Anorexia: why Asia isn’t talking about this mental illness, and the survivors and therapists battling ignorance of the eating disorder

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In 2018, Kueh moved back to Malaysia – her home country – and started working as a fitness coach. She said building up muscle “provided her a platform to eat in more diversity and bigger portions”. The young woman started performing in bikini competitions, a type of beauty pageants focused on bodybuilding, and other national beauty contests. In 2019, she was selected as a finalist for Miss World Malaysia and started working on a proposal for an eating disorder awareness campaign.“The situation is even worse in Malaysia. People just talk about losing weight, but no one ever brings it up and there are no treatment options.”

 

Dear Readers,

 

Please find below a post that was published in South Asian post last year, it sheds light on growing problem of Eating Disorders and how the most advanced country in Asia is struggling to deal with this growing problem. We share the article below for reference and research purpose only.

 

 

Anorexia: why Asia isn’t talking about this mental

illness, and the survivors and therapists battling

ignorance of the eating disorder

 

by  | Jan 20, 2020 | FeaturesHong Kong

 

Published by the South China Morning Post here.

When YongJun Kueh was 18, she discovered she had put on a little weight during exam time in her final year of high school, and decided to go on a two-day detox programme to lose it.

 

After 48 hours of a diet of juices, protein shakes and vitamin tablets, the waistband of her pants hung loose on her hips, and she felt satisfied. So she extended the program a couple more days, then a couple more weeks. A cycle had begun and she was trapped.

 

The young woman’s weight tumbled. At her worse state, she weighed 35 kg, less than an average 11-year-old girl. She was dying, yet felt carefree.  “I was conscious that I was sick. I wanted to use my will-power to overcome my body instincts,” she explained. “I felt a relief from the need to achieve something in my life.”

 

Kueh’s struggle is far from uncommon. Like in many other parts of the world, eating disorders have become a growing health concern in Hong Kong. Although there are no government statistics on the prevalence of eating disorders in the city, numerous published studies found that eating disorder rates have skyrocketed in the last three decades.

 

While public awareness and medical treatments have progressively developed in most Western countries, eating disorders are still not widely known in Hong Kong and in the rest of Asia. In the shadow of a culture that promotes and celebrates thinness as a requisite for beauty lies the failure to treat what has been found to be the most lethal of all psychiatric disorders.

 

According to a 2019 study, the global rate of eating disorder prevalence more than doubledbetween 2000 and 2018, increasing from 3.8 to 7.8% of the worldwide population. As early as in 1989, researchers at the Chinese University of Hong Kong foundthat the incidence of anorexia in Hong Kong was just under 0.4 cases per 100,000 person-years, an incidence rate similar to those reported in Western nations. In the following two decades, the number of eating disorder patients in Hong Kong doubled. In 2007, researchers foundthat eating disorders were present in 3.9% of adolescent boys and 6.5% of adolescent girls.

 

For Professor Joyce Ma, who carried out a ten-year cross-disciplinary research on anorexia nervosa in Hong Kong, causes of eating disorders are multifactorial and encompass both personal and cultural factors. “Children and adolescents with anorexia nervosa tend to experience a strong sense of ineffectiveness and inadequacy,” she said. “Dieting and reducing body weight gives them a strong sense of control.” In her latest research, Ma explains that in Chinese societies like Hong Kong, having a family member suffering from a mental disorder such as anorexia is perceived as shameful, which tends to dissuade patients and families from seeking the help of mental health professionals. Moreover, westernization and the commercialization of standards of beauty also account for the rise of eating disorders in Hong Kong, she explained.

Gabrielle K. Tüscher is an eating disorder specialist with more than 18 years of experience and who works as a private therapist and registered dietician in Hong Kong. “Eating disorders are just as prevalent in Asia as they are in the West,” she said. Yet there is a significant level of stigma and lack of understanding of eating disorders in Asian culture. Rather than being recognized as mental illnesses, disordered eating isseen as a choice, explained the therapist.

 

As a result, “the lack of understanding of patients and families is one of the biggest barriers in treatment. Eating disorders often stay under the radar, and by the time people seek help, they are already in the hospitalization phase, and sometimes it’s even too late,” said Tüscher.

 

Steph Ng was diagnosed with anorexia when she was 16, and said she was “one of the lucky ones.” The teenager’s weight had plummeted, yet her illness had stayed unnoticed. One day, during a routine medical checkup, her doctor could not find her pulse. This is only when Ng’s condition was discovered. Her mother took her out of school to feed her until her weight restored. Ng saw three different therapists before she found the right support. “The big issue is that they don’t really listen,” explained Ng. “Eating disorders are not treated as other mental illnesses because it’s treated as not. They are often seen as someone’s choice, someone’s fault.”

 

The young woman was able to recover thanks to the support of her family and to her relentless efforts to fight her illness. Today, she studies psychology in the U.S. and investigates the connection between Asian culture and eating disorders. Ng’s research showed that cultural eating norms and the ideal of thinness in Asian contexts create conflicting expectations which she identifies as a culturally specific risk factor for disordered eating. “There is a very distinct connection between food and morality,” she said.  “You are not a good person if you are not under the acceptable threshold. A functioning, healthy body is already seen as unacceptable.”

