At social events she ate tiny portions and became thinner day by day.
According to the Mayo Clinic in the USA, people with this disease have an abnormally low body weight, a great fear of gaining weight or becoming fat, and a distorted perception of weight. They place great importance on controlling their weight and figure and go to extreme lengths to do so, which significantly affects their lives.
Social media such as Instagram and TikTok have increasingly contributed to this problem. According to a 2019 survey published by the UK’s Mental Health Foundation, four in 10 British teenagers said that images on social media had made them worry about their body image. Similar results have been found in other developed countries.
Worldwide, about one in twenty adolescents suffers from anorexia nervosa, bulimia nervosa or binge eating, says Dr. Paul Kong, a Hong Kong clinical psychologist with over 20 years of experience.
Hong Kong content creator Minnie Wong was 15 when her school counselor referred her to a psychiatrist.
“I was always obsessed with food and diets in a negative way because I grew up chubby,” says the now 28-year-old, adding that she fluctuated between regular diets and crash diets and had phases in which she would binge eat.
Unresolved mental health issues and an unhealthy lifestyle had eroded her self-esteem and set in motion eating patterns that caused constant fluctuations. Her binge eating worsened and she developed an autoimmune disease and hormonal imbalance.
Unlike bulimia patients, who force themselves to regurgitate their food and exercise compulsively, binge eaters do not tend to take inappropriate measures to compensate for excessive food intake.
Wong believes that societal pressure to achieve the ideal figure, along with Hong Kong’s diet culture, contributed to her binge eating and body dysmorphia – a disorder in which one spends a lot of time comparing one’s appearance to that of others and goes to considerable lengths to hide perceived flaws.
Clinical psychologist Dr. Gabrielle Tüscher, an eating disorder specialist and nutritionist from Hong Kong, explains that eating disorders have nothing to do with a person’s appearance. Outward appearance is a reflection of the disorder, which is more complex than the result of mere lifestyle choices.
Some people may be born with a gene that makes them more susceptible to the disease, she says. Other mental health problems resulting from sexual abuse or post-traumatic stress disorder (PTSD) may also lead to an increase in the disease, especially among adolescents.
Although men also develop eating disorders, they are taken less seriously, says Tüscher. “When they try to talk about it, they are rejected in nine out of ten cases.”
She gives the example of a male client who was told by a psychiatrist that “boys don’t have eating disorders.”
Many people with eating disorders are stigmatized and may feel weak and ashamed.
“There is a perception that people who suffer from eating disorders simply do not have the willpower to stick to a diet and that this is because they are weak,” says Wong.
“I was afraid of being judged for it, and the fear was overwhelming,” she says.
“Physically, I was exhausted and my period didn’t come,” she adds. “Emotionally, I felt a lot of guilt.”
Fortunately, her family and friends were there to provide her with emotional support when she was at her lowest ebb trying to hide her illness and pain.
“It took me a few years to realise how serious the illness was. I really regret not seeking professional help, but luckily my friends noticed my problems,” she says.
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Why we need to talk about eating disorders and body image in Hong Kong
Why we need to talk about eating disorders and body image in Hong Kong
Eating disorders have existed for generations, but there are no special treatment programs in Hong Kong, says Tüscher. Parents struggle with the decision to hospitalize their children because they fear they will fall behind in school.
Hospitals in Hong Kong specialize in anorexia, Tüscher adds, which leads to a general lack of awareness of other forms of eating disorders such as bulimia and binge eating.
The government places more emphasis on preventing obesity and “labeling dietary supplements on food” than on treating patients with binge eating, she says.
For those in need, the general practitioner should be the first point of contact, says Tüscher.
It is becoming increasingly common for eating disorders to co-occur with other mental health problems such as depression, anxiety and ADHD, so treatment should be individualised and the patient should be referred to different psychiatrists for different problems, she adds.
Eating disorders can be caused by deep-rooted psychological issues, says Kong, so patients should undergo comprehensive psychological treatment to not only achieve a healthy body weight, but also feel strong and confident overall.
A cured patient can control his or her expectations regarding food well and eat a balanced diet.
A patient should not assume that recovery is a linear process, Kong adds. There will be fluctuations, but when relapses occur, you can motivate the patient to address them in a healthy way.
For Wong and Chung, healing was not easy.
“It took me years to get to where I am today,” says Wong, who now has a better handle on her relationship with food, although there are days when she falls back into her old eating habits.
“I am more mindful and learning to give myself support and space to get through these days.”
As a content creator, Wong regularly shares fashion inspiration, self-affirming messages, and travel stories with her more than 40,000 YouTube subscribers and 80,000 Instagram followers.
She now views food as nourishment and love rather than a source of guilt, and she wants to share this attitude with her followers, who are also mostly young adults.
“(I’m just sharing) my own life and my story. I want to become someone that the younger Wong needed inspiration from. I also can’t forget my super-amazing followers and the little community I’ve built online that I’m grateful for,” she says.
Motivated by her experiences with anorexia, Chung is now a registered dietitian and provides nutritional advice to her audience.
Don’t be afraid to ask for help. We should all learn to value ourselves as people beyond our appearance.
She approaches food with an intuitive mindset – she doesn’t think too much about calories, but understands what constitutes a balanced diet. At social events, she now eats her favorite dishes without self-consciousness.
Today, Chung’s Instagram posts are filled with gourmet food spreads and pictures of her unabashedly indulging in them, paired with candid captions that shed light on her rocky road to body acceptance.
She and Kong recommend the Hong Kong Eating Disorders Association as a professional resource. It provides supportive services for people with eating disorders and their caregivers to promote a spirit of “helping people help themselves.” It also helps them find appropriate treatment.
“Don’t be afraid to ask for help,” says Chung, adding, “We should all learn to value ourselves as people beyond our appearance.”
