Reflections on the Weight Stigma Conference 2015

This past week I had the opportunity to attend the third annual Weight Stigma Conference (WSC) in Reykjavik, Iceland. I lived Tweeted throughout, as did some others, so if you’re interested in seeing the social media from the conference I recommend checking out the #StigmaConf2015 hashtag on Twitter. A few people asked if I would blog about the conference, and I’m more than happy to do so! If you’re not a fan of conference recap blogs, stay tuned for our regular Science of EDs programming soon.

Overall, I thought this conference was fantastic. Though it was not a conference strictly geared toward eating disorders, weight stigma is not helpful for anyone in any kind of body and engaging in any kind of behaviours around food and exercise. It oversimplifies complex issues, makes body management a personal issue with strong political stakes, and reduces eating disorders and obesity to a binary … Continue reading →

Culture and Eating Disorders: Treatment Outcomes in Singapore and Hong Kong

In this last post about eating disorders in Singapore, I’ll write about the one Singapore-based retrospective outcome study in relation to a similar retrospective study conducted in Hong Kong.

In the Singapore study, researchers reviewed the charts of 94 patients diagnosed with anorexia nervosa from 1992 to 2004 at the National University Hospital, looking back from the time of the study. They didn’t contact any of the subjects for follow-up. 49 were first seen as inpatients, 34 as outpatients, and 11 were seen as outpatients but later admitted. The hospital doesn’t have a specialized ED service, so the authors relied on dietetic notes that unfortunately don’t provide a full picture of the patients’ eating disordered behaviors and cognitions.

The authors wrote about patient ‘improvement’ (not recovery!) as making a weight gain of at least 0.5 kg, or about 1 pound. 83% of their patients attended follow up appointments, which lasted … Continue reading →

Sensing the Body: Bodily Experience in Anorexia Nervosa

I’ve been reading a lot of literature on bodies and eating disorders lately as I gear up to write the theoretical paper that becomes the basis of my PhD qualifying exam. Perhaps unsurprisingly, I’ve become a little preoccupied with teasing out my understanding of the relationship between body image and eating disorders in an era in which even saying those words in the same sentence sparks visceral reactions among listeners.

This post is not about whether body image causes eating disorders or not (sorry to disappoint). It is, however, about one of the best articles I’ve stumbled across thus far that seeks to shed some light on the ways in which those with eating disorders (specifically anorexia nervosa, in this case) might experience bodily sensations, which in my view is much more interesting than quibbling about whether body image is the primary causal factor for eating disorders.

In the article, … Continue reading →

Culture and Eating Disorders: The Thin Ideal in Singapore

The paper I’m writing about in this post is a master’s thesis published elsewhere in adapted form as a book chapter – not the usual subject here, admittedly. However, for lack of more detailed qualitative research, it’s quite useful in fleshing out some of the observations in more descriptive studies on Singaporean eating disorder patients. This origin is one among a few other caveats to bear in mind; among them, Isono Maho’s ethnography does not aim to be a representative study of ED patients in Singapore, but rather a reflection on the aspects of Singapore culture that related to her interviewees’ particular experiences. Some of the themes Isono Maho found in this data set, nevertheless, help to supplement other studies’ findings, including those indicating that patients with eating disorders in Singapore tend to:

  • Present with body image concerns
  • Attribute comments and judgments from others as factors in their eating disorders.
Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 2

I previously looked at two retrospective studies of anorexia patients in Singapore, which primarily concerned female patients. In this study, Tan et al (2014) looked at 72 male-identified patients diagnosed with all forms of eating disorders.

  • 1% had anorexia nervosa (15.3% binge-purge subtype, 20.8% restrictive subtype)
  • 3% had bulimia nervosa (27.8% purge subtype, 5.6% non-purge subtype)
  • 5% had EDNOS
  • 9% had BED

The mean age at intake was 19.9 years old; patients were mainly students (41.7%) and national servicemen (41.7%). Compulsory army service (National Service) usually takes place in the two years after high school graduation, though some may defer until completing further studies. The typical age range for those in National Service is 19-24.

