#LockdownSA: Emotions influence eating habits

With the general stress of coronavirus and with more people living alone, or in tense family situations – overeating, bulimia and other disordered eating may be triggered due to these risk factors.

Managing an eating disorder can be particularly difficult under lockdown and experts say that severe cases of disordered eating have generally been on the increase. They recommend adapting treatments and becoming more aware of destructive habits.   

“There’s a lot of emotions that we bring to eating, regardless of whether someone has an actual eating disorder or not,” says registered dietician Lila Bruk. 

She goes on to explain that there is a range of behaviours in the category of disordered eating, some of which may be condoned as socially acceptable. She says, “if we look at disordered eating, the spectrum runs very far – from someone who might feel like occasionally they overeat or eat past the point of feeling comfortable to someone with a full-blown eating disorder.” 

Dynamics of lockdown  

According to the South African Depression and Anxiety Group the most common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. While anyone can develop these disorders, they are often seen as developmental illnesses presenting in adolescence or as a response to trauma.  

Linde Viviers is thconsultant clinical psychologist at Akeso Crescent Clinic’ s Eating Disorder Unit in JohannesburgThe unit offers multidisciplinary treatment, and according to Viviers, they have observed higher levels of requests for treatment of severe cases.  

She says, “the dynamics and the impact of the lockdown may bring existing vulnerabilities to the surface.”  

Eating disorders develop over time and may only be presenting fully now, or lockdown may mean that family members are noticing behaviours and seeking help for a person who has previously kept these secret.  

Viviers explains that people with active eating disorders or those in recovery may be more vulnerable now, because lockdown can amplify feelings of anxiety and loss of control that are commonly at the root of these disorders. Being in close quarters with family members could increase destructivbehaviours if they are coping mechanisms for interpersonal tension.  

She adds, “daily routines and structures around working, eating, sleeping, and exercise may have changed which may also lead to a relapse.” 

Bruk says that she also expects that eating disorder behaviours would intensify, particularly where people spend more time alone or caught up in overthinking. She says, “especially for bulimia very often feelings of loneliness and abandonment tend to exacerbate symptoms.”  

Healthy eating made more difficult 

Bruk says she is seeing an increase in people eating for comfort or reasons other than hunger, and that the lockdown has made healthy eating more challenging across the board. Food insecurity, which has been exacerbated by income loss attributed to the national lockdown, has also made it infinitely more difficult to eat a balanced and healthy diet. 

Amanda* in Johannesburg, has been hospitalised for anorexia before. She says that she was “originally anxious about the lockdown and eating habits” because of the fluctuation in her diet.  

I went from not eating at all to eating pretty much anything nice I can find,” she says. 

Akisha* from Pietermaritzburg, says that the lockdown has meant a decrease in her eating disorder behaviours, for instance, because cooking at home makes her more aware of what she is eating.  

There are always people at home watching my behaviours and for the first half of the lockdown I had a three-week streak of no purging.”  

While treatment for disordered eating and diagnosed eating disorders varies from person to person, Bruk advises that “there needs to be someone they can connect with” during the lockdown period. Viviers says that professional support should be continued, including virtual or in-person therapy as well as nutrition and weight monitoring with a dietician 

While Akisha has found support with friends and online communities, she feels issues like eating disorders are ignored or not dealt with in her Indian South African households.  

She says, “unfortunately given the dynamics at home it is impossible to go to a psychologist and seek professional help because of the stigma attached and the fact that it would mean I was not a perfect child.” 

Balance and routine key 

On a practical level, Viviers says “one of the most important treatment strategies is to keep to a daily structure or meal plan.” This includes eating at regular times, ideally spaced 2,5 to 4 hours apart and together with people if possible. Balanced and appropriate exercise and positive affirmations can help create a healthier connection between the mind and body.  

Amanda affirms that she has had to adjust her methods of staying balanced, by meal planning, forcing herself to eat and motivate myself every single day that even though we are in lockdown, I need to keep healthy so that I can make it through.” 

Bruk says, “it is important to try as much as possible to link the outcome of the food with the food itself.”  

She advises that despite lockdown, one should create an environment that encourages good food choices, and awareness is key. Keeping a food diary about the content, timing and associated mood of meals is an important tool to pick up destructive patterns and be able to make better decisions instead of falling into automatic decision making patterns.  

In anorexia cases, for instance, says Bruk, “they’ll keep choosing the same foods because that’s what they feel safe with even though maybe it isn’t the best option for them.”  

