Six-fold increase in eating disorders among teenagers since 2002
By Janice Ng and Julia Ng, Channel NewsAsia | Posted: 20 February 2007 2019 hrs

Photos 1 of 2
SINGAPORE: The number of teenagers with eating disorder has increased six-fold since 2002.

The Singapore General Hospital said 140 new cases are reported every year.

But only 10 to 20 percent of them are seeking treatment.

A study of some 1,000 girls across Asia, aged between 15 and 17, shows teenage girls suffer from a severe lack of confidence.

In Singapore, more than eight in ten want to change the way they look, while six in ten feel bad about themselves because of looks or weight.

Read more here
http://www.channelnewsasia.com/stories/singaporelocalnews/view/259641/1/.html

An article in the newspapers about anorexia and bullimia dated 28th March 2007 (1 month plus ago)

Eating disorder? Genes to blame too

By Judith Tan - Mar 28, 2007
The Straits Times

The common perception of anorexia and bulimia sufferers is that they have brought the problem upon themselves by trying to get a fashionably slender figure.

But the causes of eating disorders among young girls and women are far more complex.

Researchers have found that genes seem to play an important role in determining who is vulnerable. It is much like the link between smoking and lung cancer, said Dr Blake Woodside, a psychiatrist at the University of Toronto.

'Not all smokers develop lung cancer. There is a genetic risk factor for smoking-linked cancer. Similarly, not all women exposed to the ideal of being fashionably thin develop eating disorders,' he said.

True, society's obsession with attaining what it perceives to be an ideal body is a contributing factor, which is why 'we get overly concerned with our weight and diet'.

'Yet less than 0.5 per cent of all women develop anorexia nervosa. This points to the fact that that societal pressure is not the lone cause,' he said.

To read the full article, refer to the below link
http://health.asiaone.com.sg/womensmatter/20070328_005.html

Got this from a search. its a news article dated 2 months ago

Prime News
1 in 4 teens and young adults could face mental problems
Salma Khalik, Health Correspondent
546 words
12 March 2007
Straits Times
English
(c) 2007 Singapore Press Holdings Limited

Experts to help IMH identify symptoms early, start treatment

A MAJOR effort is under way to identify the symptoms of mental problems and start treatment early.

This comes in the face of findings which show that one in four teens and young adults here and in other developed countries could have psychological problems.

The Institute of Mental Health (IMH) has invited nine experts, both foreign and local, to help it develop a study to see how this can be done.

The hope is that this will help prevent the onset of serious diseases such as schizophrenia

One expert on the IMH panel, Associate Professor Alison Yung of Melbourne University, said: 'If we can pick them up early, we may not even need medicine to help them.'

The concern stems from studies conducted internationally - covering several developed countries, including Singapore - which have shown that 25 per cent of those in their teens and early 20s suffer from mental problems such as anxiety, depression, anorexia, psychosis and personality disorder.

For most, the problems are transient. But 10 per cent are at risk of serious long-term psychosis - or mental problems such as schizophrenia, hallucinations and delusions.

This means that going by Singapore's population growth rate, 1,000 babies born here each year could end up with serious psychological problems.

In 20 years, some of them may join the 5,300 patients warded at the IMH last year for psychosis - adding to the strain on available funds.

Already, about a third of the $40 million from Medifund, the government kitty to help the poor pay health-care bills, goes to IMH patients each year.

Grasping the extent of the problem, Associate Professor Chong Siow Ann, who heads the IMH's Early Psychosis Intervention Programme, invited the nine experts to help.

A panel member, Associate Professor Richard Keefe of Duke University in the United States, said that most serious mental illnesses hit people in their teens or early 20s - when the brain's frontal lobe is developing.

He explained: 'This is the area that helps you plan, organise, strategise - all the high-level processing. It is important in controlling behaviour and emotion - which adolescents struggle with.'

His explanation is borne out by the age range of the IMH's psychotic patients, many of whom were warded between the ages of 22 and 26.

Half of the IMH's 32,000 outpatients are also being treated for chronic schizophrenia.

Schizophrenia, one of the more serious forms of psychosis, makes patients hear voices or believe that others are reading their minds or controlling their thoughts.

