Starving for data: Eating disorders prevalence and research gaps in Southern Africa

Objective: Studies reporting prevalence estimates of eating disorders in Southern Africa are scarce. To fill this gap, the present Research Forum reviews existing literature on the prevalence of eating disorders, including as assessed by clinical interviews, screeners, and self-reported behaviors, among individuals in Southern Africa. Key recommendations for future research directions are provided.

Method: The present Research Forum was registered in the International Prospective Register of Systematic Reviews (#541032). Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed studies in all languages were searched across multiple databases up to March 2025 using predefined keywords; 209 studies were screened for content.

Results: A total of 16 English studies in six countries were included, all published between 1981 and 2025. Eating disorder point prevalence, defined as the proportion of clinically diagnosed cases, was 0.7%. Named eating disorder prevalences ranged between 0.5% and 4.7%, and high prevalences of pica were found. Prevalence based on screening instruments, indicating increased risk (i.e., proportion scoring above the clinical cutoff) ranged from 3.5% to 37.5%.

Discussion: Studies were few, methodologically diverse, and culturally heterogeneous. Key recommendations for future research include examining factors related to globalization and food insecurity and their potential interplay with the manifestation of eating disorder symptomatology, exploring the roles of ethnicity and sex, evaluating the cultural appropriateness of (Western) standardized assessment tools, and incorporating more diverse samples.