Despite what many people believe, a person with a serious eating disorder may not necessarily be thin or underweight.
Ahead of Eating Disorder Awareness Week, 24 February to 2 March 2026, Fierdous Achmat, an occupational therapist practising at Netcare Akeso Montrose Manor, says there is a spectrum of eating disorders, many of which can go unnoticed by medical practitioners and loved ones for long periods before they are recognised.
“If someone starts being a picky eater, perhaps, or only eating at certain times, it may be seen by loved ones as a passing fad. If they don’t lose a lot of weight over time, their fussy or unusual eating habits may be overlooked. 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.”
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Achmat works in the dedicated eating disorder recovery unit at Netcare Akeso Montrose Manor in Cape Town, where they treat both adults and adolescents who seek help from countries around the world. She says the incidence of eating disorders is rising globally.
“It’s estimated that up to 8.4% of women and 2.2% of men will experience an eating disorder during their lifetime. In Southern Africa, screening studies indicate that up to 37.5% of young people may exhibit clinically significant disordered eating attitudes or behaviours,” says Achmat.
Serious risks
Achmat emphasises that when undiagnosed, eating disorders can cause serious long-term damage to health and cognitive functioning. “Left untreated, there’s a real chance of premature death because of various complications and, sadly, even suicide. That’s why professional help is so critical.”
She explains that eating disorders encompass a broad range of diagnostic categories. “Besides the better-known anorexia nervosa and bulimia nervosa, where a person will lose weight noticeably, other disorders like binge eating disorder, avoidant/restrictive food intake disorder, pica (craving and consuming things that are not food, like earth), rumination disorder (repeated regurgitation of undigested or partially digested food) and other eating disorders may not always result in noticeable weight loss. So, one can’t just assume that if a person is not skinny, they do not have a serious eating disorder.”
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Binge eating disorder
She explains that binge eating disorder is more common than anorexia nervosa and bulimia nervosa combined, making it the most prevalent eating disorder worldwide.
“Affecting an estimated one to three percent of the population, those with binge eating disorder 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 binge eating disorder 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.”
In the meantime, the person may suffer from severe psychological distress and functional impairment, says Achmat. “Similarly, those with atypical anorexia nervosa may have a ‘normal’ or higher weight but be demonstrating harmful restrictive behaviours. They may be at risk of significant physical and psychological effects. For those with limited access to safe or consistent forms of regulation, binge eating becomes a rapid and reliable coping mechanism. The behaviour persists not because of weakness, but because it works briefly.”
Achmat agrees that people with eating disorders may be reluctant to seek help. “The person may shy away from anything that could interfere with the way they manage their food intake. Speak to your family medical practitioner if you need help convincing a loved one to seek assistance. Remember, there’s no time to waste; the sooner they receive treatment, the better.”
Close support is essential
The eating disorder recovery unit at Netcare Akeso Montrose Manor supports clients during early intervention and provides support over longer periods for those with long-term eating disorders. “We also provide maintenance support for those who may struggle if symptoms re-emerge. Our 12-week inpatient programme addresses each client's unique circumstances and is supported by a psychiatrist. For us, it’s paramount to involve the family too. If our client has support on discharge from the clinic, the scope for their recovery beyond that is much better.”
Clients at Netcare Akeso Montrose Manor receive person centred care from an experienced multidisciplinary team comprising psychiatrists, psychologists, a registered counsellor, occupational therapists, a dietitian, and a catering team. Art therapy, drama therapy, trauma-informed and movement-based expressive interventions also form part of their tailored treatment programme. “Our experienced professionals can help those with eating disorders achieve weight stabilisation, normalise their eating patterns, and shift their damaging and self-destructive attitudes towards food, body image, and eating behaviours.”
Achmat says that in South Africa, access to specialist eating disorder services remains limited, which often leads to fragmented treatment, inconsistent messaging, and delayed diagnosis. “Eating disorders are very difficult to overcome without close support. I can’t stress enough that specialised, holistic treatment is critical to help someone with an eating disorder. It can help to put those affected back on a healthy path and even save lives.”
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Despite what many people believe, those with eating disorders are not defined by body size, age, race, cultural group affiliation or gender. In fact, there is no single profile that describes a person with an eating disorder.
“You can’t assume that only teenage girls are affected by eating disorders,” Fierdous Achmat, an occupational therapist practising at Netcare Akeso Montrose Manor, 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.”
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The causes of eating disorders are varied and include genetics, personality traits, and trauma. Symptoms can range from severe weight loss to uncontrollable bingeing and purging, excessive exercise and dieting, and an abnormal focus on body image.
If someone you know displays any of the traits below, please encourage them to seek help.
- Odd rituals, such as cutting food into very small pieces or measuring food
- Eating only ‘safe’ or ‘good’ foods, low in kilojoules and fat
- Dressing in layers to hide weight loss or gain
- Excessive exercise
- Long bathroom visits after eating
- Spending lots of time thinking about and planning the next eating binge
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Ends
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 www.akeso.co.za 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 www.netcareappointmed.co.za or by calling 0861 555 565.
References and further reading
https://www.nationaleatingdisorders.org/my-loved-one-as-an-eating-disorder-but-refuses-treatment-what-should-i-do/#:~:text='Egosyntonic'%3A%20Eating%20disorders%20are,to%20get%20rid%20of%20it
https://www.who.int/news-room/fact-sheets/detail/mental-disorders
https://www.netcare.co.za/News-Hub/Articles/evolution-of-a-world-class-specialised-eating-disorder-clinic
For media enquiries, please contact MNA at the contact details listed below
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Issued by:
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MNA on behalf of the Netcare Akeso Montrose Manor
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For media enquiries contact:
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Martina Nicholson, Meggan Saville, Estene Lotriet-Vorster,
Clementine Forsthofer or Natasha Burger
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Telephone:
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011 469 3016
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Email:
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[email protected]
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