Eating Disorders - it's Not About the Food!
EATING DISORDERS - ITS NOT ABOUT THE FOOD!
The clock strikes 12pm (midday) - time for lunch. For most, this is a routine experience of enjoying a meal, taking time out from your busy day and possibly even having a moment to chat and socialize with friends. For those suffering with an eating disorder, it is a time of dread and anguish. Despite the fact that they have been thinking about food all day, the “voice” inside their head makes them feel guilt and a sense of shame for wanting to eat or trying that “high carb meal”. They live in a world where eating would mean a loss of control or an overwhelming act that goes against their perceived body image or deep-seated beliefs about their food, weight and appearance. Thinness equates to happiness yet there is never ever “thin enough”.
Having worked extensively with treating individuals suffering from eating disorders, I have often been asked by others (some even professionals themselves) “why can’t they just eat?”; “aren’t eating disorder patients are all the same?”. The naivety of these questions highlights how little we actually know about these patients and their struggles and how there is still such stigma and judgement associated with this mental illness.
The biggest misconception with eating disorders is that their illness is about an avoidance of food and wanting to be thin. However (and very often), this is not the case. The food is rather a symptom of much more complex issues. There are usually complicated underlying emotions which are at the root of the eating struggles. It is also important to realize that an eating disorder can serve a purpose. For example, in an environment where one is not in control, it provides them with security, safety and reassurance. I often explain this to patients and parents as “the iceberg effect”- the eating disorder is the tip of the iceberg (what we can see). What is going on underneath is what’s really keeping the ice afloat.
Disordered eating is most common in children and teenagers with 1 in 5 children and teenagers having disordered eating patterns according to research published in The Journal of American Medical Association of Paediatrics in 2023. This was the first global analysis of studies on this problem. The study also showed that eating struggles are more common amongst girls, older adolescents and those with higher body mass
In South Africa, there are no studies that measure how common diagnosable eating disorders like anorexia and bulimia nervosa are. However, roughly 1 in 6 South African girls expressed attitudes and behaviours that could indicate a possible eating disorder or risk of developing an eating disorder and 45.3% of teenagers in South Africa report being “highly dissatisfied” with their bodies.
One of our biggest challenges in dealing with eating disorders in South Africa, is the dearth of eating disorder services. Patients struggling with eating disorders can be managed in a hospital setting or as outpatients. While most prefer the outpatient form of treatment, management needs to be individualized and directed based on a person’s weight, the severity of their struggles, the supportive structures in their home environment and their motivation for recovery. One who is medically compromised, needs to be stabilized in hospital before any form of eating disorder intervention can be put in place. While there are a few inpatient units across private and government psychiatric facilities, most of the care is done through outpatient services and patients seeking out their own individual practitioners (dietician, psychologist, psychiatrist etc). It is important to remember that whether one receives care as an inpatient or outpatient, there is not one person (no matter how qualified) nor one medication that can treat an eating disorder. A team approach is always best due to the complexity and nature of the illness.
I often say that you don’t have to be a medical expert to know when someone is struggling with an eating disorder. Very often people will pick up the signs but then don’t know how to approach the topic. Here are a few tips to help and support an individual in getting help early:
- Always approach the subject without judgement
- Choose a time or place where you will be safe and not disturbed
- Avoid talking to someone before/after meals
- Broach the topic gently. Remember an eating disorder is usually a symptom of a much more complex underlying causes and emotional distress.
- Use the first person narrative: “I’m worried about you”; “I’ve noticed you are not eating as much at meal times”
- Use open ended questions like “I wondered if you would like to talk about how you are feeling?”
- Don’t focus on the food behaviours in isolation as it may cause them to become defensive/ deny their symptoms
- Rather focus on the what is happening for them emotionally. Emphasise that you care about them and their emotional well-being
- Open up the lines of communication
It is very common for one to become defensive but don’t take this personally. Remember the eating disorder exists during emotionally challenging times. It serves a function and the person may not be willing to give that up just yet.
By Dr Felicity Marcus Specialist Psychiatrist (with an interest in eating disorders and adolescent psychiatry)
*Information provided by the publicist
