Body Image and Eating Disorders in Children and Teenagers
From East to West, children and teenagers constantly gather information from people, things and events in their environment. They use this information to make judgments and form opinions about themselves, others and the world around them.
Can exposure to unrealistic expectations and perfectionism affect the self-confidence of our children and teenagers, leading to them taking extreme measures to ‘fit in’ with their idols?
In an age where global information is at their fingertips, we explore the impact of childhood role models on later body image related behaviours.
K-pop and Eating Disorders
K-pop is a popular genre of music originating from South Korea that has been hugely influential in the whole ‘diet scene’ because young people want to look like their favourite K-pop stars. Many of these stars are known for their extreme diets.
For several years, media outlets have reported that many young artists have left behind the K-pop world in order to focus on eating disorder treatment.
JinE, of the popular eight-member girl band ‘Oh My Girl’, has bravely discussed her year-long treatment for an eating disorder.
Mental health and physical health can be adversely affected by the often unrealistic expectations related to perceived beauty and body shape and size within the K-pop halls of fame.
Teens in South Korea and Eating Disorders
The extreme diet and beauty ideals that have some cultural underpinnings are without a doubt harmful to both the K-pop stars and also to the tween and teen girls who eagerly follow them. Restricting, extreme dieting, cosmetic surgery and an obsession with ‘the perfect look’ have become synonymous with the South Korean music industry.
The obsession with weight gain, compulsive use of weight measurements and BMI scales is driving adolescents in South Korea to extreme diets and compensatory behaviours. Young people following the ‘Pro-Ana’ movement, growing in popularity in the region, often subscribe to social media accounts that promote and encourage dangerous and life-threatening methods to control weight and reduce body size and shape.
Culture and Eating Disorders in Asia
There are many cultural messages that reinforce or support the trend towards disordered eating in Asia. For many families, food and eating together is an important event. This can be a wonderful experience of togetherness or a breeding ground for the beginnings of disordered eating.
In a culture where it can be considered rude or impolite for children to leave anything on their plates, young people learn to consume food to escape the family’s wrath only to purge (vomit) as soon as they can leave the table. Commonplace in Japan, this childhood gamble significantly increases the risk of bulimia in adolescence.
In a region where being ‘thin’ is considered not only attractive but essential, young people can feel inferior, unwelcome and hopeless in a larger-sized body. Family, friends and even strangers routinely comment on body shape and size, often exclaiming what could be seen as weight shaming comments, which can evoke intense emotions.
Eating Disorders Are a Global Problem
Once considered only to affect the affluent European and American female population, we now understand that eating disorders are an emerging global issue. As the diagnosis of eating disorders rapidly increases in Asia, researchers worldwide have attempted to understand the growing numbers of young people who meet the criteria for diagnosis.
Barbie and Eating Disorders
Scientists have researched the impact of playing with dolls in a smaller body size for several decades. There is considerable evidence that children as young as five years old express dissatisfaction with their own bodies, having been exposed to play dates with the perceived plastic perfection that has become the ‘Barbie Girl’.
Research has shown that children report feeling inadequate and ashamed of the body they live in, having glimpsed into the world of the popular children’s doll.
The average young girl in the US owns 10 Barbie dolls by her eleventh birthday.
What is an Eating Disorder?
The Alliance for Eating Disorders reports that somewhere in the region of 70 million people are currently suffering from an eating disorder.
Eating disorders are complex behavioural conditions characterised by severe and enduring disturbance in food and eating behaviours AND accompanied by distressing thoughts and feelings. They are a severe mental health condition that affects physical, emotional, biological and social functioning.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 publication of the American Psychiatric Association (APA) classification and assessment tool. It lists the following diagnostic criteria for eating disorders:
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
- Other Specified Feeding and Eating Disorder (OSFED)
- Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Unspecified Feeding or Eating Disorder (UFED).
Eating disorders often coexist with other psychological problems or psychiatric diagnoses. Mood disorders, depression, anxiety disorders, obsessive and compulsive disorder, alcohol and drug problems, borderline personality disorder, C-PTSD, and other developmental traumas are often seen in young people presenting with the signs and symptoms of an eating disorder.
90% of eating disorders begin before the age of 20.
How Common Are Eating Disorders in Asia?
Approximately 10% of young people in Asia are believed to have an eating disorder. This number is rising in both boys and girls.
The number of people diagnosed with eating disorders in Asia has risen sharply since the mid-late 1990s. In Asia, young people between the ages of 15–34 years are most likely to be diagnosed with an eating disorder.
