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

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)

By Anne Harding Tue Sep 4, 2:54 PM ET

NEW YORK (Reuters Health) - Family therapy is more effective than traditional solo psychotherapy in helping teens with bulimia to abstain from binging and purging, a new study shows.

The study is the first in the US to evaluate any treatment for bulimia nervosa in adolescents, Dr. Daniel le Grange of the University of Chicago, the study's lead author, told Reuters Health. He and his colleagues tested a family-based treatment modeled on an effective therapeutic strategy for anorexia nervosa in adolescents known as the Maudsley approach.

In the US, le Grange noted, psychotherapy in which a person meets with a therapist to understand the emotional issues involved in their eating disorder is currently the standard treatment for bulimia nervosa. To investigate whether getting families involved might make treatment more effective, they randomly assigned 80 adolescent patients (12 to 18 years old) with bulimia to supportive psychotherapy or the family-based approach.

The family-based therapy consists of three phases: in the first, lasting two to three months, patients and their parents meet weekly with a therapist, with the goal of helping parents stop their children from engaging in unhealthy weight-control behaviors.

Once the patient is able to abstain from bulimic behavior, the family moves on to the second phase, in which therapy sessions are every other week and the goal is to "transition control over eating issues back to the adolescent," le Grange and his colleagues explain in the Archives of General Psychiatry.

In the third phase, families meet with the therapist once a month and attempt to address how the eating disorder affects developmental processes in adolescence.

Patients in the supportive therapy arm of the study followed the same basic frequency schedule of therapy meetings, with the goal of exploring emotional problems that may have triggered the disorder.

At the end of treatment, 39 percent of the 41 patients who participated in family-based therapy were completely abstaining from bulimic behaviors, compared to 18 percent of the 39 patients who underwent psychotherapy.

Six months later, 29 percent of patients in the family therapy group were still abstinent, compared to 10 percent of those in the psychotherapy group.

"There's room for improvement," said le Grange, who pointed out that he and his colleagues used the rigorous standard of complete abstinence to gauge treatment effectiveness, not whether a patient had merely shown reductions in binging and purging behavior.

While family-based treatment for bulimia nervosa is not currently widely available in the US, interested parents can seek out practitioners trained in the Maudsley approach for anorexia nervosa, who will be able to adapt the strategy to bulimic patients with the help of a treatment manual, added le Grange. Therapists with experience in the Maudsley approach are listed at www.maudsleyparents.org.

"I'm excited about what we've done," he concluded, "but I temper my excitement by the fact that this is the first study."

SOURCE: Archives of General Psychiatry, September 2007

Taken from
http://news.yahoo.com/s/nm/20070904/hl_nm/teens_bulimia_dc

Purging disorder in women little known
Amy Lorentzen
Thu, Sep 20, 2007
AP (Associated Press)

DES MOINES, Iowa (AP) -- An Iowa researcher is studying a little-known eating disorder that some doctors may miss: purging disorder. Though similar to women with bulimia, patients who fit this description don't binge-eat. Yet they feel compelled to purge, usually by vomiting, even after eating only a small or normal amount of food, said Pamela Keel, the University of Iowa researcher who led a study on the subject.

Keel, a psychology professor, and colleagues from Iowa and the Harvard Medical School describe their research in this month's issue of Archives of General Psychiatry.

"Purging disorder is new in the sense that it has not been officially recognized as a unique condition in the classification of eating disorders. But it's not a new problem," Keel said. "Women were struggling with purging disorder long before we began studying it."

If further study supports that it is a distinct disorder, Keel said the American Psychiatric Association could revise its criteria for diagnosing eating disorders. That's important because doctors could then better screen these patients and identify treatments for them. Otherwise, they might be missed because they are normal weight and don't report binge-eating, she said.

"The bottom line is there are women out there right now who have this condition, and very little is being done to figure out why they have this problem or how to help them with it," Keel said.

The study focused on women because they are about 10 times more likely than men to suffer from bulimia, in which people compulsively overeat and then force themselves to vomit, fast, take laxatives or exercise excessively to burn calories.

The dangers of purging disorder are similar to those of bulimia: psychological problems, dehydration, electrolyte imbalances that can affect the heart and kidneys, and potential dental problems because of self-induced vomiting.

Keel's research, conducted from 2001-05, was funded by the National Institute of Mental Health. The study looked at 90 women: 20 women had symptoms of purging disorder, 37 had bulimia and purged after binge-eating, and 33 had no eating disorders. Each woman was interviewed about her eating habits, drank a liquid meal and had blood drawn before and after the meal.

Keel said there were significant differences in the groups when it came to satiety, or feeling full.

In response to the liquid meal, women with purging disorder and those who had no eating disorder had similar levels of a chemical called cholecystokinin. It is released from the upper tract of the small intestine and appears to signal people to stop eating.

