Teen Eating Disorders in Singapore: Anorexia, Bulimia and Binge Eating Disorder (BED)
A Generation Affected by Eating Disorders and the Parents Who Care.
Teenagers and young adults in Singapore are more likely to be diagnosed with an eating disorder than at any previous time. Eating disorders amongst children, tweens, teens and young adults continue to rise at an alarming rate in Singapore, both in the expat and local communities.
Prevalence of Eating Disorders in Singapore
The recent periods of restricted movement, school closures and the loss of day-to-day routines and connection have led to a significant rise in young people seeking mental health advice in Singapore.
A growing number of those seeking psychiatric support are concerned about issues relating to eating disorders and their body shape and size. Struggles with food during isolation, together with increased feelings of anxiety and depression, have created fertile ground for disordered eating and eating disorders to take hold in Singapore’s younger generation.
53% of 12-year-old girls report dissatisfaction with their body, while over 80% of 10-year-olds report a fear of being ‘fat’.
With increasing numbers of young people seeking help for eating disorders, mental health professionals are assessing children at much earlier ages than previously encountered. Concerned parents of children as young as nine are increasingly contacting Child and Adolescents Psychiatrists for advice, support and access to eating disorder treatment.
Eating Disorder Diagnosis: 8% (and rising) of Young People in Singapore Are At Risk
A Singapore-based study revealed that the number of young people seeking help for eating disorders is steadily increasing, with almost 8% of 12–26 year olds at risk.
40–70% of Middle-School Girls Dislike Two Or More Areas Of Their Body.
Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder in Singapore all have a mean age of onset of 12–13 years.
Avoidant Restrictive Food Intake Disorder (ARFID) has a slightly lower median age of onset at 11 years.
Eating Disorders Also Challenge Boys and Men in Singapore
Eating disorders have often (wrongly) been considered to be a female-only concern.
Whilst it can be seen that eating disorders are more often diagnosed in girls and women, the rise of eating disorders in boys and men in Singapore (and in the Asia region) is notable.
25% of boys in primary school report wishing to be ‘thinner’.
The quest for a specific body shape and the influence of social media and pop idols is reported as being highly influential in male body dissatisfaction.
Education and Advice for Parents and Schools
Parents reaching out for advice and support typically have a gap in their understanding and knowledge of eating disorders. Eating disorders were simply not discussed or treated as recently as 40 years ago.
As eating disorder research in the region becomes more readily available, parents, families and educators are becoming more aware of the severity and complexity of eating disorders in teenagers and young adults.
The Wave continually campaigns for greater education for psychiatrists and dieticians in the region and for eating disorders to be included in core competencies for mental health professionals. The Team at The Wave have partnered with PSIMA to increase education, research and available treatment options to families in the region.
Diet Culture in Singapore: Dying To Be Thin
Singapore reports high levels of dieting and dissatisfaction with weight and body shape. It is reported that almost 60% of people in Singapore report ‘currently being on a diet’. That’s more than 1 in 2 people dieting at any one time.
Eating disorders manifest where diets exist.That is one fact that we know to be true about the complex and sometimes fatal mental health condition.
Ditch the Diet
Restriction or dieting of different types in the home and in family settings is not unusual. Dietary rules and restrictions, together with cultural food and body messaging, can impact at-risk teenagers.
Direct instruction that certain food groups should be restricted, limited or omitted is unhelpful and can lead to children labelling food as ‘good’ or ‘bad’, ‘healthy’ or ‘unhealthy’. This can reinforce black and white, or rigid, rule-based eating. This is the underpinning of disordered eating taking hold.
Advice for young people to restrict carbs, fats or sugars is not unusual, although it is unhelpful. Instructing children, teenagers, and young adults about food intake can create a pathway to a disordered relationship with both food and body image. They should be encouraged to experiment with food and enjoy all food groups and types.
Weight bias and weight stigma are evident in every corner of society, and Singapore is no exception. It is often helpful for families to have a candid exploration of each member’s relationship with food and any body issues, looking at the weight bias or stigma that we may all carry.
