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Many people think you have to be dangerously thin to have an eating disorder, but that’s a myth. This misunderstanding is dangerous because it stops people from getting the help they need.
Experts are sharing a critical message during Eating Disorder Awareness Week (February 24 to March 2) in South Africa: a person’s physical or mental health cannot be judged solely by their weight.
Eating disorders affect people of all shapes and sizes, and the invisible struggle is just as serious as the visible one.
Fierdous Achmat, an occupational therapist at Netcare Akeso Montrose Manor, warns that many eating disorders go unnoticed because they don’t fit the “skinny” stereotype.
“If someone starts being a picky eater, perhaps, or only eating at certain times, it may be seen by loved ones as a fad. If they don’t lose a lot of weight over time, their fussy or unusual eating habits may be overlooked,” shares Achmat.
“The concern with this, though, is that eating disorders are urgent health crises that need immediate attention. The earlier eating disorders are treated, the better the outcome.”
Fierdous Achmat, an occupational therapist at Netcare Akeso Montrose Manor.
Eating disorders are on the rise globally, affecting people of all genders and backgrounds. According to Achmat:
Up to 8.4% of women will experience an eating disorder in their lifetime.
About 2.2% of men will be affected.
Screening studies suggest up to 37.5% of young people in South Africa show signs of disordered eating.
While anorexia and bulimia are well-known, other conditions are actually more common but harder to spot. Binge Eating Disorder (BED) is the most prevalent eating disorder worldwide, more common than anorexia and bulimia combined.
“Affecting an estimated 1-3% of the population, those with BED are often not diagnosed for lengthy periods. Bingeing is often missed because it does not fit the stereotypical image of an eating disorder.
“Because many people with BED live in larger bodies, clinicians may tend to prioritise weight loss rather than psychological assessment. Shame, secrecy and fear of judgement further reduce disclosure, reinforcing silence around the behaviour,” explains Achmat.
Other disorders include:
Atypical anorexia: All the symptoms of anorexia, but the person remains at a normal or higher weight.
Avoidant/ restrictive food intake disorder (ARFID): Restricting food intake due to low interest, sensory sensitivities or fear of negative consequences such as choking or vomiting.
Pica: Craving non-food items like dirt, clay, ice, hair or paint chips.
Rumination disorder: Repeatedly bringing up undigested food.
An eating disorder is a mental health crisis, not just a “diet gone wrong”. Without help, these conditions can lead to permanent organ damage, cognitive issues and even suicide.
“You can’t assume that only teenage girls are affected by eating disorders,” Achmat explains.
“Never think you can just look at someone and judge whether they have an eating disorder. Eating disorders are not primarily illnesses of the body, but rather reflections of a severe mental illness. Severity cannot be measured in kilograms.”
If a friend or family member shows these behaviours, it may be time to seek professional advice.
Cutting food into tiny pieces or obsessively measuring portions.
Only eating “safe” or low-calorie foods.
Wearing baggy layers to disguise weight changes.
Long visits to the bathroom immediately after meals.
Working out excessively regardless of injury or weather.
If you or a loved one needs support, help is available across South Africa.
Eating Disorders South Africa (EDSA) provides information and support groups. Contact them at 081 444 7000 or visit edsa.co.za.
Netcare Akeso 24-hour crisis line, call 0861 435 787 for immediate, non-judgmental support and advice or visit www.akeso.co.za.