Treating schizophrenia early is crucial, said Professor Patrick McGorry of the University of Melbourne. 'After a couple of years, it becomes relatively permanent, and treatment at that point is largely ineffective.'

Prof Chong hopes to get the IMH study off the ground towards the end of this year, once approval and funding is obtained.

Duke University's Prof Keefe described Singapore as an ideal place for such a study. The country is 'compact and structured', and it is easier to follow up on patients, unlike in the US, where people move around a lot.

salma@sph.com.sg

Menstruation key to bone rebuilding in anorexics
Tue, Jul 24, 2007
Reuters

NEW YORK (Reuters Health) - Adequate nutrition can rebuild bone mass in women with anorexia, but the restoration of normal menstrual periods appears to be necessary for fully normal bone metabolism to be recovered, a new study shows.

"Our observations may be important to an understanding of the mechanism of possible reversal of osteoporosis in anorexia nervosa, for which there is as yet no effective treatment," Dr. Jennifer Dominguez of Columbia University Medical Center in New York City and her colleagues conclude.

Studies in which anorexic women have been given oral contraceptives or estrogen to help restore bone mass have had mixed results, Dominguez and her team note, while the process by which bone thinning occurs in these patients is not fully understood. Further, they add in the July issue of the American Journal of Clinical Nutrition, "the role of nutrition in the recovery of bone has been underestimated."

To better understand bone loss and rebuilding in these patients, the researchers followed 28 women with anorexia nervosa who were undergoing treatment to help regain weight, comparing them to a control group of 11 healthy young women.

After just over two months on nutrition therapy, the anorexia nervosa patients showed significant increases in bone mineral density, the researchers found. Patients' levels of the protein osteocalcin, which is secreted by bone cells and is a key marker of bone formation, also rose. But levels of N-telopeptide, a marker for bone breakdown, remained abnormally high, except among eight women who began menstruating normally after recovering 90 percent of their ideal body weight.

The average bone mineral density among women who didn't begin menstruating after treatment was lower than the bone mineral density for the women who started menstruating and the healthy controls.

The findings suggest, Dominguez and her colleagues note, that women with anorexia have normal to increased rates of bone formation, but that bone breakdown outpaces bone building, resulting in loss of bone mineral density.

"Our data suggest that nutritional therapy is critical and necessary for optimal effect of other therapies," the researchers write. These drugs include antiresorptives -- drugs that block bone breakdown - and estrogen replacement therapy. In fact, they add, such treatment may not be effective until nutritional therapy has restored normal bone formation.

SOURCE: American Journal of Clinical Nutrition, July 2007.

REUTERS

Taken from
http://health.asiaone.com/Health/Women%2527s%2BMatters/Story/A1Story20070724-19530.html

Too thin teens

Tan Dawn Wei & Bryna Sim
12 August 2007
Straits Times
English
(c) 2007 Singapore Press Holdings Limited

Anorexia cases here are up and the attitude of some teens that it's hip to have the illness has doctors worried

ALL she wanted was for her sisters to stop calling her 'fat' and 'bimbo' and to win more friends at school.

And the best way to get there, she felt, was to lose the baby fat on her face. But that led her straight to hospital and 'humiliating' treatment for anorexia nervosa.

The 14-year-old's plight is sadly typical of most sufferers of the eating disorder.

Like many victims, Michelle - not her real name - is from a middle-income family, goes to an elite girls' school and does well in her studies.

Her problems started last year in Secondary 1.

Taunted by her classmates and sisters, she started rejecting food, eating only vegetables and small spoonfuls of rice for dinner, sometimes her only meal for the day.

'All the girls around me were very thin and they all seemed to have many friends. I felt very left out,' said the pale, rail-thin teenager in between sobs.

When a school trip came up earlier this year, a teacher noticed her bony frame and sallow face and decided she was not well enough to go. The school counsellor then alerted her parents.

By the time Michelle's mother, Mrs Lim, checked her into the eating disorder programme at Singapore General Hospital (SGH) last month, the 1.5m-tall teen had lost 10kg in six months and weighed just 29.5kg. She should be at least 42kg to qualify as healthy.