She further explains that as menstruation requires a certain percentage of body fat, most women would stop menstruating if they followed the aesthetic expectations pushed upon them.

 

Ng deplores the lack of research on eating disorders in Hong Kong. “People think it doesn’t exist,” she said.

 

Kueh agreed, saying she felt that “no one would understand” her problem. “Eating disorders are invisible in Hong Kong. People don’t know it’s an issue,” she said, adding that anorexia afflicted her during all four years of university in Hong Kong. “There are many walking skeletons, everyone promotes thinness, but people never talk about eating disorders,” she said.

Recovering from an eating disorder in Hong Kong is difficult. Pamela Rana struggled with bulimia nervosa, an eating disorder characterized by episodes of binge eating followed by purging, for over 20 years. For her, the city offered the perfect hideaway for someone who struggles with disordered eating. Myriad restaurants, cafes and food stores allowed her to easily ‘get her fix’ while her illness stayed unnoticed in Hong Kong’s culture of privacy.

 

Pervasive weight-loss medication ads and commercials featuring excessively skinny bodies do not help either. Extreme slimness in Hong Kong is not only seen as desirable, but shines as the ultimate beauty standard. Rana’s unhealthy thinness was admired, complimented, celebrated.

 

“It’s easy to hide here. People are naturally a lot smaller, plus there is the pressure to be skinny. It’s easy to develop the disease quickly,” she said.

 

The other part of the problem is that people do not know who to contact when they decided to get some help, and often end up going to professionals who are not qualified to treat eating disorders, said Tüscher.

 

Eating disorders are a complex, difficult and lengthy disease to treat, said the therapist. Proper treatment, she added, requires a multi-disciplinary team involving two to four trained specialists.

 

Yet this training does not exist in Hong Kong. As a result, some therapists will treat patients and fail to provide proper therapy, while others will reject eating disorder cases altogether. The very few trained professional practicing in Hong Kong have been trained abroad, according to Tüscher.

 

Only one public hospital in Hong Kong offers an in-patient clinic for eating disorder treatment. But the treatment offered focuses mainly on weight restoration, while providing little psychological follow up, said Tüscher.

 

And on top of that comes the barrier of cost. “You are looking at HK$20,000 to HK$40,000 a month,” said the therapist. “But there are ways to work around it. Proper treatment is possible, people just have to know where to find it,” she said.

 

In the absence of government efforts to tackle the issue, non-profit organizations have taken the lead to promote public awareness and provide help to patients. Since 1999, the Hong Kong Eating Disorder Associationhas provided support and medical treatment plans to eating disorder patients and runs community education projects to reduce eating disorder misunderstanding and stigma.

 

Mind HK, a mental health charity working on improving awareness and understanding of mental health in Hong Kong, was created three years ago when youth suicide rates peaked. But as self-help organizations without regular funding from the government, these associations can only provide limited services to patients.

 

Earlier this year, Channel News Asia, an English language news channel based in Singapore, dedicated an episodeof its award-winning documentary series Get Real on Hong Kong’s “obsession with thinness.” Tüscher, who appeared in the film, said she was thrilled when the channel contacted her. “The documentary had positive responses, and opened a dialogue in society,” she said.

 

Tüscher started to train psychologists to treat eating disorders, but she said it’s difficult to bring the right training into Asia and to draw people’s interest. “Mental disorders were always there, but people are just starting to talk about them. Unfortunately eating disorders are at the bottom of the stigma poll,” she said.

 

In 2018, Kueh moved back to Malaysia – her home country – and started working as a fitness coach. She said building up muscle “provided her a platform to eat in more diversity and bigger portions”. The young woman started performing in bikini competitions, a type of beauty pageants focused on bodybuilding, and other national beauty contests. In 2019, she was selected as a finalist for Miss World Malaysia and started working on a proposal for an eating disorder awareness campaign.“The situation is even worse in Malaysia. People just talk about losing weight, but no one ever brings it up and there are no treatment options.”

 

Rana suffered from several relapses but kept fighting. Today, she is the mother of a 6-month-old baby girl, and still actively works toward her recovery every day. “It’s still there,” she said, explaining that she still struggles with over-exercising, sleeping issues and anxiety over food. But ‘coping tools’ such as online support groups, meal planning and a regular writing practice, help her to stay accountable to her recovery. She made the decision to quit her job as a business analyst and pursue a life-coaching career. Rana also shares her experience and recovery resources through her blog Support ED Recovery Asia.

 

After fighting anorexia for five years, Ng said “recovery never ends.” “There is always something I can work on, and there is always something I’ve done that I can be proud of.” The young woman also started a blog, Body Banter, which aims to empower young people to drive positive change in the conversation about body image.

 

“My desire is to come back to Hong Kong and address the treatment gap,” said Ng. “There is nothing that speaks to me more than that.” She also hopes to expand Body Banter into a non-profit organization and do prevention work in schools. “It wasn’t a fun time in my life, but it definitely shaped me. So I might as well use it.”

 

 

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Islam and Eating Disorders founded in 2012 – run by Maha Khan, the blog creates awareness of Eating Disorders in the Muslim world, offers information and support for sufferers and their loved ones.

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