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.

The study includes 20 participants, with 11 having a diagnosis of BN, 7 of AN, and 1 EDNOS. The researcher narrowed this group to 16 interviewees for the purposes of …

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 also acknowledged body image issues, particularly around their abdomen. 66.7% engaged in excessive exercise.

If you look at these statistics, you can see an illness pathway that is distinct from …

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 of research study I usually write about for this blog. It is more of a theoretical exploration. So, there were not participants and “method,” per se. Instead, the …

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 like Hong Kong in its rapid economic development, coupled with a competitive and individualistic culture that places high value on academic achievement. However, the two broad studies on anorexia nervosa …

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. I’ll also highlight some promising directions in rectifying the situation. I’ll start with an exploration of the potential ramifications of this lack: burnout amongst those who do decide to treat …

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 and how well this training equips them to handle eating disorders in their various clinical fields. The second, from Canada, looks specifically at psychiatrists, who we might think would …

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 listen to young athletes talk about their coach’s prescribed low-carb diet for the team, I want to scream.

It becomes clear to me, through these encounters and others, that we …

Disclosure and Pathways to Treatment in Eating Disorders

We hear a fair bit about the length of time it can take to access eating disorder treatment. Delays are particularly distressing as the evidence points to better outcomes for those who receive timely care for their eating disorders (e.g. Treasure & Russell, 2011). We know about some of the potential barriers to care for eating disorders, including the lack of specialized services, the stereotypes and stigma that can impede formal and informal help-seeking, and the financial costs of seeking care not always covered by insurance. However, we know less about when people with eating disorders disclose their struggles, who they disclose to, and how this impacts their path to care.

When I was searching for articles related to treatment access for eating disorders, I came across a preliminary study published in 2012 by Gilbert and colleagues investigating disclosure of eating disorders and subsequent pathways to care. Because it is a brief report, I was curious to see whether others had taken the work in the “future directions” the authors suggest. However, I could find very few studies …

Reflecting on the 2015 International Conference on Eating Disorders

When I get back from conferences I always have this odd mix of elation and overwhelmedness. This is never more acute than when I return home from an eating disorder conference. I get back to my apartment, flop down on my couch, and revel in the silence- while stewing in my mind about everything that happened, how to make sense of it, and where to go from here.

Sometimes it takes a bit of time to really digest (apparently I can’t write about eating disorders without inadvertently using food or bodily metaphors!) all that went on. So, I appreciate your patience in waiting for this post. In case you don’t follow my incessant Tweeting, last week I was at the International Conference on Eating Disorders (ICED). Last year, I had my Science of Eds partner in crime with me, and the year before that she went solo (recaps here and here).

I’d like to begin by saying how wonderful it is to hear people talk favorably about the blog. I love blogging here, and I am so grateful to …

Not So Fast: Is There a Connection Between Religious Fasting and Eating Disorders?

I’ve always wondered about how being encouraged to fast for religious reasons might impact those who are vulnerable to eating disorders and those who already have eating disorders. I can’t imagine it would be easy to be around others who were fasting in the name of religion while struggling with an eating disorder. Equally, I can certainly see the dangers of participating in fasting for those who are predisposed to eating disorders.

Despite not being religious myself, however, I understand that fasting is important to some people who subscribe to religions that encourage the practice. So, how might we balance the potential dangers of fasting with the freedom of religious observance? And, what is the impact of religious fasting on individuals with eating disorders, or those developing eating disorders?

In this post, I’ll highlight some of the main findings from 2 studies about religious fasting and eating disorders: one quantitative study exploring the experiences of women in Bulgaria and one case series about eating disorders and Ramadan.

Fasting: Uniformly Negative?

It would be easy for me to say that no …