While lockdown conditions can put more pressure on those recovering from or dealing with an eating disorder, the management can be adapted. If you are struggling with disordered eating or think you may have an eating disorder, please reach out to a doctor or a mental health support structure. – Health-e News 

#CoronavirusSA: Diabetes inaction will cost lives

Integrating diabetes testing and prevention strategies into the country’s Covid-19 response plans are key to reducing the mortalities the country may face, writes Karyn Maughan.

Diabetes – a life-long condition in which the body either cannot make enough insulin or cannot effectively use what it produces – is on the rise in South Africa, with the International Diabetes Federation (IDF) reporting that the country has highest proportion of adult diabetics on the continent. According to the 2019 report on mortality and causes of death by Statistics South Africa, diabetes is the second deadliest disease in the country. It has killed more people than HIV, hypertension and other forms of heart disease.  

Last year, the IDF released a study finding that the number of South Africans diagnosed with the disease had more than doubled from 2017, to a staggering 4.5million people. Frighteningly, the diabetes advocacy organisation also found that, in their Africa regional network, South Africa had registered the greatest number of deaths due to diabetes on the continent. 

Type Two diabetes, in particular, clearly constitutes a potentially devastating crisis for South Africa’s already fragile public health care system. The IDF’s 2019 Diabetes Atlas shows that 12.7% of adults in South Africa had diabetes in 2019, a 137% increase on the 2017 figure of 5.4%. The report also bolstered the findings of a forecasting study published in the Lancet in 2018, which predicted that diabetes would be the leading cause of death in South Africa in 2040.  

Covid-19 compounds diabetes issues 

That threat has now been exacerbated by the fact that diabetics are identified as a group of people most vulnerable to severe or deadly outcomes if infected with Covid-19. 

But, it would appear, government has done little to nothing to make information on the numbers of diabetics who have been infected with Covid-19 or how many diabetics have died as a consequence of the virus publicly available – although, it would appear that this information is accessible to the state.  

In early May, Health Minister Zweli Mkhize stated that an as-yet undisclosed analysis of hospitalised patients showed that “consistent with evidence emerging worldwide, hypertension, diabetes and cardiac disease are the three most common comorbidities associated with serious illness from Covid-19”. Weeks later, Western Cape premier, Alan Winde revealed that, of those people who had died in the province to date, 96% had an underlying health condition such as HIV, diabetes, hypertension and tuberculosis. 

Health-e News sent questions to the health department about whether government had done any research on the numbers of diabetics who had died from Covid-19 or its complications, and whether the state had any strategy to test people for diabetes during its Covid-19 testing process. The IDF estimates that two-million South Africans are ignorant of the fact that they have the disease. Arguably, improved screening for diabetes can significantly improve the prospects of such people surviving Covid-19 – particularly when uncontrolled diabetes constitutes such a significant threat for coronavirus patients. 

At the time of publication, the health department had not responded to these questions, despite promising to send them to a resident expert on diabetes. 

Diabetes not a priority 

Up until now, the only in-depth South African research available on the impact of Covid-19 on diabetics has been done by Discovery Health. In May, it released information about the 1733 coronavirus cases reported across its schemes.  

Discovery Health chief executive officer Ryan Noach, said that high risk members tend to be the elderly, and members living with chronic diseases, like diabetes. But the data contained in the report provides no real insight into the vast majority of South Africa’s diabetics: those who are unable to afford private health care and depend on state facilities for care and treatment. 

What’s also apparent is that the state has not, as it has done with smokers, made any attempt to mitigate the risks faced by diabetics with targeted interventions aimed at improving their blood sugar control – a step shown to profoundly reduce the risks of serious Covid-19 outcomes for diabetics.  

This may be because the number of diagnosed diabetics in South Africa is dwarfed by the eight million-strong population of smokers. But, while the debate about the risks of severe Covid-19 infection and death in smokers continues to rage, global research has clearly shown that poorly controlled diabetics are in significant danger of death from Covid-19.  

The Centre for Diabetes and Endocrinology note that, “the problem people with diabetes may face, is primarily a problem of worse outcomes, not a greater chance of contracting the virus. When people with diabetes do not manage their diabetes well and experience fluctuating blood glucose levels, they are generally at risk for a number of diabetes-related complications. And, in general, as a population, people with diabetes do face a higher chance of experiencing severe symptoms and serious complications when infected with any virus and with Covid-19.” 

