The 15-year-old girl went on a diet after her mother said she was fat. The mother herself, who is in her late 40s, also watched her weight. Despite being slim, she avoided eating carbohydrates and exercised rigorously.
Psychiatrist Lim Boon Leng from Gleneagles Hospital recounts: "Wishing to please her mother, the girl lost a dangerous amount of weight and had to be hospitalised."
Dr Lim treated the teenager who had periods of anorexia and bulimia, which are eating disorders. Her Body Mass Index dropped to 14, indicating she was severely underweight. A BMI in the healthy range is between 18.5 and 22.9.
The girl's condition led to "stressful dynamics" in the family, adds Dr Lim. Her recovery was delayed as it was difficult to convince her to put on weight when her mother insisted on continuing with her own strict diet and exercise routine.
When the girl's father asked his wife to stop for their daughter's sake, it led to frequent arguments.
But, doctors say, mothers have an important role in helping their daughters navigate the same societal pressures surrounding women and thinness that are felt by both.
When I had a daughter, I was determined that I wasn't going to let her have a poor self-image. I want her to see that everyone deserves love, everyone deserves to feel good about themselves.
MRS KAREN EVERS-FOO, with her daughter Isabela, 14
Dr Celine Wong, a consultant at the National University Hospital's department of psychological medicine, points out: "Body image issues can be a problem for two generations. In terms of eating disorders, children can be genetically predisposed to have the same illness as their parents."
Children are also affected by their parents' lifestyle choices and values. "If parents eat portions of food that are excessively small at home, their children grow up thinking these are normal when they are not," adds Dr Wong.
"We have seen cases of girls with anorexia and their mothers had suffered from it in the past."
Body image issues tend to affect mostly women, says Dr Lim, and with parents wielding huge influence on their children as role models, having a mother with body image concerns may put a child at a high risk of having similar issues.
"The ideal body size of a tall, thin model, as reflected in the media, is not representative of the norm and is often physically unhealthy," he adds. "It is imperative to educate children that bodies come in all shapes and sizes."
It is a body-positive message that has been heard for decades, but body image issues continue to affect women of all sizes.
The ideal body size of a tall, thin model, as reflected in the media, is not representative of the norm and is often physically unhealthy. It is imperative to educate children that bodies come in all shapes and sizes.
PSYCHIATRIST LIM BOON LENG
For instance, slim and fit Kareen Lai - a certified personal trainer and founder of Mums In Sync, which runs fitness and nutrition programmes to help mothers get in shape - recalls feeling insulted when she was called "thunder thighs" by some boys when she was in junior college.
She was never overweight, but "more to the voluptuous side". She was active in her school's outdoor adventure club then and her longterm sporty lifestyle now helps her model a positive body image for her five-year-old twins, daughter Aasha and son Kiran.
Ms Lai, 33, and her 34-year-old husband, an army regular, ensure that their children exercise with them about three times a week, doing activities such as cycling, swimming and rock-climbing.
"What I try to instil in my twins is that being active keeps them strong and healthy, rather than that exercise gets you slim," she says, adding that she wants her daughter to grow up accustomed to images of strong women engaged in sport, rather than those of models.
Sometimes, though, concerns about body image are legitimate.
Secondary 5 student Grace Bi, 17, was overweight as a child in primary school, bearing taunts from schoolmates of looking like a "balloon".
Tips for parents
Parents can limit the risks of their children having body image issues. Here are some suggestions from Dr Lim Boon Leng, a psychiatrist at Gleneagles Hospital.
• Parents should be good role models and not harp on dieting and aspiring to a slimness that is impossible to achieve.
• Emphasise a healthy lifestyle, including a nutritious diet and getting enough exercise and sleep.
• Maintain a good relationship with your child and communicate frequently. This is especially important during the teenage years when peer pressure and social media exert their greatest influence. This will allow parents to nip problems about body image in the bud.
Dr Celine Wong, consultant, department of psychological medicine, National University Hospital, has these suggestions.
• Build the child's self-esteem by spending quality time with him or her and understand their goals and hopes.
• Inculcate values that focus on inner beauty such as being kind, loving or helpful, as opposed to focusing on outer beauty such as slim bodies and pretty faces, as well as external achievements in academics and sports. • Avoid being critical and judgmental. Many children with eating disorders become highly critical of themselves because of their experience of criticism growing up. They internalise the critical parent and become highly restrictive in how they eat and judge themselves harshly.
• Avoid conditional love. Be loving and accepting of your children, regardless of how they look and what they achieve, as long as they try their best.
Even her family members called her names like "little pig" in Mandarin, though she feels they were more terms of affection.
It was only when Ms Bi was in Secondary 2 - she weighed her heaviest at 78kg and stood at 1.66m - that she decided to do something about her weight.
"I started caring more about my image," she says adding that she was also spurred to lose weight when she noticed many of her slim schoolmates had boyfriends at the time.
She followed YouTube videos on cardio exercises and worked out up to an hour daily and jogged three times a week. She also ate more vegetables than rice and avoided sweets, tidbits and carbonated drinks.
She lost about 18kg over two years, but her mother, Ms Sue Anne Kuek, 57, raised concerns over her daughter's dramatic weight loss.
"I was worried that she was overdoing it. Weight loss should be a gradual process," says the assistant manager at a country club who is married to a 52-year-old graphic designer. They also have a son, 23, who is an undergraduate.
Ms Bi stopped what she calls her "obsession" with losing weight last year because she wanted to focus on her N-level examinations.
Her mother is now proud of the efforts she made to lose excess weight. "It was hard work. I respected her determination to do something for herself," says Ms Kuek.
In the case of life coach Karen Evers-Foo, 46, being plus-sized meant enduring humiliation from a young age and consequently wanting her children to have a good body image.
In secondary school, she was curvy though not overweight, but slimmer girls passed snide comments about how she was too fat to wear trendy clothes.
At 26, she was diagnosed with an underactive thyroid, the cause of a puzzling gain of 10kg in less than two months.
Family members urged her to lose weight and a former female boss advised her to look "presentable". Salespeople told her they did not stock her size. She has clocked looks of "disgust" and faux concerns about her "health" aimed at her. When she was single, she was rejected "many times" on dates on account of her weight.
Now about a UK size 18, she says: "When I had a daughter, I was determined that I wasn't going to let her have a poor self-image. I want her to see that everyone deserves love, everyone deserves to feel good about themselves.
"It is difficult to be body-positive in this part of the world, where the majority of Asians are on the slender side."
She has a 14-year-old daughter and a 17-year-old son, and is married to a 46-year-old technical project manager in the telecommunications industry.
Wanting to be part of a body-positive community, she took part in the inaugural Ms Amazing Plus Size Beauty Pageant in 2010, where she was second runner-up.
Over the years, she has told her daughter, Isabela, who at 1.74m is slightly taller than many of her peers, about having a good selfimage, regardless of one's size.
It seems to have paid off.
Isabela, a Secondary 2 student, says these conversations with her mother tend to be short, simply because she does not face any challenges regarding her body image.
"She always taught me to have a positive body image," she says.