Of the patients in the study, 88.9% identified a precipitating factor for their eating disorder, including being overweight (59.7% reported pre-morbid obesity) and having people make comments about their body. 68.1% of patients … Continue reading →

Eating Disorders are a Political Issue: Bulimia Nervosa and Advanced Capitalism

If you know me even a little bit, you can imagine my glee at coming across a paper entitled “The Political Economy of Bulimia Nervosa.” YES! I exclaimed. Let’s explore the ways in which our systems of food production are linked to eating disorders. Let’s complicate the idea of “the social” as it relates to eating disorders and do an analysis of the complex socio-political and economic forces that govern our world.

So, let’s get right into it, shall we?

The Article

Pirie (2011) argues that it is important to understand eating disorders from a political economic perspective so that we can look beyond an equation of the “cultural” and media representations of femininity. The way in, he suggests, is through a look at how food systems have shifted since the time at which bulimia nervosa was introduced as a psychiatric diagnosis, around 1970.

The article is not the kind … Continue reading →

Culture and Eating Disorders: A Singaporean Perspective — Part 1

Some previous posts on this blog have explored whether eating disorders might (or might not) be considered culture-bound, or in other words specific to or presenting specifically in certain cultures. If you consider eating disorders to be “culture bound,” they would present primarily in Western cultures, with non-Western cultures ‘receiving’ eating disorder pathology through Westernization. In this post, I explore eating disorders in the Singaporean context to continue to unpack the relationship between culture and eating disorders. Singapore is an interesting place in which to look at eating disorders (not just because I live there) because it complicates the idea of “culture-boundedness.”

Studies have been conducted in Asia; primarily in Hong Kong and to a lesser extent Japan. Most notably, Lee (1991) found non-fat-phobic presentations in Hong Kong supported by Ngai, Lee & Lee (2000) (see this post for more on the Ngai study). Singapore is … Continue reading →

Is The Doctor In? Eating Disorders Training Amongst Medical Professionals — Part 3

The thing about critiquing systemic issues like lacking training environments for medical professionals (and others) is that we have to be cautious to not place undue blame on those who are stuck immobilized between the desire to a) train or b) get training in eating disorders. If the solution to the egregious lack of training was simple, I feel sure that someone would have done it already! What I am gesturing at, here, is that the reasons behind lacking training opportunities are deeply rooted in socio-political, historical, and economic trends and policies. Those providing training and those seeking training do not exist in some glorious black hole devoid of austerity (frugalness, restrainedness) and neoliberalism.

In this post I’ll focus on a few studies that help to illuminate why these gaps in training might exist, including dominant sentiments (in the general public, in government, in training environments themselves) toward eating disorders. … Continue reading →

Is the Doctor In? Eating Disorders Training Amongst Medical Professionals — Part 2

It is challenging for me to rein myself in when I start ranting about the poor state of affairs of eating disorder training for medical professionals. However, I reconcile my critical ranting with a paradoxical penchant for optimism. I figured, in my searching, that there must be something out there that gives us more to work with. Is there a functional model of providing training for medical professionals? At the very least, are the opportunities that do exist doing a good job at equipping healthcare providers with the skills they need to begin to navigate the complexity of eating disorders?

Building on part one, in which I highlighted 2 studies offering some challenging knowledge around how little is on offer within medical training environments, I will focus here on 2 studies about the outcomes of training. The first, a UK study, explores whether medical professionals are trained in eating disorders … Continue reading →

Is the Doctor in? Eating Disorders Training Amongst Medical Professionals — Part 1

Something that has often shocked and, frankly, appalled, me is how little training exists for those at the front line of eating disorder service delivery. I’m talking about people like family doctors, teachers, coaches, and others who might act as key gatekeepers for eating disorder services; those who don’t make eating disorders the focus of their practice but who likely encounter people with eating disorders as a part of their work life.

When I hear horrible stories about doctors shrugging off symptoms of eating disorders because the person presenting to the office does not “look like they have an eating disorder,” I want to cry. When I talk to teacher friends about the lack of built-in training around eating disorders (sometimes they have sought out opportunities to enhance their mental health awareness, but these don’t tend to be built in), I wish I had more to offer them. When I … Continue reading →