Mrs Lim has since taken Michelle out of SGH after objecting to its order of complete bed rest. Michelle could not shower for days and had to use a bed pan, which her mum called 'humiliating'. She also wrote to The Sunday Times and Singapore Children's Society to complain about the treatment.

But her illness did not come as a complete surprise to Mrs Lim as she had been through it herself.

'I was hoping it wasn't anorexia, but I was in denial,' said the private tutor. 'I didn't want her to end up like me.'

Michelle, who still suffers from hair loss, severe constipation and insomnia, returned to school last Wednesday, but dealing with her illness will be a 'long, hard process', said Mrs Lim.

It is a traumatic story that is becoming increasingly common here. There are no statistics on eating disorders, but a 2005 study cited 126 cases of anorexia seen by the Institute of Mental Health from 1994 to 2002.

Before 2002, SGH, the only hospital here with an eating disorders programme, saw about 20 to 30 patients a year. Last year, it saw 200.

What is concerning professionals is the attitude of some of the teens who see anorexia as hip.

'There is a copycat effect. It's like an 'in' thing among girls, especially those in girls' schools and universities,' said Dr Liow Pei Hsiang, consultant at Alexandra Hospital's psychiatry unit, where the number of patients seeking treatment for eating disorders has doubled in four years.

And so it is. Michelle and her classmates fight to be the skinniest in class. 'We would try to outdo each other by seeing who ate less that day, or who exercised more,' she said.

The most common eating disorders are anorexia, in which a sufferer severely restricts food intake, and bulimia nervosa, which involves bingeing and purging.

They hit females 10 times more than males. Females in adolescence and their 20s are particularly vulnerable, said Dr Lee Ee Lian, senior consultant psychiatrist and director of the SGH eating disorders programme.

At least one top girls' school, Methodist Girls' School, has seen a slight rise in the number of students with eating disorders but counsellor Ann Robers declined to give figures.

Teachers have been given checklists designed by Mrs Robers to help identify girls who may suffer from any psychological problems, including eating disorders.

The students are also regularly weighed in physical education class - if their weight drops sharply, the counsellor and parents are notified.

The Health Promotion Board is monitoring the issue and organises seminars for teachers and school counsellors on dealing with various health issues, including eating disorders.

SGH's Dr Lee has seen her fair share of truly challenging cases over the years, like several teen patients with body mass indexes (BMI) of nine and who were so weak they could not speak or swallow. The healthy BMI range is from 18.5 to 22.9.

One anorexic woman was hospitalised 50 times in four years while another had severe psychotic depression. 'She heard voices telling her to kill herself, which she eventually did,' said Dr Lee.

The eating disorders programme loses one patient every year to suicide, pneumonia and starvation. Not all suffer from eating disorders exclusively; some may have other psychological problems.

Studies put the mortality rate of eating disorders at between 5 and 20 per cent. But even if you do not die from it, there could be long-term effects like brain atrophy, osteoporosis and infertility.

Dr Ken Ung, of Adam Road Hospital, says 10 to 20 per cent of those afflicted never recover.

'Every time I see a case, I pray and try every trick in the book. Sometimes it works, sometimes it doesn't,' said Dr Ung, who treats up to 50 new cases a year. 'You can say, 'You're not getting out of here until you put on 5kg'. But when she leaves, she stops eating again.'

One 13-year-old sufferer who is determined never to starve herself again is June (not her real name).

Last year, the 1.53m-tall teen ate only bread and hit her condo's gym every day. 'I would look in the mirror and still think that I was fat, although I was actually very skinny. I wanted to eat, yet I told myself I hated food because I was afraid that I would get fat.'

She was always tired, getting styes and coughs that would last for months.

After her weight plummeted from 40kg to 32kg in the first four months of last year, she started to will herself to eat and is now 43kg.

The youngest of three children of a university lecturer and housewife can proudly say she wolves down four slices of pizza at one sitting. 'And I feel like a whole new person,' she said.

dawntan@sph.com.sg

brynasim@sph.com.sg

Post your comments online at www.straitstimes.com

SELF-DELUSIONAL

'I would look in the mirror and still think that I was fat, although I was actually very skinny. I wanted to eat, yet I told myself I hated food because I was afraid that I would get fat.' JUNE, 13

A few more parts of yesterday's article that I didn't finish posting up

In this ward, nurses check to ensure meals are finished
Entering Ward 46A at the Singapore General Hospital takes a bit of doing.