Family Influence in the Treatment of Eating Disorders in Singapore
Parents often ask if they are to ‘blame’ for their child’s eating disorder. The short answer is that eating disorders are incredibly complex, and no single factor is responsible for or causes EDs in young people.
An eating disorder is a severe psychiatric condition that is made up of many parts. It is often referred to as the ‘Perfect Storm’. Genetics, environment, education, friends, family and individual character all come together and can play a part in the development of an eating disorder in those who are more vulnerable.
Families are essential in eating disorder prevention, treatment and sustained recovery.
- Avoid discussing weight, shape or size; for yourself or others. To do so, models dissatisfaction with body image to children and teenagers and can encourage diet culture.
- Mums and dads, ditch the diet. Diet culture is not only harmful to children and young people, but it is also harmful to you.
- Focus less on weight, shape and size. Focus more on humility, kindness and body positivity.
- Explain that social media images are corrected, Photoshopped and not real. Let your children and teenagers know that they are great in every way.
- Perfectionism and obsession with straight ‘As’ is not more important than health. Put your child’s mental health before grades. Every. Single. Time.
- Help your child to separate self-esteem from body image. Often the number on the scales relates to how valuable we believe that we are.
- Children and teenagers do not need scales in their bedrooms or bathrooms. (Mums and dads don’t need them either!)
Eating Disorder Treatment in Singapore
Hospital admissions and residential treatment admissions have increased by more than 40% during the past two years, a number that is set to continue to rise. The diagnoses of Anorexia Nervosa and Bulimia Nervosa in Singapore continue to show a steady rise, particularly in the 13–24 year old age group.
Mental health professionals and dieticians in Singapore report increased assessments for disordered eating in the 9–12 year old age group.
Singapore has some level of medical intervention available and admission into Eating Disorder Units with General Hospitals (Singapore General Hospital, Eating Disorder Unit +65 6321 4377. Outpatient Unit, Level 3).
In Malaysia, the regions only specialist Eating Disorder Program for teenagers and young adults is based just outside Kuala Lumpur. Combining psychiatry, education, medical interventions, dieticians and psychotherapists, The Wave Clinic provides one of the world’s leading evidence-based Eating Disorder Programs for teenagers and young adults.
The Wave is trusted by international and expat families and receives over 85% of international admissions. The benefit for young people is the provision of all aspects of treatment in one program along with medical supervision in a home-from-home environment, therefore avoiding hospital stays and the possible associated trauma.
When Teens Lose More Than Weight: A Childhood Lost to Eating Disorders
Parents often begin to notice the outward signs and symptoms of their child’s eating disorder quite late in the course of the illness. By the time the symptoms or behaviours are obvious to those at home, the eating disorder has become reasonably well established.
Children and teenagers preoccupied with weight, shape, and body size can become withdrawn, isolated, and may stop participating in activities they previously enjoyed.
As the eating disorder begins to take hold, other areas of life may suffer, including friendships and family relationships.
Many families wrongly assume that if education and studies are unaffected that the situation cannot be ‘so bad’. This can lead to a delay in reaching out for support and treatment, which can have catastrophic effects in the longer term.
Young people who are challenged by eating disorders may display obsessive and compulsive behaviours. One of the areas affected can be academic life. This may manifest as perfectionism, leading to overwork and excessive concern in relation to grades. ‘Good enough’ is seen as a failure, and anxiety to reach perfect ‘As’ can become a symptom of the illness. Perfection can infiltrate all areas of a young person’s life and become restrictive. Achievement often becomes more important than enjoyment, with anxiety and feelings of low self-worth claiming much of the young person’s daily process.
Comparisons in Eating Disorders
Comparing oneself with others is in part a developmental stage. We begin to compare ourselves with others at around age 4. We can often compare ourselves in a developmental manner to peers and siblings. In Singapore, an affluent, mobile society where comparisons are made in many areas of life, young people report increased levels of stress and pressure. Teenagers describe placing a great deal of importance on studies and exams.
As eating disorders progress, the comparisons made between the self and others return in the most unhelpful ways, whether it is education, grades, relationships, clothes, body shape, weight or food on the plate.
