Eating disorders are real illnesses that don’t discriminate on race or class, have little to do with vanity and can have life-long after-effects.
Anorexia nervosa, bulimia nervosa and binge-eating disorder are “silent diseases” that impact on sufferers’ physical health and quality of life, their ability to function in daily life and their relationships with family and friends. Anorexia nervosa has the highest death rate of all mental health conditions.
The South African Depression and Anxiety Group (Sadag) explained that an eating disorder was an illness that resulted in people either overeating or starving themselves or adopting unhealthy behaviours concerning food and body weight.
The South African Society of Psychiatrists (SASOP) said media stereotypes of beauty and “ideal” body types had long been implicated as contributing to eating disorders, especially for those already vulnerable or at-risk.
Professor Christopher Paul Szabo a SASOP member, said there was a “real vs ideal” disconnect between average body sizes and types in real life versus the often-unattainable ideals portrayed in the media and by social media users.
“This potentially creates incorrect perceptions that being underweight, meaning below healthy norms, is desirable and contributes to the unhealthy attitudes and behaviours around weight, food, dieting and body image that are central to eating disorders,” he said.
Szabo said the causes of eating disorders were complex and their treatment was specific to each individual. While body image concerns were central, eating disorders were also “powerful indicators of distress that goes beyond food and body issues alone. Every sufferer has an individual story.”
He warned that dieting should be added to the list of risky behaviours for teenagers, along with the more usual concerns of unprotected s-e-x and abuse of drugs and alcohol, especially when there was no clear health reason for dieting.
Broadly defined as unhealthy preoccupation with eating, food, weight, exercise or body image – together with behaviours such as restriction of intake, excessive exercise, binge eating or purging – that impacts on quality of life and the ability to function in daily life, eating disorders are most prevalent in teenage and young adult women.
Szabo said the stereotype of eating disorders being limited to females was also changing – teenage boys and young men are increasingly at risk due to pressures to achieve perceived ideal male body types, usually involving exercise to lose weight and build muscle.
This leads to possibly excessive exercise and the use of nutritional supplements (or anabolic steroids, or both) to replace healthy eating habits, he said, but cautioned that there could also be underlying medical conditions and that medical professionals should be careful of assuming an eating disorder diagnosis before excluding other possibilities.
On treating eating disorders, Julie Deane-Williams, a registered dietitian and Association for Dietetics in South Africa (ADSA) spokesperson who has a special interest in treating eating disorders, said in some cases, the dietitian may be the first port of call for help.
“Even though there are high levels of denial associated with disorders such as anorexia nervosa or bulimia nervosa, the dietitian is often the healthcare professional on call, especially when it comes to a person struggling with emotional/comfort eating or binge eating disorder.”
Sadag said successful treatment may come from a combination of approaches.
Talking to a therapist – particularly cognitive behavioural therapy – can help change unhealthy eating habits and thinking patterns.
Nutrition education, family counselling, and support groups also help, while weight-loss programmes can also get long-term control over binge eating. If depression is an issue, medication can help too.