Visitors to Singapore's only eating disorder treatment ward must navigate a maze on the sixth floor of Block 4, before reaching the ward tucked away in a corner.

bags and pockets are checked to ensure no one is sneaking in food, as patients are on strict dietary and weight-monitoring regimes.

Once inside, the silent presence of painfully thin, pale girls greets you. Each sub-ward houses about five to six patients.

The days are not regimented except for two things - dreaded by patients - meal and supplement timse.

"They are the most stressful parts of the day" said 14-year-old Michelle (not her real name), whose mother had her discharged after a three-week-long stay.

Patients said they get an hour to finish their food. Nurses peer at plates and bowls and if they leave so much as a piece of chicken fat or rice grain, the meal is marked as incomplete."

That spells trouble for patients as it mean they will have to swallow one more supplement on top of the three they take a day.

Desperate Means

Nurses readily admit they have become stricter and craftier over the years as they tro to keep up with the girls' creative ways of making food disappear.

Some patients throw up right after a meal, shovel food into their hospital gown pockets or even hide it betwene their sheets.

"We used to alow them to toast food, but they would just burn it deliberately,"said one nurse.

But hunger fuels their creative juices. The girls say they compete to see who succeeds in not gaining weight as the days go by.

Lynette (not her real name), 13, even did star jumps in the shower to try to burn off calories. She was caught and doctors apparently ordered Complete Rest In bed (Crib) for the four girls in the sub-ward.

That meant they could not shower or use the bathroom for days on end. All bowel movements are done using a bed pan.

Even standing on the bed is banned.

For their own good

Such methods prompted Michelle's mum, a 43-year-old home tutor, to write to the Singapore Children's Society and The Sunday Times describing them as "sadistic, inhumane and humilitating".

The senior consultant psychiatrist and director of SGH's programme, Dr Lee Ee Lian, said Crib is meant to be "life-saving and curative, not punitive."

Defiant but dangerously sick patients who refuse to eat sometimes have to be strapped down or force-fed through a tube, say doctors.

A specialist at Adam Road Hospital, Dr Ken Ung, said:"Such treatment methods are primitive. But they have worked."

Bryna Sim & Tan Dawn Wei.

I came across 2 letters to the Straits Times forum in the newspapers (Sunday Times) on the 19th August. 2 ladies who wrote to the forum about it. I salute these 2 ladies who has gone through it themselves and whom shown the courage and maturity to speak up to give fairness to those working at Ward 46A and a more complete picture of what's going on. These 2 brave ladies are more brave than i ever could be.

Doc's strict plan worked for teen
I am a 17-year-old girl who suffered from anorexia and bulimia for three years, and has since recovered and reached my healthy weight.

Reading the articles, "Too Thin Teens" and "In this ward, nurses check to ensure meals are finished" (The Sunday Times, Aug 12), I felt it was unfair that Singapore General Hospital's Dr Lee Ee Lian and the nurses of Ward 46A were described as "sadistic, inhumane and humiliating" by a patient's mother.

I, too, was under the Complete Rest In Bed (Crib) treatment, which involved using a bed pan for clearing one's bowels. The purpose of Crib is to help anorexic patients conserve the precious calories their weak bodies need.

The nurses are indeed very strict; they make sure patients finish all their food and not dispose of or hide it, or throw up after eating, as some anorexic patients can be very cunning.

One good example would be me : I used to drink lots of water before they weighed me, so that my weight would appear higher. And even when the nurses confiscated my water bottles, I would wake up in the middle fo the night to drink other patients' water.

An eating disorder is a life-threatennig illness, and at my lowest state, I weighed only 28.5kg. my potassium levels dropped so low that I should have had a cardiac arrest at any moment.

During my last hospitalisaition, I was on Dr Lee's programme, which was stricter than what I had experienced previously. However, it really proved effective, although I was also angry with her at times because I was not allowed to move about the ward, was confined to my bed, and all my belongings were searched regularly to ensure that I did not hide my food.

But in the end, I recovered, and I am grateful to Dr Lee.