This has clearly not escaped the attention of organisations fighting for the ban on smoking to be lifted. In papers filed at the Pretoria High Court, the Free-Trade and Independent Tobacco Association accused government of not being consistent or proportional in its decision to ban the sale of cigarettes and tobacco during South Africa’s Covid-19 shutdown but not to place any restrictions on the sale of junk food and sugary drinks – which constitute, they argue, a threat to diabetics. It was an accusation that Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma did not respond to. 

What is apparent is that diabetes is not a priority for South African health authorities – certainly not in terms of awareness drives and, arguably, not in terms of campaigns to ensure that diagnosed diabetics are equipped with the material and information they need to manage the disease. This is despite the fact that, even without the risks attached to diabetes and Covid-19 infection, uncontrolled diabetes remains a significant health risk. It’s a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.  

As endocrinologist Dr Sundeep Ruder wrote in 2016, government’s focus on non-communicable diseases has centred on tuberculosis and HIV, which have individual budget allocations. “Diabetes is under the general non-communicable diseases budget. Non-governmental organisations receive little to no funding for diabetes education, prevention or supplies,” he stated. 

At this point, it is important to note that, globally, Type One diabetics (diagnosed as children as a consequence of genetics or autoimmune condition) make up 10% of the diabetic population. The vast majority of diabetics, 90%, develop the disease as a consequence of obesity and poor lifestyle decisions. Type Two diabetes is, largely, preventable through healthy dietary habits and regular exercise. 

That pathology is no different in South Africa. The exponential growth in diabetes in the country can be concretely linked to its well-documented levels of obesity – with more than half of all South Africans being defined as overweight or obese.  

Covid-19 arguably represents a perfect opportunity for government to not only run an effective diabetes testing campaign – aimed at reducing the risk of pandemic fatalities – but also to channel resources into ensuring that diabetics are educated about the proper management of the condition. 

Enabling diabetics to test themselves and assisting them with management of the disease may require additional budget allocation, but it will arguably also prevent the state from having to pay for amputations and kidney failure treatment further down the line. 

Current projections fluctuate but some suggest that Covid-19 will claim the lives of 45 000 – many of whom are expected to be diabetics. But, after that deadly tsunami eventually lifts, diabetes – which killed over 25 000 people in 2017 – will remain one of South Africa’s most pressing health emergencies.  

Unlike Covid-19, we know that the diabetes epidemic is among us. And we know how to stop it. – Health-e News 

#CoronavirusSA: Diabetes inaction will cost lives

Integrating diabetes testing and prevention strategies into the country’s Covid-19 response plans are key to reducing the mortalities the country may face, writes Karyn Maughan.

Diabetes – a life-long condition in which the body either cannot make enough insulin or cannot effectively use what it produces – is on the rise in South Africa, with the International Diabetes Federation (IDF) reporting that the country has highest proportion of adult diabetics on the continent. According to the 2019 report on mortality and causes of death by Statistics South Africa, diabetes is the second deadliest disease in the country. It has killed more people than HIV, hypertension and other forms of heart disease.  

Last year, the IDF released a study finding that the number of South Africans diagnosed with the disease had more than doubled from 2017, to a staggering 4.5million people. Frighteningly, the diabetes advocacy organisation also found that, in their Africa regional network, South Africa had registered the greatest number of deaths due to diabetes on the continent. 

Type Two diabetes, in particular, clearly constitutes a potentially devastating crisis for South Africa’s already fragile public health care system. The IDF’s 2019 Diabetes Atlas shows that 12.7% of adults in South Africa had diabetes in 2019, a 137% increase on the 2017 figure of 5.4%. The report also bolstered the findings of a forecasting study published in the Lancet in 2018, which predicted that diabetes would be the leading cause of death in South Africa in 2040.  

Covid-19 compounds diabetes issues 

That threat has now been exacerbated by the fact that diabetics are identified as a group of people most vulnerable to severe or deadly outcomes if infected with Covid-19. 

But, it would appear, government has done little to nothing to make information on the numbers of diabetics who have been infected with Covid-19 or how many diabetics have died as a consequence of the virus publicly available – although, it would appear that this information is accessible to the state.  

In early May, Health Minister Zweli Mkhize stated that an as-yet undisclosed analysis of hospitalised patients showed that “consistent with evidence emerging worldwide, hypertension, diabetes and cardiac disease are the three most common comorbidities associated with serious illness from Covid-19”. Weeks later, Western Cape premier, Alan Winde revealed that, of those people who had died in the province to date, 96% had an underlying health condition such as HIV, diabetes, hypertension and tuberculosis. 

