Kathleen Kwok

HONG KONG (WOMENSENEWS)–Shortly after Brenda, 20, did poorly on her final exams, she became obsessed with food and began to diet.

"I felt bad about myself because I’d failed," she said, refusing to share her last name out of shame. "I wanted to prove I had discipline."

So she planned out sparse meals each morning, cut out meat entirely, and began exercising for hours daily. When she’d lost 20 pounds–more than a sixth of her body weight–her mother brought her to a new clinic for eating disorders that had just opened at Hong Kong’s Prince of Wales Hospital. The clinic’s founder, Dr. Sing Lee, diagnosed her with an illness she had never heard of: anorexia nervosa.

Anorexia, a psychiatric disease in which patients starve themselves, was once thought to be a Western disease that affected white middle- and upper-class women. But the demographics of the illness are changing. Eating disorders are being diagnosed in Asian cities from Seoul to Bangkok. In Singapore and Tokyo, the numbers of patients rival the United States, where as many as one in 36 people have eating disorders, according to the National Eating Disorder Association. More than 90 percent of people with eating disorders are women and girls.

In Hong Kong, there are 25 times as many patients with eating disorders as there were 15 years ago, according to Lee. "In the late 1980s, I’d see one or two patients a year on the hospital’s psychiatric ward," he said. "Now psych wards see that many in a week."

Until recently, the hospital psychiatric ward is where Hong Kong’s patients received treatment once their physical complications became dangerous to their health. People with bulimia, a related eating disorder in which patients consume up to 20,000 calories in one seating, then purge the food through induced vomiting, went undiagnosed and untreated because their symptoms are easier to hide.

"These patients needed a lot of time with the doctor in counseling," Lee said. "The medical system didn’t have the capacity to meet their needs."

So two years ago, Lee opened Hong Kong Eating Disorder Clinic, the city’s only clinic for patients suffering from anorexia and bulimia. The clinic received 300 phone calls from potential patients during its first week in operation. With a piano, a karaoke machine, and a pile of fashion magazines, its interior looks more like a living room than a clinic in the sterile hospital that houses it. But in Hong Kong, it is the frontline in the battle to confront eating disorders.

Market for Diet Aids Booming in Hong Kong

Many health professionals blame the sudden increase in patients with eating disorders on Hong Kong’s ballooning weight-loss industry. Consumers can purchase diarrhea-inducing herbal teas, slimming pills, cellulite creams and products to tone and thin face muscles. And fitness centers are sprouting up on nearly every city block in business districts.

"My friends skip lunch routinely and everyone is on a diet," said Eunice Leung, 24. A long-haired woman in stylish clothes that accentuate a thin frame, Leung attends university during the school year in New York. "It’s OK for women to have a little tummy in America. There’s more pressure in Hong Kong. Even if you’re flat, you want to be even smaller."

But most doctors agree the weight-loss industry is a byproduct of a larger phenomenon in Asia: modernization.

"Asia once embraced many different types of bodies as beautiful," said Kathleen Kwok, a clinical psychologist who works with Lee at the Hong Kong Eating Disorders Clinic. "Because people were poorer, a plump body symbolized wealth and the ability to bear children."

A 2000 study conducted through Chinese University compared body image perception in Shenzhen, a city along the China-Hong Kong border, a rural Chinese village in the Hunan Province and Hong Kong. Women in rural China preferred slightly larger body types on average and they dieted less despite being slightly heavier. Hong Kong women weighed less, dieted more and strove to be thinner. The study concluded that modernization equates success with "young, slender, more glamorous women."

Brenda agrees that modern pressures caused her to develop anorexia. "It wasn’t my weight ultimately," she said. "I was stressed out and I needed to control something in my life." After two years of weekly 45-minute counseling sessions with Kwok, she considers herself to be recovered. She has been accepted to a university and says she no longer obsesses about food.

"I was lucky because my mother was a nurse," Brenda said. "She knew to bring me to the clinic."

Western Values Infusing Therapy Clash with Asian Expectations

But other Asian families have trouble embracing the Western style of therapy used to treat eating disorders, Lee says. "The mother–or even father–often wants to know what happens in therapy or they ask the therapist to say or do something to their daughter," he said. "However, from a Western perspective, the therapist is accountable to the client, not parents, in terms of confidentiality."

Kwok said one mother called every time her daughter came in and asked how much weight the daughter had gained. "She got upset when I wouldn’t tell her," Kwok said.

A greater barrier to treatment is the lack of information. Philippa Yu, 28, is a social worker at the Hong Kong Eating Disorder Association, a nonprofit formed last year to provide information and support to families of patients with eating disorders. She said many patients search for information about eating disorders on English-language Internet sites. Last year, the association began a hotline for eating disorders. In the first half of 2002, the hotline has received more calls than in all of 2001. Also, Lee recently published a Chinese-language book on eating disorders that’s in its second printing.

As the problem grows, so does the need for better and more treatment. Lee’s clinic has treated 350 patients. In the next few years, Lee hopes to expand his clinic in Hong Kong and to work with colleagues to set up similar clinics in Beijing, Shanghai, Guangzhou and Bangkok.

Like Brenda, many patients are recovering and leading normal lives again. But with eating disorders striking as many as 1 in 20 Hong Kong women ages 15 to 24, this clinic barely makes a dent in the need.

Jessi Hempel is a freelance writer currently based in Hong Kong.

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Rivers Loses Closely Watched Michigan Democratic Primary

WASHINGTON (WOMENSENEWS)–Rep. Lynn Rivers, a strong champion of women’s rights, became the first female member of Congress to lose office this year in a primary against her more conservative opponent, Rep. John Dingell.

The defeat of Rivers Tuesday in the Michigan Democratic primary was a major setback for women’s and gay rights groups, environmentalists and gun-control activists, all of whom had backed her uphill battle against Dingell, the most senior member of the House of Representatives.

The two incumbent Democrats were thrown together into the same congressional district by a Republican-designed redistricting plan.

Had they not suffered that fate, both would have likely won re-election in November. Dingell is expected to coast to victory on Election Day in the solidly Democratic district in southeastern Michigan.

Rivers is only one of several women who will be leaving the House in January. New Jersey Republican Marge Roukema and Democrats Eva Clayton of North Carolina and Carrie Meek of Florida have announced they will retire at the end of the 107th Congress. And a number of women, including Republican Reps. Nancy Johnson of Connecticut, Shelley Moore Capito of West Virginia, Connie Morella of Maryland and Heather Wilson of New Mexico are in danger of losing their seats on Nov. 5.

But those potential losses could be offset by a slate of women candidates running in open seats and against incumbents this year.

–Allison Stevens covers politics in Washington.