Forum: Time to address misconceptions about eating disorders

Eating disorders are serious mental health conditions with the highest mortality rate, yet many suffer in silence.

A local study, “Estimated prevalence of eating disorders in Singapore”, published in the International Journal of Eating Disorders in 2021, screened about 800 Singaporean adults. Researchers found that only 1.6 per cent of those who screened positive for an eating disorder reported that they were receiving treatment.

With Eating Disorder Awareness Week taking place from Feb 27 to March 5, it is timely to discuss the misconceptions surrounding eating disorders and how policies and attitudes can shape this disorder.

First, it is essential to know that an eating disorder is not exclusively a female disorder. In the local study, the ratio of males to females who screened positive for an eating disorder was nearly one-to-one.

Second, eating disorders can occur in people of any weight, shape or size. Only one subtype, anorexia nervosa, is associated with underweight features. For example, purging can be life-threatening even for someone with normal weight because the imbalances in electrolytes, such as potassium and sodium, can result in fainting, confusion, blood pressure changes, heart palpitations, seizures, cardiac arrest and even death.

This adds to the cost and burden on our healthcare system.

Healthcare professionals are trained to identify excessive weight as a health risk but may overlook the danger of eating disorders in patients with a normal weight or who are underweight.

In the fight against obesity, various national and school-based programmes include regular weight screening in schools, campaigns emphasising the dangers of excess weight, and displaying calorie counts in menus. These measures can inadvertently contribute to irrational concern with weight and shape, unhealthy diet control, excessive worry about fatty food, preoccupation with calories, and weight stigma.

It is important to note that those who have eating disorders are affected by the same factors as those who are obese, such as body dissatisfaction, dieting, media influence, and teasing about their weight. Expanding obesity prevention programmes to include the awareness and prevention of eating disorders is pivotal in achieving overall health and safety.

As a clinical psychologist, I want to highlight that an eating disorder is not a lifestyle choice but a life-threatening mental health condition which can lead to distorted views on weight and shape concerns, mood issues, and self-damaging behaviour.

It is imperative that we break away from misconceptions, train healthcare professionals adequately, and expand prevention programmes to include the awareness and prevention of eating disorders.

Annelise Lai