Health-e News sent questions to the health department about whether government had done any research on the numbers of diabetics who had died from Covid-19 or its complications, and whether the state had any strategy to test people for diabetes during its Covid-19 testing process. The IDF estimates that two-million South Africans are ignorant of the fact that they have the disease. Arguably, improved screening for diabetes can significantly improve the prospects of such people surviving Covid-19 – particularly when uncontrolled diabetes constitutes such a significant threat for coronavirus patients. 

At the time of publication, the health department had not responded to these questions, despite promising to send them to a resident expert on diabetes. 

Diabetes not a priority 

Up until now, the only in-depth South African research available on the impact of Covid-19 on diabetics has been done by Discovery Health. In May, it released information about the 1733 coronavirus cases reported across its schemes.  

Discovery Health chief executive officer Ryan Noach, said that high risk members tend to be the elderly, and members living with chronic diseases, like diabetes. But the data contained in the report provides no real insight into the vast majority of South Africa’s diabetics: those who are unable to afford private health care and depend on state facilities for care and treatment. 

What’s also apparent is that the state has not, as it has done with smokers, made any attempt to mitigate the risks faced by diabetics with targeted interventions aimed at improving their blood sugar control – a step shown to profoundly reduce the risks of serious Covid-19 outcomes for diabetics.  

This may be because the number of diagnosed diabetics in South Africa is dwarfed by the eight million-strong population of smokers. But, while the debate about the risks of severe Covid-19 infection and death in smokers continues to rage, global research has clearly shown that poorly controlled diabetics are in significant danger of death from Covid-19.  

The Centre for Diabetes and Endocrinology note that, “the problem people with diabetes may face, is primarily a problem of worse outcomes, not a greater chance of contracting the virus. When people with diabetes do not manage their diabetes well and experience fluctuating blood glucose levels, they are generally at risk for a number of diabetes-related complications. And, in general, as a population, people with diabetes do face a higher chance of experiencing severe symptoms and serious complications when infected with any virus and with Covid-19.” 

This has clearly not escaped the attention of organisations fighting for the ban on smoking to be lifted. In papers filed at the Pretoria High Court, the Free-Trade and Independent Tobacco Association accused government of not being consistent or proportional in its decision to ban the sale of cigarettes and tobacco during South Africa’s Covid-19 shutdown but not to place any restrictions on the sale of junk food and sugary drinks – which constitute, they argue, a threat to diabetics. It was an accusation that Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma did not respond to. 

What is apparent is that diabetes is not a priority for South African health authorities – certainly not in terms of awareness drives and, arguably, not in terms of campaigns to ensure that diagnosed diabetics are equipped with the material and information they need to manage the disease. This is despite the fact that, even without the risks attached to diabetes and Covid-19 infection, uncontrolled diabetes remains a significant health risk. It’s a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.  

As endocrinologist Dr Sundeep Ruder wrote in 2016, government’s focus on non-communicable diseases has centred on tuberculosis and HIV, which have individual budget allocations. “Diabetes is under the general non-communicable diseases budget. Non-governmental organisations receive little to no funding for diabetes education, prevention or supplies,” he stated. 

At this point, it is important to note that, globally, Type One diabetics (diagnosed as children as a consequence of genetics or autoimmune condition) make up 10% of the diabetic population. The vast majority of diabetics, 90%, develop the disease as a consequence of obesity and poor lifestyle decisions. Type Two diabetes is, largely, preventable through healthy dietary habits and regular exercise. 

That pathology is no different in South Africa. The exponential growth in diabetes in the country can be concretely linked to its well-documented levels of obesity – with more than half of all South Africans being defined as overweight or obese.  

Covid-19 arguably represents a perfect opportunity for government to not only run an effective diabetes testing campaign – aimed at reducing the risk of pandemic fatalities – but also to channel resources into ensuring that diabetics are educated about the proper management of the condition. 

Enabling diabetics to test themselves and assisting them with management of the disease may require additional budget allocation, but it will arguably also prevent the state from having to pay for amputations and kidney failure treatment further down the line. 

Current projections fluctuate but some suggest that Covid-19 will claim the lives of 45 000 – many of whom are expected to be diabetics. But, after that deadly tsunami eventually lifts, diabetes – which killed over 25 000 people in 2017 – will remain one of South Africa’s most pressing health emergencies.  

Unlike Covid-19, we know that the diabetes epidemic is among us. And we know how to stop it. – Health-e News