Eating Disorder in Asia – from origins to today

Statistics of the prevalence of eating disorders indicate a relatively steady increase in cases globally. From 2000 to 2018, the prevalence of eating disorders worldwide has more than double, with an increase in reported cases from 3.5% to 7.8%. The ever-increasing rate of prevalence is driven by a combination of complex issues, including the westernization of developing countries, particularly in Asia. While the prevalence of Anorexia Nervosa and Bulimia Nervosa began in Western countries in the 1960s, they were largely non-existent in Asian countries before the 1990s except in Japan. Before the mid-1990s, most Asian countries had an insignificant prevalence rate of anorexia nervosa and bulimia that was very close to 0.00%. Fast forward 5, 10, and 20 years later, and the flat line representing the increase in cases of anorexia nervosa in Asia is replaced with a steeper curve.

Anorexia Nervosa: Reasons for Century-Wide Time-Gap Cases between Western and Asian Countries

Anorexia Nervosa was coined in Western Europe in 1873 and was first reported in Japan in the mid-1970s, which means that the time-gap between emergence in Europe and arrival in Asia is about 100 years, give or take 5 years. Most illnesses and diseases take months or a few years to spread across the world. Why did it take nearly a century for eating disorders to be reported in Asia?  

  1. The Advent of Media

The role of media in the prevalence of eating disorders has been extensively researched and documented. Television was introduced in Europe and the US before Asian countries. The delay in the adoption of western media in Asia contributed in part to the century-wide time-gap in the prevalence of eating disorders between these two regions. Studies of eating disorders in Fiji by Dr. Becker provide a window into the past to enhance understanding of how television contributed to the prevalence of eating disorders in the West in the 1960s. The studies were undertaken before and after the arrival of western media in Fiji. Before Western television, the Fijian idea of beauty was a woman with a round and robust female body shape. The studies indicate that eating disorders were non-existent during this period, with only one reported case before the mid-1990s. After the arrival of Western television, the cases of eating disorders increased among Fijian women as they were pressured to attain the new, ideal beauty.

  • The Negative Impacts of Industrialization and Urbanization

The US and Western Europe were industrialized long before Asian countries. Industrialization transforms both the economic situation and social issues. It catalyzes rural-urban migration as millions of rural dwellers move to cities and towns to work in emerging factories or exploit the wide range of opportunities. The effects of urbanization still contribute to the increase in eating disorders in Asia in the 21st century. The finding of a study by Dr. Pike and Dr. Dunne associated the increase in eating disorder among Chinese women to sociocultural transformation catalyzed by rural-urban migration. As women migrate from rural areas move to cities, they face immense pressure to succeed from parents back home. Unfortunately, stiff competition in major cities makes it difficult to succeed. To set themselves apart from the competition, they turn to improve their body appearance leading to an increase in eating disorders. This is also the reason why Japan was the first in Asia to report eating disorders since it was industrialized ahead of other Asian nations.  

The Complexity of Eating Disorder Issues in Asia

Asian countries are experiencing a steady increase in the prevalence rate of eating disorders due to the complexity of eating disorder issues in Asia. Unlike the US and Europe, eating disorders in Asia are influenced by a wide range of issues, including westernization and cultural perceptions about the body and nutrition.  

  1. Westernization

The rapid economic development witnessed in Asia increases the adoption of individualistic culture promoted by westernization and places a high value on academic achievement. Both factors contribute to the increase in cases of disordered eating behaviors. This holding is supported by two studies conducted 10 years apart in Singapore, Lee et al. in 2005 and Kuek et al. in 2015. The findings of both studies show that Singaporeans suffering from anorexia nervosa experienced body image issues. Also, 58.7% and 84.9% of patients in the 2005 and 2015 study respectively identified specific triggers for their eating disorder. The triggers highlighted by the 2005 study include teasing at 26.9%, Trim and Fit program at 5.6%, health reasons at 3.2%, and stress at 11.9%. In the 2015 study, the triggers include teasing at 31.7%, stress at 24.7%, dieting at 14.8%, and being overweight at 7.7%. Analysis of the two studies highlight that only two triggers in the 2005 study and all five triggers in 2015 are similar to the triggers of eating disorders in western countries. This provides evidence that westernization is increasingly contributing to the prevalence of eating disorders in Singapore and Asia as a whole. Fortunately, Singapore has also adopted a Western approach in its anorexia nervosa treatment centers by introducing intensive outpatient program (IOP) but still lacks partial hospitalization programs (PHP). 

  • Cultural Perceptions: a fruitful landscape for pro-ana movement

The prevalence of eating disorders in Asia is also catalyzed by cultural perceptions about the body and nutrition. Korean values place more importance on the appearance of women than abilities, education, and so on. The fear of weight gain and the desire to be slim has pushed Korean adolescents to join the “pro-ana” websites and social media accounts, where they share tricks of throwing their lunch away while at school without raising alarms. The pro-ana movement promotes disordered eating behaviors and is an example of how cultural perceptions about the body has contributed to the increase in eating disorders in Asia. In Japanese culture, it is sinful to waste food. The shame and guilt associated with wasting food are contributing to the high rate of bulimia in Japan as children learn from a young age to consume everything on their plates then vomit later by force in secret. Once they develop bulimia, they suffer in silence since mental health issues are a taboo topic among the Japanese. Also, the nation lacks anorexia and bulimia treatment programs like IOP.

Statistics of Eating Disorders in Asian Countries

According to 2017 statistics from OurWorldinData.org, the prevalence of anorexia nervosa and bulimia in East Asia is higher among youths from 15 to 34 years. Prevalence among 15 to 19 year-olds is 0.29%, 20 to 24 year-olds is 0.33%, 25 to 29 year-olds is 0.35%, and 30 to 34 year-olds is 0.39%.

Statistics highlight that the trend is the same throughout Asian countries like China, Japan, South Korea, and Singapore, where the largest number of anorexia nervosa and bulimia is restricted between the age of 15 and 34. In comparison, statistics of neighboring countries like Russia and Australia highlight a wider spread outside 15 to 34-year-olds. Even though anorexia nervosa and bulimia in Russia are also more prevalent within 15 and 34-year-olds, it is less severe among teenagers.

It is important to note that these statistics focus on anorexia nervosa and bulimia but do not include binge eating and other types of disordered eating. In Japan, a study revealed that the prevalence had increased gradually from 2.5% to 3.1%. Statistics from OurWorldinData.org show that Singapore is affected the most by eating disorders in Asia, with 106.4 per 100,000 individuals, followed by Japan, South Korea, Taiwan, Malaysia, China, and India. Asian countries are not adversely affected like Australia, which has age-standardized DALYs of 178.58 per 100,000 individuals. The consistent similarity between all countries is a higher prevalence among females than males. A 2007 study conducted in Hong Kong found that about 20% (one in five) students between 12 and 18 years were at risk of developing eating disorders, with 26.6% of girls being at risk compared to 18.5% of boys.