Eating disorders in Hong Kong
By Michelle Kwan | Intern, Mind HK and Medical Student, HKU
This week is Eating Disorders Awareness Week. Do you think you know enough about eating disorders? I’d like to explore why eating disorders are not commonly discussed in the community.
What are eating disorders?
According to the American Psychiatric Association, eating disorders are illnesses in which people experience severe disturbances in eating behaviours, related thoughts and emotions (1). Common eating disorders include anorexia nervosa, bulimia nervosa and binge eating disorder.
How common are eating disorders?
The prevalence of eating disorders in Asia is approximately 3.5% (2). The prevalence of both anorexia nervosa and bulimia nervosa is higher in females than males, with males accounting for 10% — 36% of all cases. Early onset during adolescence is common, with female adolescents being of particular concern (3). In Hong Kong, around 1 in 200 female students suffer from anorexia nervosa, with a higher prevalence in specific sub-groups, such as dancers or models. Among these female students, bulimia nervosa is 5–10 times more common than anorexia nervosa and accounts for 2–3% of young women (4).
For Hong Kong, the situation is concerning. A study demonstrated that of the 857 adolescent female students who reported wanting to lose weight, only 4.8% are overweight, indicating social pressures, mental health problems, the environment and culture may be playing a role in eating problems and eating disorders (5). In a study that investigated the profile of eating disorders from 1987 to 2007, people who suffered from eating disorders were predominantly single, female and in their 20s. The cohort included a total of 195 patients, with 59% suffering from anorexia nervosa and 40% suffering from bulimia nervosa (6). This trend is similar to global statistics.
Eating disorders are often underdiagnosed, especially in men. There are several reasons that contribute to such a trend, including, sexual abuse or other traumatic events, weight history, sexual orientation and stigmatisation (7). Eating disorders need to be more openly discussed, to avoid them being neglected.
Youth and eating disorders
Eating disorders are commonly diagnosed during adolescence, with the average age of onset being 12–13 years old. According to a study conducted in 2007, 3.9% of adolescent boys and 6.5% of adolescent girls presented with disordered eating (8). Moreover, there has recently been an increasing number of diagnoses in young people (9). There are several reasons that contribute to this:
- Social media and culture
Social media often depicts slim, underweight women as the ideal of beauty, impacting our perception of what is the “norm” and what is desirable (10). Many celebrities and KOLs promote different weight loss products and slimness is often associated with health. The excessive focus on physical appearance shapes people’s thoughts in seeking the “perfect body shape”.
2. Family relationships
Family relationships play an important role in the development of eating disorders (10). Disruption of families due to divorce, separation, abuse; lack of social support; unemployment etc. are some risk factors for eating disorders. Family weight comments on children or adolescents often shape eating disorders and have been associated with impaired mental conditions.
3. Peer influence
Peers play a critical role in an adolescent’s life. Peers influence the development of individual personality, physical appearance and behavioural trends. Teenagers will try to resemble their friends’ interests, attitudes and behaviours, in order to fit in. Healthy friendships and a feeling of acceptance are important protective factors of developing eating disorders (10). The fear of not being accepted also prevents many people from speaking out about their eating disorders.
Are eating disorders linked to other mental health problems?
A recent study conducted in the United States indicates that anorexia nervosa, bulimia nervosa and binge eating disorder are associated with lifetime mood disorders, anxiety disorders, alcohol and drug use disorders and personality disorders, with major depressive disorder being the most prevalent (11). Although the association is not well-established, some older studies have suggested that these mental health problems may share many of the risk factors with eating disorders (12). Also, in the context of anxiety, it may be secondary to eating disorders or it may be the risk factor of developing eating disorders, as many people presented with anxiety a few years before the onset of an eating disorder (13).
Why don’t we hear a lot about eating disorders?
“There are several reasons why eating disorders may not be spoken about in Hong Kong as often as they should be. Firstly, the general stigma that persists around mental health difficulties means that people may feel ashamed and be reluctant to talk about their own experiences with eating disorders. Aside from the general stigma surrounding mental health difficulties, is the common misconception that eating disorders are a personal choice rather than a diagnosable disorder. As a society, we also tend to celebrate thinness, as reflected in the media and social media, and put a lot of pressure on people to look a certain way, which can then normalize preoccupation with body image.”
— Odile Thiang, Anti-Stigma Project Manager, Mind HK
Eating disorders affect many in Hong Kong, young and old, and men and women.
This article is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
For more information on Eating disorders: https://www.mind.org.hk/mental-health-a-to-z/eating-disorders/about-eating-problems/
Youth resources: Eating and body image disorders for young people: https://www.coolmindshk.com/en/resource/eating-body-image-disorders-young-people/
Eating disorders awareness week: https://www.beateatingdisorders.org.uk/edaw
Managing eating disorders during the COVID-19 pandemic: https://www.mind.org.hk/mental-health-a-to-z/covid-19/managing-eating-disorders-during-covid-19/
Hong Kong Eating Disorders Association Limited: http://www.heda-hk.org/
For a list of emergency contacts, please visit: www.mind.org.hk/find-help-now/
For other local mental health services, please visit our Community Directory: www.mind.org.hk/community-directory/
For more information on mental health in Hong Kong, please visit: https://www.mind.org.hk/mental-health-in-hong-kong/
For more information on seeking help in Hong Kong, please visit: https://www.mind.org.hk/getting-help/
Questions? Email the team at media@mind.org.hk
