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 this study; in this group, participants ranged in age from 15 to 26 years old, with 13 BN patients, 2 AN patients, and 1 EDNOS patient. 4 of the BN patients had crossed over from AN, and 6 more had a history of significant weight loss (between 5 to 20 kg) prior to diagnosis. This population has a different illness pathway from the typical patient profiled in Lee (2005) and Kuek (2015) – a point that might be worth bearing in mind for interpreting the results.
Most interviewees said that others’ direct comments made them internalize fat hatred. One, for instance, acknowledged that:
Genetic effects might be possible. But I cannot change [my genes]. I think situations that people experience and the environment that they live in are more important. (p.153)
Maho notes that similar “cultural meanings […] loomed large” (p.162) in other interviewees’ experience of eating disorders. They sought to make their experiences relatable and interpretable in light of their social environment and influences, perhaps a kind of push-back against popular understandings of eating disorders. The patients found therapists and doctors to be much more helpful than family and friends in dealing with their struggles; for example, one informant reported that her eating disorder was seen as ‘vain’ (p.75) by close friends and family.
Maho argues that this cultural emphasis on weight consciousness traps her study participants in an interesting paradox. Commenting on other people’s bodies in casual conversation is “one of the rude things done in Asia” (p.79), where “fat was less acceptable” (ibid) than in Western countries. The author argues that Singaporean clothing is sized smaller, that media representations of thin women are ubiquitous, and that slimming centers have been proliferating as evidence for her point. However, cultural media underplay this obsession with fatness and thinness. People (and media) tend to discuss celebrities who successfully lose weight in terms of “health” and “well-being” rather than attractiveness (a recent example is Chen Liping– content note: article in link contains weight loss numbers and methods).
Does that mean that people don’t want to be thinner for the sake of being thinner? Probably not – rather, the author suggests that women in Singaporean society are trying to live up to the ideal of an “intelligent, disciplined, and diligent” woman (p.135) – in their careers and family life as well as their management of their own body. This woman is one who diets but simultaneously denies that appearance is important (because she knows better to value superficial looks) – one for whom work-life balance comes almost effortlessly. It’s this ideal that ‘lean-in feminism’ espouses, an ideal that not only conceals social inequality and disadvantage, but also places this invisible burden of labor on the individual woman.
Going back to eating disorders, this paradoxical messaging loomed especially large for one informant, who had mixed feelings about whether or not she ought to be assimilating her peers’ and family’s messages about her weight. The effort and struggle that maintaining her weight involved became a source of shame, rather than an understandable experience that any woman would go through. The same interviewee emphasized the importance of being told by doctors and therapists she was not ‘useless’ (p.160), signalling how her eating disorder fed into larger anxieties about her self-worth and value. If the perfect woman is one who is intelligent and disciplined in all areas, someone who visibly struggles to achieve such perfection is easily labelled as ‘vain’ or ‘weak’. In such circumstances, it can be easier to just not talk about it at all.
The author further goes on to link this to the prevalence of ‘kiasu culture’ (130) in Singapore, as attested to by medical professionals she spoke to. Kiasu literally means ‘afraid to lose’ – one of those vague but immediately understood terms that everyone in Singapore subscribes to (with kiasu parents proudly posting on their eponymous forum). It’s not quite the same as the ‘rat race’ or other similar terms – there’s something uniquely Singaporean about it (or so many would assert) that extends even but is also super hard to pin down and analyze. Broadly put, it refers to the Singapore culture of needing to get ahead in the rat race and a highly competitive, achievement-oriented culture.
At an individual level, this ‘kiasu culture’ translates to a very competitive, achievement-oriented mindset. One thing that struck me in the quote I reproduced above from an informant is how she said that she could not ‘change her genes’, but went on to imply that she should be able to rise above them, so to speak, and not be limited by her biology. Struggles – mental and physical – with her weight seem to her a question of willpower and discipline, where a more forgiving approach might say ‘embrace your body’s natural weight!’ (Also ignored by participants, and the media as large: the matter of class, because not everyone can pay tens of thousands for slimming center treatments).
I’ve focused here on one perspective highlighted in Maho’s thesis, which by no means is representative of all the eating disorder patients she interviewed. One other informant, in contrast, reports that she “starved [myself] to let [my family] know I was unhappy” (p.156), seeing her eating disorder as serving a communicative function. What all her interviewees have in common is their view of their eating disorders as deeply connected to their culture and social environment, emphasizing external triggers for their illnesses that created an internalized sense of shame and inferiority surrounding their bodies. It would be simplistic, obviously, to say that fat-shaming produces eating disorders, but in these cases at least it seems to affect how eating disorders emerge and how people experience them, for better or worse.
Limits and further questions
The author selectively presents this perspective emphasizing cultural influences, possibly at the expense of discussing other influences on her interviewees’ eating disorders. For example, depression and other comorbidities would probably be more closely linked to other patients’ eating disorders. Recall, too, that not all patients in earlier studies reported body image disturbance as influences on their eating disorder. A male perspective would also have provided grounds for an interesting comparison.
As an anthropologist, Maho is also clearly more interested in such explanations than what she refers to as a predominantly Western biomedical model of disease – a priority that she shares with her participants. I think it’s important to recognize how the participants constructed their own meanings of their illness, as a way of coming to terms with it and shaping their own recovery. However, it also perhaps suggest the need for better psychoeducation and awareness to help patients better understand the biological roots of their illness and reduce the shame or self-blame associated with the disorder.
The bigger question I have at the end of this paper is what the process of recovery looked like for the patients in this study. Maho mentions only briefly the centrality of therapists and doctors to patients in providing an understanding and less judgmental perspective. However, maybe because her participants did not consider themselves fully recovered, she largely ignored the issue of what recovery looks like in a culture that emphasizes thinness. Did her participants learn to take body-shaming comments in stride as just ‘one of the things that’s done’, or did they have to negotiate a different relationship to their social environment? What kind of conversations and discussions might be opened up by a greater receptiveness to seeing their experiences not simply as a ‘vain’ disease?
Isono Maho (2003). Thinness in Asia: Eating Disorders in Singapore as Seen Through Anthropological Eyes.
Available at Oregon State University archives
Portions adapted in the Fat Studies Reader (“Bon Bon Fatty Girl”), co-written with Dr Lee Ee Lian