The nurses were also very caring and always ready to help us although they had to be strict with us.

I hope my letter can paint a fairer picture of Dr Lee and the team at Ward 46A. She is not a monster out to humiliate her patients, but rather, she has our best interests at heart. She has to use such methods to help her patients.
Felicia Huang Liling (Ms)

Grateful to team at Ward 46A

I read with heartache the article, "Too Thin Teens" (The Sunday Times, aug 12). I am 24, and have been fighting an eating disorder for four years.

It is extremely diffcult for any normal person to understand how and why a sufferer thinks or behaves the way she does. Whether it is due to peer pressure or as a way to feel in control, developing an eating disorder can take away one's entire freedom, and even life. It is also an extremely lonely illness.

With regard to the eating disorder programme at the Singapore General Hospital's Ward 46A, I would like to express my gratitude to the entire medical team. I have had my share of stays in the ward, and however strict the rules seemed, I must admit they are necessary, as an eating disorder can drive one to resort to irrational behaviour.

In fact, similar programmes overseas are known to be much stricter.

i must applaud the progress of the programme. Compared to four years ago, Ward 46A has come a long way in terms of facilities, environment, activities and programmes.

I especially wish to thank the nurses of Ward 46A for their hard work. Throughout my handful of stays, they never failed to touch my heart with their devition and patience. Despite the strict regulations they had to enforce, these nurses treated every single patient with thee same love and concern.

I am also grateful to the medical team, especially Dr Lee Ee Lian, and to senior psychologist Evelyn Boon and social worker Antia Foo, who have not only helped me, but also brought my family closer throughout these years.

Although I am still battling this condition, I remain positive about being able to recover from it. I would not have come so far without them, and my parents' constant support.
If you notice your loved ones showing symptoms of an eating disorder, please seek help before it is too late. it is almost impossible to fight it alone.

Lee WeiQi (Ms)

Discover Eating Disorders
25 February - 1 March 2008

The Singapore General Hospital's Lifestyle Improvement & Fitness Enchancement or LIFE Centre is a hospital-based centre that provides integrated and holistic care for patients with lifestyle-related medical conditions,in particular patients with eating disorders and obesity.

The Eating Disorders Programme at LIFE Centre is a dedicated treatment programme for the management of eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disoder. Eating disorders are complex psychological problems with potentially serious medical complications. Eating disorders are not only about food and weight, but are frequently symtomatic of deeper, more complex psychological and biological issues.

Date : 25 Feb 08
Time : 11:30am-12:30pm
Venue : Healing Garden. Life Centre Bowyer Block A level 1, SGH
Event : Launch Signing of Seventeen body Peace Treaty.

Date : 26 Feb 08
Time : 12:00pm-2:00pm
Venue : Healing Garden (same as above)
Event : Size Free T-shirt Design
Join us in designing a t-shirt to encourage positive body-image

Date : 27 feb 08 - 29 Mar 08
Time : 9:00am-5:00pm
Venue : LIFE Centre, Bowyer Block A Level 1 SGH
Event : The Great Jeans Give Away
Did you buy a pair of jeans that was a little too snug but you are hoping to lose a few kilos to fit into it? Give them away and celebrate your natural size!
Donated jeans will be given to Red Cross

Date : 01 Mar 08
Time : 10:00am-12:00pm
Venue : Void Deck, Blk 6 level 9, SGH Registration fee $10*
Contact person : Nana 63265400 9am-5pm
Event : Public Forum - "Help Your Teenager Beat An Eating Disorder"
9:30am Registration
10:00am Welcome and introduction.
Dr Lee Huei Yen, Consultant
Department of Psychiatry - SGH
10:05am "Help Your Teenager Beat An Eating Disorder"
Professor James Lock,
Director, Eating Disorder Programme and Clinic Standford Unversity School of Medicine
10:25am "Practical Tips and Resource"
Ms Esther Chan, Medical Social Worker - SGH
11:05am Q&A
11:35am End

Time : 1:00pm
Venue : LIFE Centre, Bowyer Block A, Level 1, SGH
Contact : 17mag@sph.com.sg
Event : Seventeen Perfect Fit workshop
Anyone can look good! Get advice from sylists from Seventeen Singapore