SA’s ‘invisible’ eating disorders

Addressing the underlying pain of binge eating and extreme diets

Tuesday, May 14 2024

Unhealthy relationships with food can take many different forms, affecting both men and women, and may not always be immediately recognisable as eating disorders, leaving many people to suffer in silence. 

“The wide range of eating disorders and the ways they can manifest are so diverse, yet most people immediately think of anorexia nervosa or bulimia. Society often mistakenly associates eating disorders with women, overlooking the complexity of eating disorders,” says Marlene van den Berg, therapeutic programme manager and occupational therapist at Netcare Akeso Montrose Manor. 

“One of the lesser known eating disorders is orthorexia nervosa, which may be more prominent in cosmopolitan cities like Johannesburg or Cape Town where there is a particularly strong trend towards obsessive health-orientated behaviour.”

“A hallmark of orthorexia is that the person becomes overly fixated on health-conscious food and behaviours, and may not eat enough to sustain them physically,” adds Peta-Lyn Foot, therapeutic programme manager and occupational therapist at Netcare Akeso Randburg – Crescent Clinic. 

“Orthorexia involves a compulsion for only eating ‘pure’ or subjectively ‘correct’ foods, and feeling emotional distress connected to foods that do not fit in with these perceptions. Often beginning as a desire to eat more healthily or make more ‘clean’ conscious purchasing decisions, some people's dietary choices may be taken to extremes and become overly restrictive. 

“Some of the warning signs of orthorexia may include forgoing meals or missing social functions to avoid certain types of food or drink, or the person’s highly selective food preferences may make a nutritious balanced diet unaffordable or otherwise not supportable,” she says.

Van den Berg says that even though orthorexia is not necessarily associated with weight loss, people may also exercise excessively, trying to make up for eating foods that don’t conform to their own self-imposed dietary ‘rules’. 

“Often people with this disorder may project an image of being health conscious, but if taken to extremes the truth is to the contrary, as not only does this eating disorder signal deeper underlying emotional needs, orthorexia may also lead to nutritional deficiencies and avoidable sport injuries,” Van den Berg says. 

“A healthy lifestyle must include balance and have healthy long-term implications. A good test is to check your emotional response if there is a day when you aren’t able to follow your preferred ‘healthy’ lifestyle, leading you to miss an exercise session or eat something outside your preferred diet. If you are being hard on yourself or feeling guilt or shame about it, it may be time to open up to a mental health professional.”

“Binge eating is another eating disorder that is too often overlooked or misunderstood, and it has a psychological basis for recurring episodes where the person loses self-control and feels compelled to eat a lot more food than would be usual in a matter of hours, often leaving the person with feelings of shame or guilt,” Foot adds. 

“It is unfortunately often hard for people suffering from binge eating to recognise that their behaviour is linked to an underlying mental health disorder, and so it is even harder for them to seek help as the person may fear the stigma of being labelled as gluttonous or lacking discipline,” she says.Mental health professionals such as those practising at Netcare Akeso Montrose Manor and Netcare Akeso Randburg ¬¬– Crescent Clinic, recognise binge eating as a disorder and multidisciplinary treatment coordinated by the Centre of Psychotherapy Excellence (COPE) programme is available for this as well as other eating disorders. 

“Male eating disorders in particular are often misunderstood and easily missed, which means these conditions tend to be underreported. Many men grapple with stigma around male mental health generally, and when it comes to eating disorders, it may be even harder for men to recognise and address,” Van den Berg points out. 

“In South Africa, there is a significant cohort of men with binge eating disorders, yet often adult male binge eating is framed as a food addiction and may present with other substance use disorders,” she says. 

“There is no ‘quick fix’ for curing eating disorders, as these are complex psychological conditions that require emotional processing to address the underlying need the person’s relationship with food is attempting to fulfil, and this takes time and commitment.”

Foot urges anyone who is concerned about their or a loved one’s relationship with food to seek professional support. “If you or someone you know are showing signs that might potentially point to an eating disorder of any kind, do not ignore it. These disorders can progress quickly and impact all spheres of the person’s life if not identified and managed appropriately,” she says.

If you or someone you know is struggling with an eating disorder or any other emotional or mental health difficulties, Netcare Akeso’s range of services, including psychiatrists, psychologists, occupational therapists and dieticians, are available to provide professional support. Netcare Akeso’s 24-hour crisis line is always available on 0861 435 787, any time of day or night, with trained counsellors to listen and guide you on the options and resources available.


About Netcare Akeso

Netcare Akeso operates a network of private inpatient mental health facilities and is part of the Netcare Group. Netcare Akeso provides individual, integrated and family-oriented treatment in specialised inpatient treatment facilities, as well as certain outpatient services, for a range of psychiatric, psychological and substance use conditions. Please visit or contact [email protected] for further information.
In the event of a psychological crisis, call 0861 435 787, 24 hours a day for emergency support. Psychiatrist consultations can be made through Netcare appointmed™, online at or by calling 0861 555 565.
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