In recent decades, eating disorders have become increasingly common in Asia. With more and more young people affected by the conditions, promoting local research into treatment approaches and increasing accessibility of professional support have become crucial to safeguarding the health and well-being of teenagers and adolescents.
What Are Eating Disorders?
Eating disorders are difficult relationships with food that go on for some time and significantly affect your life.
It’s normal to find eating hard from time to time, in certain circumstances, or when you’re feeling a particular way. However, when these issues begin to affect your day-to-day life, they may become a problem.
There are lots of different types of eating problems, or disordered eating behaviours. For example, you may:
- Focus on controlling how much you eat
- Feel the need to get rid of food from your body
- Be preoccupied with weight or shape
- Be scared that you may gain weight
- Feel guilty for enjoying food
- Use food as a coping mechanism for emotional distress
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists four main types of eating disorders. If your doctor thinks that your eating problem falls into one of these categories, they may diagnose you with an eating disorder. Remember, though, that eating disorder diagnoses can be very specific and even if you do not receive a diagnosis, you still deserve care and support.
Your doctor may give you a diagnosis of:
- Anorexia nervosa – when eating problems are accompanied by a very low body weight
- Bulimia nervosa – characterised by binge eating followed by “purges”
- Binge eating disorder – where you sometimes cannot stop yourself from eating
- Other specified/unspecified feeding or eating disorder – where an eating problem significantly affects your daily life but does not fit well into one of the other categories
How Common Are Eating Disorders in Asian Countries?
In recent years, studies from Singapore, China, and Iran have found that eating disorders are at least as common in Asian countries as in Western Europe. Asian nations also show similar patterns of both eating attitudes and body dissatisfaction.
In 1998, a study in South Korea found that 8.5% of adult men and women displayed abnormal eating pathology. A 2021 study of women in mainland China found that 7% met the screening criteria for an eating disorder. The same year, a separate study in Iran found that 12% of adolescent boys and 13% of adolescent girls were likely to have eating disorders. A further study in Singapore found that 6% of people met the diagnostic criteria for a clinical eating disorder, while an alarming 37% met the criteria for another feeding or eating disorder.
Despite the prevalence of eating disorders, only a minority of young people receive the treatment they require. Moreover, many eating disorder treatments, largely developed in Europe and North America, do not fit perfectly into local healthcare narratives and norms. Scientists in each of the aforementioned countries are pushing for increased accessibility to treatment and the proliferation of research and development in local contexts so that young people living in an Asian country can access effective support.
Why Are Eating Disorders Becoming More Prevalent in Asia?
Asia is a huge geographical region spanning a diverse variety of cultures, traditions, and societies. Given these complexities, it’s important to recognise the limits of any generalised statements about trends in the region.
A 2015 paper in the Journal of Eating Disorders describes how eating disorders have spread across Asian nations following processes of economic transformation: industrialisation, urbanisation, and economic growth. Some evidence suggests that ‘westernisation’ may play a role, with social ideals of a thin body image becoming increasingly common in Asian countries. These norms may come hand and hand with the proliferation of Western media, fashion, and advertising that promote appearance as a crucial factor in determining a woman’s success.
At the same time, the presence of eating disorders in some Asian countries before they became deeply affected by Western norms suggests that the picture may not be so simple. In Hong Kong, for example, researchers documented instances of eating disorders without any type of fat-phobia and in the absence of societal norms that over-evaluate shape and weight. While these societal norms may play a large role in the development and prevalence of eating disorders, they do not fully explain them.
Exploring Atypical Anorexia Nervosa
Cases of anorexia nervosa that do not meet the typical criteria are known as atypical anorexia nervosa. Nonfat-phobic anorexia nervosa is an atypical form of anorexia because it does not involve the over-evaluation of shape and weight that typically characterised eating disorders.
A 2014 study exploring typical and atypical anorexia in a Japanese sample found that fatphobic and non-fatphobic anorexia had significant differences in their physical and psychological pathology. They found notable divergences in scores on the Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI) as well as differences in BMI and duration of illness. The variation and multiplicity of forms of anorexia nervosa, some specific to certain places and societies, underlines the importance of further research.
What Are the Risk Factors for Eating Disorders in Asian Countries?
In response to the rise of eating disorders in Asian nations, several research papers have explored the potential risk factors among young people and adults that may make them more vulnerable to developing eating disorders.
A 2021 study investigated correlations between emotional factors, personality traits, and addiction-like eating among college women and men in South Korea, China, Singapore, Hong Kong, Japan, and Taiwan. They found that addiction-like eating correlated with negative mood, as studies in Europe and the US have also shown.
Other research has found that a desire to lose weight can drive disordered eating, while many young people with eating disorders struggle with low self-esteem, feeling like a failure, and mental health issues like depression.
As in Western countries, early interventions, such as school-based interventions, may reduce the risk of eating disorders developing. Boys may benefit from low-intensity interventions while girls may respond better to higher-intensity programs.
Treatment For Eating Disorders in Asia
In general, evidence-based eating disorder treatments that have developed in Western settings are also effective in Asian nations.
Some evidence-based treatment options include:
- cognitive-behavioural therapy
- family-based treatment
- dialectical-behavioural therapy
- support groups
Cognitive-behavioural therapy (CBT) is the most established treatment for eating disorders. CBT is a type of talk therapy that focuses on the interactions between our thoughts and behaviours, identifying negative thought and behavioural patterns and making meaningful and lasting adaptations that promote positive change.
The CBT approach to eating disorders works on the premise that most types of eating disorders have a shared psychological basis of over-evaluation of shape and weight. This psychology drives the different unhealthy eating behaviours across the various types of disorders. During CBT sessions, young people learn skills and strategies to help them develop healthier eating patterns while addressing underlying issues that affect their psychology such as perfectionism and low self-esteem.
While treatment approaches such as CBT are largely effective in Asian nations, medical professionals have found that certain societal differences can make aspects of treatment less relevant or accessible. Experts hope that as research on eating disorder treatment in Asia increases, new forms of treatments will emerge that better suit their setting.
A Transformative Recovery Experience at the Wave Clinic
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If your child is struggling with an eating disorder or another mental health condition, we’re here to help. Contact us today to explore our creative paths to recovery.