"That makes sense, because in terms of eating patterns, women with purging disorder are not actually eating more" than the women who had no eating disorder, Keel said. The bulimic women had lower levels of the chemical.

The women with purging disorder said they felt much more full after the test meal, and they reported more stomach discomfort than the bulimic women and the women with no eating disorders.

"It kind of begins to provide a clue for why these women may feel a need to purge after eating an amount of food that most people would be fine with. They are actually responding to it differently," Keel said.

The women with purging disorder and the bulimics shared emotional and psychological characteristics, including body image problems, anxiety and depression. Both groups also had strict rules about what they could eat and when, Keel said.

Keel "has helped put purging disorder on the map" as something that should be studied, said Dr. Tim Walsh, professor of psychiatry at Columbia University Medical Center.

Many people with eating disorders don't meet all of the criteria for anorexia or bulimia, "so it suggests that we need additional descriptions to help patients," he said. Walsh heads a work group with the American Psychiatric Association that is charged with revising criteria for diagnosing such disorders.

Leslie Sim, a psychology professor and consultant with the Mayo Clinic's eating disorders program, called Keel a "great researcher" in the field and said her findings were new and interesting.

Sim said current criteria "are kind of limiting for diagnosis and treatment and also for reimbursement by insurance companies."

Keel is recruiting subjects for another study, which she said will look more closely into factors that give rise to the unique response to eating by women who have purging disorder.

---

On the Net:

University of Iowa: http://www.uiowa.edu/

Mayo Clinic: http://www.mayoclinic.com/

Taken from
http://health.asiaone.com/Health/News/Story/A1Story20070920-26188.html

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

Life hijacked by look-good urge

Ray (not his real name) dropped out of Anglo Chinese Junior College last year because the 19-year-old was too ill to continue.

A good-looking boy with a ready smile, Ray began battling a severe eating disorder three years ago.

It was around that time, at the end of 2005, that Ray's mother noticed he did not mix much with friends any more and that he barely ate any food.

He exercised obsessively, making a religion of his daily run and spending hours at the gym.

'I thought I was healthy. I wanted to look good and have that buff look,' he said.

But he could not look at food normally.

'I would look at something and think, 'Can I see someone who looks good eating it?' If I couldn't, then I would not eat it,' he said.

He became dangerously underweight and had to be admitted to hospital in December 2005.

'The strange thing is that I felt normal. I thought the people around me were overreacting,' Ray said.

His perspective was in fact typical of people with eating disorders: Ray thought he was just being healthy, not realising that he was endangering his life. He thought his parents were trying to fatten him up.

As soon as he was discharged from hospital, he started the cycle of exercising and starving himself again.

'If my friends wanted to meet me for dinner, I would cancel that because it clashed with my exercise schedule,' he said.

In March 2006, Ray was hospitalised again. Once his weight stabilised, he was admitted to the Institute of Mental Health (IMH) for two months as he was also dangerously depressed. He was miserable and tried to run away from there.

After several admissions to the hospital and IMH, Ray realised that the desire to look good had hijacked his life.

'I just wanted to be happy,' he said.

Turning point
In March 2007, he told senior psychiatrist Dr Lee Ee Lian, who heads the Eating Disorders Programme at SGH, that he wanted to change his lifestyle.

He started attending the day programme for people with eating disorders at the Life Centre, when it opened in October last year.

He goes to the centre every day now, where along with other teenagers like him, he is taught to eat normally and encouraged to re-examine how he looks at himself.

Ray said coming to the centre has helped him accept all parts of himself and to stop the obsessive scrutiny to which he subjected himself.

In the presence of psychologist Evelyn Foo, Ray said he has learnt to think of the person with the distorted thoughts as Rex.

'It's like fighting an opponent. You look in the mirror and it's an evil version of you. Rex is the me I don't want to be,' he said.

Ray wants to be happy and successful and he has come to realise that he had equated 'being good looking' with these things. This was particularly fuelled by the fact that he was fat as a child and felt that the only way to be popular was to be good-looking. These are the feelings he identified and is working through with a psychologist.

When he is at the Life Centre, he sometimes visits the wards so he can talk to other patients with eating disorders.

'I like it here. All of us are kind of going through the same thing,' he said.

Ray said the one thing that has kept him coming back is the concern shown by SGH's Eating Disorders Team.

'They stuck with me. Even when I was in IMH, Dr Lee told me they would accept me back in the programme any time I was ready,' Ray said.

He plans to continue in the programme for a few more months and find a job.

'I hope I find something that's fun,' he said.

This story was first published in The Mind Your Body supplement on Feb 20, 2008

The article has been taken from
http://health.asiaone.com/Health/News/Story/A1Story20080226-51463.html