condition.
• Four out of ten individuals have either personally experienced an eating disorder or know someone who has.

Recognising the signs of an eating disorder 

• I only eat safe foods, low in calories and fat.
• I have rituals, such as cutting food into small pieces or weighing food.
• I exercise in excess.
• I dress in layers to hide my weight.
• I avoid family or friends as they interfere with my eating rules.
• I have become withdrawn and secretive.
• I spend a lot of time thinking about and planning my next binge.
• I am spending too much money on food.
• I don't feel I have control and eat either too much or too little.
• I am preoccupied with thoughts about food.
• I feel guilty after eating.
• I am terrified of being overweight.

Ends.

1. References
   Eating Disorder Hope. Compulsive Eating, Binge Eating Disorder & Bulimia – Can I Have All Three? [Internet]. Available from www.eatingdisorderhope.com/information/bulimia/compulsive-eating-binge-eating-disorder-bulimia-can-i-have-all-three
2. Eating Disorder Hope. Eating Disorder Statistics & Research [Internet]. Available from: www.eatingdisorderhope.com/information/statistics-studies

About the Akeso Group:
Akeso Clinics is a group of private in-patient psychiatric hospitals, and is part of the Netcare Group. Akeso provides individual, integrated and family-oriented treatment in specialised in-patient treatment facilities, for a range of psychiatric, psychological and addictive conditions.

Please visit www.akeso.co.za, email [email protected], or contact us on 011 301 0369 for further information. In the event of a psychological crisis, please call 0861 435 787 for assistance.