The last week of February is celebrated globally as the Eating Disorder (ED) Awareness Week. It aims to prevent eating disorders and disordered eating while reducing the stigma associated with this disorder. The misconceptions of ED and social stigma continue to perpetuate the disorder and impede help seeking behaviours. It is crucial to recognise how societal influences, our attitudes (weight stigma), and behaviours shape this disorder and the effort to reduce its rising trend.
Common Misconceptions about Eating Disorders
Firstly, ED is not a female disorder. In the first local study that estimated the prevalence of ED in Singapore, the ratio of males to females who screened positive for an ED was nearly 1:1 (Chua et al., 2021). Another common misconception of ED is that it comes with low weight. In fact, ED has a wide spectrum and only one subtype of ED (i.e. Anorexia Nervosa, AN) is associated with underweight features. Many suffer with an ED in various forms and complexity, like bulimia nervosa (BN), binge-eating disorder (BED), and other specified feeding or eating disorder (OSFED). In the local study by Chua et al. (2021) that screened a total of 797 Singaporean adults, 37% fell under the OSFED, only 6.2% met the full criteria for AN, BN, and BED, and 19.5% are at a high risk of developing an ED. Sadly, only 1.6% of those who screened positive for an ED reported currently being in treatment. Many people who require treatment may not always fit into a clear diagnosis of ED and they suffer in silence.
Eating Disorders – the collateral damage in our fight against obesity
This is a shame that can be prevented. In our fight against obesity, there are various national and school-based programmes that include regular weight screening in schools, promotional campaigns emphasising the dangers of excess weight, and displaying calorie counts in menus. These measures can inadvertently contribute to overconcern with weight and shape, unhealthy diet culture, excessive worry about fats in foods, preoccupation with calories, and weight stigma (Lee & Hoodbhoy, 2013). For example, binge eating that comes with a higher body weight is very often associated with shame as one deems to have no self-control. Our health care professionals are trained to pick up higher weights as a health risk but overlook the danger of ED in patients with normal or lower weight. As a result, there is a negative connotation associated with heavier weight. Our society is obsessed with diet and fitness culture, in the name of health, yet we do not address the harmful effect of ED on one’s mental health. When thinness is highly valued, it blinds us from the detrimental and sometimes life threatening impacts of ED. It is important to note that ED shares many common risk factors with obesity such as body dissatisfaction, dieting, media influence, and weight related teasing (Lee & Hoodbhoy, 2013). Expanding obesity prevention programmes to include the awareness and prevention of eating disorders, is a pivotal step to work towards the approach of health at every size and to promote overall health and safety.
Eating Disorders are more deadly than we think
ED has the highest mortality rate of any psychiatric illness (Arcelus, 2011). It is very complex, difficult to treat, and present with various comorbidities. However, what makes it harder is that many suffer in silence and do not think they deserve treatment unless they have an extremely low body weight which is often life threatening and warrant hospitalisation. The awareness of ED needs to be strengthened to reduce the costs and emotional burden on our healthcare system, our families, and individuals. ED comes in any weight, shape or size. The truth is, without a low body weight, any form of ED can threaten one’s physical health. For example, purging can also be life threatening as the imbalances in electrolytes, such as potassium and sodium, can result in fainting, fever, digestive problems, confusion, blood pressure changes, heart palpitations, seizures, cardiac arrest and even death (Centre for Clinical Interventions, 2022).
Eating disorders are not illnesses with low weight. They are disorders with distortions in cognition, excessive weight and shape concerns, mood issues, and harmful self-damaging behaviours. Eating Disorders are not lifestyle choices. While we continue to fight against ED, we must come together as a society to reflect and be mindful of our own attitudes, to educate ourselves more about ED, to be trained in this area (if you are a clinician), and to extend our support to those who are suffering in silence. Everyone deserves a chance to get well.
Annelise Lai is a Clinical Psychologist at The Other Clinic, working with teens and adults. She works with general psychiatric conditions and has a specialisation in Eating Disorders.
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731. doi:10.1001/archgenpsychiatry.2011.74
Centre for Clinical Interventions. (2022, July). Eating disorders. Vomiting and your health. Government of Western Australia. https://www.cci.health.wa.gov.au/Resources/For-Clinicians/Eating-Disorders
Chua, S. N., Fitzsimmons‐Craft, E. E., Austin, S. B., Wilfley, D. E., & Taylor, C. B. (2021). Estimated prevalence of eating disorders in Singapore. International Journal of Eating Disorders, 54(1), 7-18. https://doi.org/10.1002/eat.23440
Fairburn, C. G. (2008). Eating disorders: The transdiagnostic view and the cognitive behavioral theory. https://psycnet.apa.org/record/2008-07785-002
Lee, H. Y., & Hoodbhoy, Z. (2013). You are worth more than what you weigh: preventing eating disorders. Annals Academy Medicine Singapore, 42(2), 64. https://www.researchgate.net/profile/Dr-Hoodbhoy/publication/236067756_You_Are_Worth_More_Than_What_You_Weigh_Preventing_Eating_Disorders/links/5889aee9a6fdcc9a35c2ee00/You-Are-Worth-More-Than-What-You-Weigh-Preventing-Eating-Disorders.pdf
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