Comparisons in eating disorders are the killjoy in the room: fuelling self-doubt and self-loathing, causing decreased confidence and extreme social anxiety. Comparisons can become incredibly powerful in young people with a degree of clinical perfectionism and severely affect their ability to function at home, work or school. Clinical perfectionism can follow, often with rigid – and ultimately unhelpful – rules for life.
The Importance of Early Intervention
Early intervention is essential. All research indicates that the sooner treatment begins, the more likelihood of sustained and long-term recovery.
FREED, the early intervention in eating disorders model, developed by King’s College in London, is designed to help young people to access treatment within two weeks of them reaching out for assistance.
Mental Health in Singapore
In 2019, over 12,600 young people in Singapore contacted mental health services for advice, support and intervention.
Mental health services and specialist practitioners in Singapore continually seek to improve the treatment options available for young people. Seeking support for mental health concerns for young people in Asia is becoming more commonplace, with superb government initiatives and remote services becoming readily available in both the private and public sector.
Eating disorders are often diagnosed alongside other mental health conditions, and it is not unusual for young people to have one or more co-occurring diagnoses.
Eating disorders have a high rate of fatality in their later stages. The complications and early death rate from eating disorders are greater than any other psychiatric diagnosis. This can be further complicated by an increased risk of self-harm (cutting, burning, hair pulling, skin picking and other self-injurious behaviours) and thoughts of suicide. Many young people diagnosed with an eating disorder describe episodes of extremely low mood, irritability, anxiety, obsessive and compulsive behaviours and clinical perfectionism – leading to low self-value and depression.
Adolescent suicide in Singapore continues to be the leading cause of death in the 10–29 age group. 71 young people completed suicide in Singapore in 2019, with numbers rising year on year.
Eating Disorder Treatment is Much More Than Weight Restoration
Parents may have noticed changes in the body shape and weight of their children and teenagers. Any significant changes should be discussed with their family doctor (as long as they have experience treating eating disorders) or with an Eating Disorder Specialist or ED Registered Dietician.
An eating disorder cannot be diagnosed from a single indicator; it can certainly open discussions and warrant further investigation. An Eating Disorder Specialist and trained psychotherapist can be a great support throughout.
For those who have reached low and dangerously low body weights, there is a medical urgency to carefully beginning weight restoration. During this time, a Registered Dietician will join the medical team who will oversee the delicate balance of physical and nutritional needs.
Food is indeed medicine in Eating Disorder Treatment. Many young people will have extensive rules, rituals and restrictions that have become ingrained in their eating patterns. When teenagers and young people are receiving treatment for their eating disorders, and other co-occurring conditions, they will be gently challenged on the behaviours that have developed as part of the eating disorder.
Full Recovery From an Eating Disorder is Possible
Hope is the mainstay of great treatment for eating disorders. At The Wave, we know that full recovery is possible. It is most certainly not easy, and it can take a long time.
We are really careful to remember that recovery is never a race.
Further Reading and Contacts
Estimated prevalence of eating disorders in Singapore. Sook Ning Chua, PhD. (2020). Willet International Journal of Eating Disorders.
Singapore General Hospital – Singhealth
Eating Disorders in Children and Adolescents in Singapore – Adolescent Medicine Service KKH.
The Wave Clinic – +60 327 271 799 (General enquiries)
Identification and management of eating disorders in children and adolescents; David S Rosen. (2010). Pediatrics.
Eating Disorders in Asia. A Silent Killer in 2021. Yassin; F. 2021.
Fiona Yassin is the International Clinical Director at The Wave Clinic in Kuala Lumpur, working with teenagers, young adults and their families. Fiona is a UK registered Psychotherapist and Supervisor of Clinicians. EMDR trained and a member of EMDRIA, Fiona recognises the role of complex trauma in eating disorders and is currently developing Trauma-Focused Eating Disorder Services in Asia and the Middle East. Fiona is an International Chapter member of IAEDP, CBT-E, and RO-DBT trained. Fiona is also a Fellow of APPCH, and she loves her cats 🙂