According to Malaysiakini, it is estimated that only 1% of the Malaysian population suffer from eating disorders. Such statistics are hard to come by locally, which only reflects on the lack of awareness among Malaysians about eating disorders. Just as with any other form of mental illness, it is important to bring attention to such issues, as well as understanding and destigmatising them. To find out more about eating disorders, I had the opportunity of interviewing Lum Khay Xian, a Clinical Psychologist from Relate Malaysia.
According to Lum, eating disorders can be labelled by two key features, which are disturbed eating habits and disturbed weight control behaviours. Disturbed eating habits can include restricted food intake, strict dietary rules or altered mealtime behaviours. Meanwhile, disturbed weight control behaviours may involve excessive exercising, vomiting or misuse of laxatives. As an example, many people, especially females, undergo diets and restrict their food intake. Once dietary rules become increasingly strict to the point where their daily food consumption is unbalanced, this dieting becomes ‘disturbed’. Likewise, moderate exercise is healthy, but it can become dangerous when overdone. When someone is exercising excessively, they will feel distressed if they are prevented from exercising and will continue exercising despite injuries or bad weather. They may also prioritise their exercise regimen over having fun or spending time with others.
There are three common types of eating disorders. The first one is Anorexia Nervosa. According to Lum, it can be characterised by the restriction of energy intake relative to requirements leading to significantly low body weight in the context of sex, age developmental trajectory and physical health. It can also be characterised by the fear of becoming fat or gaining weight even if one may be underweight. Secondly, Bulimia Nervosa may be understood as frequent episodes of overeating followed by behaviours such as self-induced vomiting to prevent weight gain. It comes with the feeling of losing control during binge-eating episodes. On average, this behaviour takes place about once a week for three months. Binge Eating Disorder (BED) is the third type of eating disorder. It can be characterized by recurrent episodes of eating large amounts of food, often very quickly and to the point of discomfort. During these episodes, one may experience loss of control, experiencing feelings of shame, guilt and distress afterwards.
The effects of eating disorders are potentially life-threatening and can seriously affect a person's emotional and physical health. Its effects can be potentially short-term or long-term. Some of its effects include anaemia (iron deficiency), compromised immune system, diarrhoea, kidney failure, heart problems or death. Those who are struggling with eating disorders may also risk infertility and females may experience a loss or disturbance in menstruation. Recurrent vomiting can result in inflammation and rupturing of the oesophagus and stomach. Eating disorders can also result in high blood pressure and cholesterol, resulting in an increased risk of stroke, diabetes and heart disease.
Lum says that the causes of eating disorders are very complex and there is no single causal factor. The first factor is societal pressures to be thin. The standard of beauty in Asian culture has evolved over the last 30 years to one that is unnaturally thin and unhealthy for women, but it is the standard they are expected to meet. As a result of these standards, many women turn to starving themselves rather than exercising to achieve their desired weight and shape.
Eating disorders can also be caused by the belief that thin is ideal. The more people buy into the ideal that being thin is the only way to look beautiful, the more displeased they are with their own bodies. The tendency of comparing one's body with someone else's whom they perceive to be more attractive, especially on social media, can lead to feelings of low self-worth and disordered eating. The internalisation of this ideal can lead one to frequently observe and monitor their own bodies and how they actually look, comparing their bodies to the thin ideal or what they think they should look like. By dwelling too much on the inconsistencies between what one sees, what one thinks and their idea of a ‘perfect self’, afflictions such as increased appearance anxiety, body shame, loss of awareness of their internal, physiological and emotional state can occur as a result.
Another cause of eating disorders is the social environment you are in. Friends, family and peers can play an important role in transmitting the thin ideal. In Asian families, it is common to openly comment on weight and eating behaviours. "The paradox in Asian cultures is that you have to eat what is given to you, but at the same time, you have to remain slim," said Lum. In this case, food becomes both a sign of love and a cause for judgement. When there is weight loss, family and friends may encourage disordered eating through their praises, emphasising the importance of discipline and self-control. On the other hand, when there is weight gain, there will be critical comments, frequent reminders about your weight, or even controlling what you can eat and how much you eat.
When asked about the pandemic’s impact on people struggling with eating disorders, Lum said that the circumstances of the pandemic have placed individuals at higher risk of developing and maintaining high-risk disordered eating behaviours. Many who have not been able to get together with friends due to stay-at-home orders have turned to social media to fill the void. While these apps can help the youth stay connected, they also have their downsides. Social media offers a constant way to compare yourself to others and rely on superficial means of building self-esteem, such as how many likes or comments they get on a post and their picture. Unlike magazines, movies and TV shows, social media gives the impression that it is much more real. So people start to compare themselves to an unrealistic and often impossible standard which can eventually lead to dangerous behaviour in an attempt to achieve something that they cannot.
Friends and family are key in encouraging loved ones struggling with eating disorders and body image issues to seek help. Be it if they are unaware that there is a problem, if they are afraid or ashamed to seek help, or if they are unsure about giving up their concerning behaviours, it can be hard for them to seek help. Family and friends can play an important role in identifying worrying symptoms and encouraging them to seek help. Talking to a loved one who is struggling with eating disorders in private can help them open up. It can be uncomfortable having one's personal issues discussed in front of many people, so find a time and place where you can sit with them and bring up your concerns to them without being rushed or other people in the room. Be transparent with them about your concerns. Talk to them about behaviours and changes you have observed, but if possible, point out behaviours that are unrelated to eating and weight, as this will make it easier for them to see and accept the issue. Discussing such concerns can bring up a lot of emotions, so it is important to not be overtaken by them. Rather focus on the behaviours and changes you have observed and point them out calmly. Remove any potential stigma by reminding them that there is no shame in admitting that they are struggling with an eating disorder or mental illness. "Many people will be diagnosed with these issues during their lifetimes, and many will recover," says Lum.
Besides that, you should encourage them to seek professional help. Many who struggle with eating disorders need professional help to get better. You can help them out by finding them a physician or therapist if they do not have one or attend an appointment with them where the issue is being discussed. The most effective treatment for anyone struggling with eating disorders is psychotherapy and the collaborative care of other health professionals specialising in medical and nutritional needs, usually available in public hospitals. If at any point, you or your loved ones are unsure where to seek professional help, you can reach out to Relate Malaysia on their Facebook page or their website. They can help out to locate any specialist or mental health professionals.
By Precillia Rubini