What is Anorexia? An Explainer for Africans

 

By: Favour Okere. Freelance Health Writer and Datelinehealth Africa (DLHA) volunteer. Medical review and editorial support provided by the DLHA Team.

Black girl with excessive weight loss due to anorexia.

 

 

Key Facts

• Anorexia is a severe eating disorder characterized by an intense fear of weight gain and distorted body image.

• It affects people of all backgrounds, including Africans, contrary to common misconceptions.  

• Early detection and comprehensive treatment that include medical and psychological interventions, and prevention efforts promoting healthy body image are important.

• The challenges to addressing anorexia in Africa include limited awareness, stigma, and lack of resources.

• Overcoming these barriers requires a collective effort to raise awareness and improve access to specialized care.

 

 

Introduction

 

Anorexia nervosa (often called anorexia) is an eating disorder and serious mental health condition. [1] It is a mental and physical disease that was recognised in France in the 19th century. [2] Anorexia is a severe and potentially life-threatening eating disorder characterized by an intense fear of gaining weight, a distorted body image, and a relentless pursuit of thinness. People with anorexia often don't eat enough food, exercise too much, and engage in other harmful behaviors to control their weight. 

 

Addressing anorexia is important as it can result in severe physical and psychological consequences such as anaemia, malnutrition, multiple organ damage, infertility, thinning of the bones, [3] muscle wasting, and an increased risk of premature death. 

 

 

Prevalence of Anorexia in Africa

 

While anorexia is often perceived as a disorder more prevalent in Western cultures, it is also present in African countries, although the prevalence rates tend to be lower compared to Western nations. [4}

 

The condition has historically been overlooked or misunderstood, but it is becoming a growing concern as beauty standards keep changing with exposure to the Western media.

 

There is a lack of large-scale epidemiological studies on eating disorders (EDs), including anorexia, in many African countries. The first reports of Eating Disorders in Africa emerged in the 1970s and 1980s. [5] Recent systematic reviews on the prevalence of EDs did not include any studies from Africa. The few studies undertaken suggest that the prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) is lower in Africa than globally, and that women with AN-related pathology may present atypically, with less weight concern.

 

 

Myths and Misconceptions about Anorexia

 

Myth 1: Anorexia is a lifestyle choice or a diet gone too far

 

Anorexia is a complex mental health disorder with biological, psychological, and social components, not merely a choice or a failed diet. It is a serious illness that requires professional treatment.

 

Myth 2: Anorexia only affects wealthy, white individuals

 

Anorexia can affect people of all socioeconomic backgrounds, ethnicities, and cultures, including Africans. While it was once thought to be more prevalent in Western countries, cases of anorexia are increasingly being reported across Africa.

 

Myth 3: People with anorexia are vain or attention-seeking

 

Anorexia is a serious mental illness, and individuals who suffer from it do not choose to have this disorder or engage in harmful behaviors for attention. Their actions are driven by an intense fear of weight gain and a distorted perception of their body.

 

Myth 4: Anorexia is solely about food and weight

 

While food and weight are central concerns for those with anorexia, the disorder is often due to deeper psychological issues, such as low self-esteem, perfectionism, anxiety, and a need for control.

 

 

Signs and Symptoms of Anorexia

 

• Significantly low weight for age

• An intense fear of gaining weight

• Distorted body image and a relentless desire to be thinner, even when underweight

• Excessive exercise or other compensatory behaviors (e.g., purging, laxative abuse) to control weight

• Deliberately missing meals or avoiding to eat food seen to be fattening

• Stoppage of period (in women who have not reached the age of menopause).

• Delay or period not starting (in young girls)

• Lightheadedness, hair loss, dry skin, etc.

• Using medications to prevent weight gain from food eaten

• Denial of the seriousness of the problem.

 

 

Risk Factors/ Causes of Anorexia

 

While the exact causes of anorexia are not fully understood, a person with anorexia is more likely to come from a family with a history of certain health problems. [6] These include weight problems, physical illness, and mental health problems. Mental health problems may include depression and substance use disorder. 

 

Other factors include:

• Genetic predisposition

• Personality traits like perfectionism, anxiety, obsessive-compulsive tendencies, and low self-esteem. [7]

• Cultural pressure and societal ideals

• Traumatic life events or major life transitions such as starting college, a new job, or a change in living situation

• Dysfunctional family dynamics like a history of being teased or bullied about weight or strained family relationships

• Co-occurring mental health conditions

 

 

Diagnosis of Anorexia

 

Diagnosing anorexia involves the following:
 

• Physical examination and assessment of your weight, height, and body mass index (BMI)

• Evaluation of your eating patterns, behaviors, and attitudes toward food and body image

• Psychological assessment by a doctor or mental health professional to identify underlying mental health issues, such as depression, anxiety, or obsessive-compulsive tendencies

• Medical tests (e.g., blood tests, bone density scans) to rule out other potential causes of weight loss or malnutrition and assess the physical effects of the disorder

 

Your mental health professional also will use the diagnostic criteria for anorexia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. [8]

 

 

Treatment of Anorexia

 

Treating anorexia often requires a team of healthcare professionals, and includes:

 

Hospitalization

 

If you are diagnosed with anorexia, you may require hospitalization or intensive outpatient treatment to restore healthy eating habits and address any medical complications resulting from malnutrition.

 

Psychotherapy

 

Individual, family, or group therapy can help address the underlying psychological issues contributing to anorexia, such as distorted body image, low self-esteem, and dysfunctional thought patterns.

