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."