Eating disorders are often misunderstood as a problem of food, weight, or appearance.

But health experts warn that by the time a child stops eating regularly, overeats in secret, or becomes obsessively focused on exercise, something far deeper may be unfolding.

These illnesses are not phases, not attention-seeking behaviours, and not simply the result of social media trends.

They are complex mental health conditions rooted in emotional pain, anxiety, trauma, and family dynamics.

Understanding the early signs — and knowing how to respond with care rather than fear — can make the difference between prolonged suffering and the start of recovery.

Occupational therapist Marlene van den Berg says eating disorders are complicated because many people very often think it’s just about weight.

“We don’t really understand that an eating disorder is really a very severe mental health condition that presents quite physically,” Van den Berg warned during a SA Depression and Anxiety Group (Sadag) Ask The Expert session recently.

“It presents in your relationship with food, your relationship with your body and ultimately your relationship with yourself.

“You will not see an eating disorder at the same level as a drug addiction or a gambling addiction. We speak about a process and illnesses where I cannot deal with my emotions, and I cannot deal with what’s going on around me.

“It’s more than just what you’re eating and what you’re not eating or how much you weigh. It’s really about what is going on in your dynamics and your internal mindset that affects your mental well-being.”

Van den Berg says eating disorders are a hidden and unspoken illness.

“Clients come into the clinic, families bring their overweight loved ones into the clinic, and we say to them, it’s not about the food. The parents are like, ‘What does she weigh?’ But we’re like, we want to speak about the child’s trauma. And we want to speak about the dynamics in the family, and we want to speak about the pressure,” Van den Berg says.

“Then people are quite hesitant because eating disorders and hide the deeper issues and the symptoms. It’s not that someone is throwing up because they want to lose weight. They’re throwing up because there’s so much emotional turmoil in them that they cannot hold, and they just want to release it.

“We have normalised binge eating. [But] these people can’t stop themselves because they have this big need for comfort and support, and they get that through food.

“A lot of eating disorders actually start as, ‘I wanna be healthy’. We’re in the beginning of the year [and] my New Year’s resolution is to lose weight and be healthy and run a marathon, but then that so quickly goes obsessive and toxic,” Van den Berg says.

A lot of eating disorders actually start as, ‘I wanna be healthy’. We’re in the beginning of the year [and] my New Year’s resolution is to lose weight and be healthy and run a marathon, but then that so quickly goes obsessive and toxic

—  Van den Berg, Occupational therapist

Murray Hewlett, CEO of Affinity Health, says midlife comes with “biological, emotional, and social changes that can increase the risk of disordered eating”.

“Hormonal shifts during perimenopause and menopause, stress, body image concerns, and significant life transitions can all play a part,” he says. “Many adults also turn to strict diets or health resets after pregnancy or illness, which can unintentionally lead to unhealthy eating habits.

“Eating disorders don’t only affect teenagers or young women; they can occur at any age and in any gender. Research shows that about one in five women and one in seven men experience an eating disorder by the age of 40. The most common type in adults is binge eating disorder, which affects around 2–3% of people and can cause severe emotional and physical distress.

People who have normalised binge eating need help (Cristina Villar Martin)

“Many adults in midlife live with eating disorders that go unnoticed or untreated. For men, symptoms are often overlooked because disordered eating can appear as extreme clean eating, rigid gym routines, or an obsession with fitness rather than obvious distress about food or weight.”

Hewlett warns that eating disorders are not lifestyle choices but severe medical conditions.

“Anorexia nervosa has one of the highest death rates of any mental illness, caused by heart problems, electrolyte imbalances, and even suicide.

“Bulimia nervosa can damage tooth enamel, irritate the throat, and cause heart issues due to low potassium levels. Binge eating disorder is linked to obesity, type 2 diabetes, fatty liver, sleep apnoea, and joint pain.”

Van den Berg stresses that families need to remember that an eating disorder is a family illness.

“We say that an eating disorder is co-created. Everyone in the family contributes. The dad’s absenteeism, the mom’s issues with her own body, and the grandmother maybe passed away. It’s all of these things for a lot of families in our system of denial, in our mental stigmatisation.”

Sowetan