The Gen XY Lifestyle

Is your teenager’s diet a fad or an eating disorder?

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Many people, influenced by various lifestyle diet and nutrition trends, as well as opinions about an ideal physical appearance, have become more self-conscious about their eating habits and health.

Teenagers going through puberty is an example of a group that might be more affected by such opinions and representations.

But when does it cross the line from being health conscious to an eating disorder? An obsession with dieting can spiral into an unpleasant eating disorder and affect a person’s daily life negatively.

Having an eating disorder (ED) can be classified when an individual is excessively preoccupied with food and/or weight to a point where it begins to consume and negatively affect other aspects of their lives. Left untreated, it can potentially have devastating consequences for their physical and mental health. 

The Active Age discusses eating disorders with Dr. Grace Huang, a resident doctor at DTAP Clinic and finds out more about what is an eating disorder, symptoms and how to identify and seek appropriate treatment.

the Active Age (AA): What is an eating disorder?

Dr. Grace Huang (GH): When someone becomes excessively preoccupied with food and/or weight to a point where it begins to consume and affect other aspects of their lives, it may be a sign of an eating disorder (ED). If left untreated, this may potentially have devastating consequences for their physical and mental health.

Eating disorders are a group of health conditions revolving around food and/or weight issues, which can have damaging and even potentially fatal physical and mental complications. Eating disorders are more than just about food or weight. There may be other emotional issues and negative thinking that fuels this behaviour.

AA: Are there many types of eating disorders and what are the common ones you have observed in Singapore?

GH: The most common EDs which people hear about are Anorexia nervosa, Bulimia nervosa and Binge-eating disorder.

While there is less data about the prevalence of EDs in the local context, and the breakdown of which EDs are most common, there is evidence that suggests the problem may be bigger than we think. There has been a rise in the new cases presenting at Singapore’s national eating disorder clinic[1]. A recently published study estimating the prevalence of EDs amongst adults in Singapore reported that an alarming 42.7 percent of respondents screened positive for a clinical ED and 19.5 percent were at high risk of developing an ED[2].

In Anorexia nervosa (AN), individuals persistently restrict their food intake, have an intense fear of weight gain, engage in persistent behavior that interferes with weight gain, and have a distorted perception of their own weight/body shape.

Those who suffer from Bulimia nervosa (BN) are similarly critical about their own weight/body shape and go through recurrent episodes of binge eating, during which they feel a sense of loss of control over their eating, followed by inappropriate compensatory behaviours to prevent weight gain.

Binge eating disorder is different in that individuals do not resort to inappropriate behaviours to compensate for their binges, which are also not related to anorexia or bulimia episodes.

Some other EDs that you may not have heard of include Avoidant/Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding or Eating Disorder (OSFED). ED sufferers may exhibit symptoms and complications of an ED but may not always meet the criteria for AN/BN/BED.

Orthorexia nervosa is characterised by an unhealthy obsession with healthy eating. While it is not officially recognized as a formal mental health diagnosis, it is becoming increasingly relevant, especially with increasing societal emphasis on clean eating and healthy diet trends. Individuals with orthorexia may have very strict rules about their eating and may obsess about healthy eating to a point where they suffer physical complications e.g. malnutrition, and excessive psychological distress.

AA: How do they develop?

GH: Eating disorders are complex conditions. A combination of genetic and biological factors like changes in neurotransmitters, combined with psychological, emotional factors and social circumstances may all contribute. People with a family history of EDs or a personal history of other mental health disorders like anxiety or depression are at increased risk of developing an ED themselves. Sometimes, what starts out as a diet may also spiral out of control and into a full blown ED.

AA: How can we go about helping a family member or friend if we think they are suffering from an eating disorder? 

If you notice that your loved one may be suffering from an eating disorder, it is important to speak to them about it to voice your concerns and to convey that you care for them and want to help.

While it may be difficult to broach the topic or you may worry about saying the wrong thing, the last thing you should do is to ignore the problem. While you can explain why you are concerned, you should try to avoid being critical as this will only alienate them more. It is also possible that you may be met with denial or defensiveness and you should try to remain supportive and patient.

You should also encourage them to get professional help.

ED treatment employs a variety of approaches ranging from various types of psychotherapy/counseling, to nutritional counseling with the aim of weight restoration, and possibly medication such as antidepressants if the individual is also struggling with other mental health issues. Family based treatment involves the family providing support and helping with improving eating behaviour.

Most treatment can be done in an outpatient setting, although individuals with severe EDs or at risk of significant health complications may require inpatient treatment.

 Having a supportive network is extremely important during the recovery journey and your encouragement and support can make a difference.

[1] Lee HY, & Hoodbhoy Z (2013). You Are Worth More Than What You Weigh: Preventing Eating Disorders. Annals Academy of Medicine, 42, 64–65.

[2] Chua, S. N., Fitzsimmons-Craft, E. E., Austin, S. B., Wilfley, D. E., & Taylor, C. B. (2021). Estimated prevalence of eating disorders in Singapore. The International journal of eating disorders54(1), 7–18.

Photo by Annie Spratt on Unsplash