Eating disorders are common but serious medical conditions that often start in teenage years. Dr Victor Kwok, psychiatrist and medical doctor, explains why the pandemic may have resulted in more cases. He will also discuss the symptoms of eating disorders and various treatment methods.
Question: What are the top 3 most common eating disorders in adolescence in Singapore?
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder
Q: The news reported an increased in number of cases https://www.straitstimes.com/singapore/new-programme-supports-parents-caring-for-children-with-eating-disorders-as-number-of-cases-rises that KKH has seen an increased of cases. What could give rise to the numbers?
The stress and uncertainty during the pandemic may have given rise to more cases of eating disorders in children and teenagers. They had to adapt to numerous changes in school e.g. virtual classrooms and stopping of CCAs. Studies found that people with pre-existing disordered eating can develop worse symptoms. They may have more binge-eating episodes, especially since the kitchen is better stocked.
Another reason for the increase in number of cases could be due to the greater awareness by parents, teachers, school counsellors and family doctors on eating disorders. There has been less stigma towards all types of mental illness as well and people are becoming more help-seeking.
Q: What can trigger eating disorders among teens?
Eating disorders often start in the transitional years like the start of secondary or high school or the first year of college. Some teens recall unkind remarks or teasing about their weight or body by family, relatives (especially during festive gatherings) or friends.
Some of the risk factors are:
- Having family members with eating disorders.
- A history of physical and emotional abuse at home or school (e.g. bullying).
- Perfectionistic personality and other types of personality disorders.
- Family culture that focuses on external beauty.
- Social media especially those that propagate unrealistic body image.
Q: What is your advice to parents to spot eating disorders?
Eating disorders often happen insidiously and the teenager may hide the symptoms. When a child makes an effort to lose weight, especially when their weight is normal to start with, talk to them to see if they have strong body image issues. Look for signs like excessive exercise, fear of sitting down after meals and excessive walking. They may also skip meals, or make excuses to eat less. When eating with family, they may get angry with normal portion sizes and insist on small portions. They may also refuse food that they deem unhealthy or have high calories.
Other signs are episodes of uncontrollable overeating and running to the toilet after meals. They may spend more time looking at recipes, food programs on social media and may like to cook for others.
Q: How are these eating disorders diagnosed, and what’s the treatment?
Treatment is usually done by a psychiatrist or paediatrician. These doctors will conduct physical examinations and blood tests to make sure the patient is not in danger. Patients who are medically unstable (blood abnormalities, low heart rate or extremely low body weight) or psychiatrically unstable (i.e. suicidal) may require urgent admission to a hospital for treatment. Once they are stable, the family will have to work closely with the psychiatrist to help the child restore normal body weight and normal eating behaviours. Some cases will also benefit from talk therapy. For those who are anxious or depressed, the doctor will discuss with family on the use of antidepressants.
Q: I came across one of your articles https://www.herworld.com/life/wellness/singapore-healthy-eating-making-you-sick-dangerous-eating-disorder/ which talks about healthy eating being a disorder. So how is eating healthy a disorder?
While healthy eating is good, some people may go overboard with their diet and exercise. This may lead to unhealthy weight, vitamin deficiencies and medical problems. In some of these cases, they may not have body image issues.
Q: Will teens outgrow these eating habits?
Eating disorders are serious medical conditions that carry the highest risk of mortality (10%) amongst all psychiatric conditions. The death rate is even higher than depression and some childhood cancers. In addition, anorexia nervosa in young children can stunt their growth permanently. It may lead to fertility problems and osteoporosis in later years. Therefore it is important to seek help early from a professional who has experience in treating eating disorders.
Dr Victor Kwok