There has been a significant increase in young people seeking help for eating disorders and body image concerns in the past ten years. Current research in the field of eating disorders in Asia is very limited. This is in part due to the lack of specialist provision in the region.
In Japan, South Korea, Singapore and Malaysia, the rates of newly diagnosed eating disorders are thought to be higher than anywhere else in the world.
I Want to Look Like Barbie
‘Mum, I want plastic surgery.’
Tween and teen body image issues are ranked amongst the top three concerns of girls aged 9–12 years. In a recent interview, a 10-year-old girl thoughtfully expressed that ‘not being thin enough or attractive enough to boys’ was one of the biggest concerns for her peer group. As eating disorders and body image concerns are diagnosed in increasingly younger children, we must consider the cultural environment that supports cosmetic and aesthetic surgery as a means to achieve perfection.
As more children are requesting cosmetic surgery, the trend in South Korea of middle-years children using school breaks to undergo procedures is becoming the norm. Alarmingly, this includes children as young as nine.
South Korea is the worlds’ cosmetic surgery capital. With numbers of procedures now greater per capita than the USA or the UK, young people are continually exposed to adults expressing dissatisfaction with their bodies.
What Can Parents Do to Help?
Unless a person loses a lot of weight in a short period, eating disorders cannot be seen from the outside. It is not possible to see an eating disorder or to tell the severity from the bathroom scales. All eating disorders or emerging disordered eating are serious.
Parents can help by acknowledging the problem and seeking help from an eating disorder specialist. We understand that early intervention has a significantly higher rate of success. In many cases, early intervention can prevent hospitalisation.
Many young people with eating disorders will believe that they are not unwell enough to receive expert eating disorder care. They may think that their weight is not low enough or their organs not damaged enough. This is simply not correct.
‘Just eat’. Whilst food is medicine, and all food is good food, eating disorder recovery is about so much more than ‘just eating’. The great news is that full recovery from eating disorders is possible with the right help and support.
The Wave Programs for Eating Disorders are the only dedicated eating disorder programs in Asia. Psychiatrists, psychotherapists and dieticians work together with experts by experience and mindful movement practitioners to look at all aspects of the eating disorder and a return to living life to the full.
Families can also help by promoting conversation around the dinner table that steers clear of weight, food, calories and any other diet-related talk. Our young people are watching our relationship with our bodies and the food that we choose very carefully. If you are a parent who struggles with food, body image or compensatory behaviours, find a specialist to talk to. It could make all the difference.
Health at Every Size (HAES)
As parents, carers, educators and mental health professionals, we can make changes that promote nurturing acceptance in our young people. This is directly at odds with the punitive and body-punishing messaging that can be experienced.
Our bodies are not all the same. Just as your shoe size and foot shape are slightly different from those around you, so is every other part of your body. To attempt to shoehorn your foot into a much smaller shoe would be rather painful. It is precisely the same principle with our bodies.
Each person’s genetic make-up is unique. That influences our bone structure, our shape and our weight. We can work together to appreciate those differences. We can nurture and love our bodies whilst mindful of the exceptional jobs that they do.
‘Ideal weight’ is not a number on a scale. It is not a colour on a BMI grid. It can take place across a number of weights, shapes, looks and sizes. Well-being and a body that is loved and appreciated is empowering.
Finding connection and fulfilling your emotional, physical and psychological needs helps place food in a neutral space. Accepting food as nourishment and pleasure will support your body in finding a content space whilst honouring hunger, fullness and appetite.
Where The West Meets The East
There may be many differences in cultures, languages and religions; however, young people in all corners of the world are at a greater risk than at any other time of developing an eating disorder. Eating disorders are no longer seen to be the curse of the affluent or the middle classes. They are not related to race, skin colour or religion. Eating disorders affect people from all walks of life. They steal life in equal measure on any continent.
There are remarkable similarities in how children and young people develop through play and exploration of the world around them, wherever they live. It is our place as parents, carers and educators to provide safe opportunities for them to be happy in their bodies and enjoy the experiences that the world has to offer without experiencing weight or shape bias.
Eating disorder diagnosis in Asia is relatively new; it is rising sharply, and it deserves our attention. The Wave is committed to helping to change the way eating disorders are viewed in society and within the mental health profession. We are collaborating with leading psychological associations in Malaysia to develop education and services to benefit all.
Fiona Yassin is the International Clinical Director at The Wave Clinic in Kuala Lumpur, working with teens, 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 🙂