 

 Medication

 

In some cases, medications may be prescribed to manage co-occurring conditions like depression, anxiety, or obsessive-compulsive disorder, which can contribute to anorexia.

 

Support groups and education

 

Participating in support groups and receiving education about anorexia can help individuals and their families better understand the disorder and develop coping strategies.

 

The specific treatment plan is based on an individual's unique needs and may involve a combination of these approaches. Recovery from anorexia is a long-term process that requires patience, commitment, and ongoing support.

 

 

Consequences of Untreated Anorexia

 

Anorexia is very harmful on the body, and can lead to serious medical problems such as (See figure 1):

Figure 1: Consequences of untreated anorexia. Adapted from: Eating Disorder Victoria. Click on image to enlarge.

 

• Anemia (low iron level in blood)

• Heart problems (including irregular or slow heart beat, heart failure, etc.)

• Low blood pressure

• Dizziness, Fainting spells, Mood swings. Anxiety, Depression, Suicide

• Kidney problems

• Imbalance in body fluids and essential minerals

• Constipation, Diarrhoea, Bloating, Abdominal pain

• Lack of menstruation in women

• Low libido in women and testosterone in men

• Bone loss, Muscle weakness, Fatigue.

 

 

Prevention of Anorexia

 

There is no sure way to prevent anorexia, but you can take steps to develop healthy eating habits and lower the risk of developing anorexia. These include:
 

• Promoting positive body image and self-esteem from an early age.

• Challenging unrealistic media representations by advocating for more diverse and realistic portrayals of body types in media.

• Educating individuals, families, and communities by raising awareness about the signs, risks, and consequences of anorexia. [9]

• Encouraging healthy eating habits and a balanced lifestyle.

• Providing accessible mental health resources

 

 

Challenges to Addressing Anorexia in Africa

 

• Limited awareness and understanding

 

Seeing anorexia as a lifestyle choice rather than an illness and a lack of understanding about causes of the condition are major challenges within African communities. These may lead to misdiagnosis, stigma, and delayed treatment. [10].

 

• Stigma and cultural taboos

 

Mental health issues, including eating disorders, are often shrouded in stigma and cultural taboos in many African societies, making it difficult for individuals to seek help or talk openly about their struggles.

 

• Lack of specialized healthcare resources

 

Many African countries have limited specialized healthcare facilities, trained professionals, and treatment programs dedicated to addressing eating disorders like anorexia.

 

• High cost and limited access to mental health services

 

Without insurance coverage or even with limited coverage, the cost of residential treatment can be difficult to afford for many Africans. Also, limited access to mental health services, particularly in rural areas, can significantly hinder early detection, diagnosis, and treatment of anorexia.

 

 

Conclusion 

 

Anorexia nervosa is a severe eating disorder that can have life-threatening consequences if left untreated. Early intervention and a multidisciplinary approach involving medical care, nutritional counseling, and psychotherapy are needed for recovery. With proper treatment and support, individuals with anorexia can overcome this disorder and develop healthier eating habits.

 

 

References

1. Overview—Anorexia nervosa. [Internet. 2021, February 11]. NHS.UK. Retrieved April 20, 2024 from https://www.nhs.uk/mental-health/conditions/anorexia/overview/

2. Touyz, S., Bryant, E., Dann, K.M. et al. (2023). What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure. J Eat Disord 11, 221 (2023). https://doi.org/10.1186/s40337-023-00944-3.

3. Eating disorders: About more than food - National Institute of Mental Health (NIMH). (Internet. n.d.). Retrieved April 30, 2024, from https://www.nimh.nih.gov/health/publications/eating-disorders.

4. Njenga FG, Kangethe RN. Anorexia nervosa in Kenya. East Afr Med J. 2004 Apr;81(4):188-93. doi: 10.4314/eamj.v81i4.9153. Available from: https://pubmed.ncbi.nlm.nih.gov/15884284/.

5. Van den Heuvel, L.L., Van der Merwe, C.A., Jordaan, G.P., Szabo, C.P. (2023). Eating Disorders in Africa. In: Robinson, P., Wade, T., Herpertz-Dahlmann, B., Fernandez-Aranda, F., Treasure, J., Wonderlich, S. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-97416-9_17-1.

6. Hopkins Medicine. Anorexia nervosa. Internet. 2023, January 31]. Retrieved April 30, 2024 from https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/anorexia-nervosa.

7. NEDA..Eating disorder risk factors. [Internet. n.d.]. Retrieved April 30, 2024 from https://www.nationaleatingdisorders.org/risk-factors/.

8. Mayo Clinic. Anorexia nervosa - Diagnosis and treatment [Internet. 2018, February 20]. Retrieved April 30, 2024 from https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/diagnosis-treatment/drc-20353597.

9. Stetetzer. R. How to prevent eating disorders in teens and adolescents. Erica Leon Nutrition. [Internet. 3033 February 9]. Retrieved April 30, 2024 from https://ericaleon.com/2022/02/09/prevent-eating-disorders-teens/.

10. Oyindasola, KO, Adedoyin, FF, Adedoyin, AA. Anorexia nervosa: opportunities and challenges in treatment. In Weight Management. IntechOpen eBooks. (2022). https://doi.org/10.5772/intechopen.103751. Available from: https://www.intechopen.com/chapters/81007

 

 

Published: May 5, 2024

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