Anorexia cases here are up and the attitude of some teens that it's hip to have the illness has doctors worried
ALL she wanted was for her sisters to stop calling her 'fat' and 'bimbo' and to win more friends at school.
And the best way to get there, she felt, was to lose the baby fat on her face. But that led her straight to hospital and 'humiliating' treatment for anorexia nervosa.
The 14-year-old's plight is sadly typical of most sufferers of the eating disorder.
Like many victims, Michelle - not her real name - is from a middle-income family, goes to an elite girls' school and does well in her studies.
Her problems started last year in Secondary 1.
Taunted by her classmates and sisters, she started rejecting food, eating only vegetables and small spoonfuls of rice for dinner, sometimes her only meal for the day.
'All the girls around me were very thin and they all seemed to have many friends. I felt very left out,' said the pale, rail-thin teenager in between sobs.
When a school trip came up earlier this year, a teacher noticed her bony frame and sallow face and decided she was not well enough to go. The school counsellor then alerted her parents.
By the time Michelle's mother, Mrs Lim, checked her into the eating disorder programme at Singapore General Hospital (SGH) last month, the 1.5m-tall teen had lost 10kg in six months and weighed just 29.5kg. She should be at least 42kg to qualify as healthy.
Mrs Lim has since taken Michelle out of SGH after objecting to its order of complete bed rest. Michelle could not shower for days and had to use a bed pan, which her mum called 'humiliating'. She also wrote to The Sunday Times and Singapore Children's Society to complain about the treatment.
But her illness did not come as a complete surprise to Mrs Lim as she had been through it herself.
'I was hoping it wasn't anorexia, but I was in denial,' said the private tutor. 'I didn't want her to end up like me.'
Michelle, who still suffers from hair loss, severe constipation and insomnia, returned to school last Wednesday, but dealing with her illness will be a 'long, hard process', said Mrs Lim.
It is a traumatic story that is becoming increasingly common here. There are no statistics on eating disorders, but a 2005 study cited 126 cases of anorexia seen by the Institute of Mental Health from 1994 to 2002.
Before 2002, SGH, the only hospital here with an eating disorders programme, saw about 20 to 30 patients a year. Last year, it saw 200.
What is concerning professionals is the attitude of some of the teens who see anorexia as hip.
'There is a copycat effect. It's like an 'in' thing among girls, especially those in girls' schools and universities,' said Dr Liow Pei Hsiang, consultant at Alexandra Hospital's psychiatry unit, where the number of patients seeking treatment for eating disorders has doubled in four years.
And so it is. Michelle and her classmates fight to be the skinniest in class. 'We would try to outdo each other by seeing who ate less that day, or who exercised more,' she said.
The most common eating disorders are anorexia, in which a sufferer severely restricts food intake, and bulimia nervosa, which involves bingeing and purging.
They hit females 10 times more than males. Females in adolescence and their 20s are particularly vulnerable, said Dr Lee Ee Lian, senior consultant psychiatrist and director of the SGH eating disorders programme.
At least one top girls' school, Methodist Girls' School, has seen a slight rise in the number of students with eating disorders but counsellor Ann Robers declined to give figures.
Teachers have been given checklists designed by Mrs Robers to help identify girls who may suffer from any psychological problems, including eating disorders.
The students are also regularly weighed in physical education class - if their weight drops sharply, the counsellor and parents are notified.
The Health Promotion Board is monitoring the issue and organises seminars for teachers and school counsellors on dealing with various health issues, including eating disorders.
SGH's Dr Lee has seen her fair share of truly challenging cases over the years, like several teen patients with body mass indexes (BMI) of nine and who were so weak they could not speak or swallow. The healthy BMI range is from 18.5 to 22.9.
One anorexic woman was hospitalised 50 times in four years while another had severe psychotic depression. 'She heard voices telling her to kill herself, which she eventually did,' said Dr Lee.
The eating disorders programme loses one patient every year to suicide, pneumonia and starvation. Not all suffer from eating disorders exclusively; some may have other psychological problems.
Studies put the mortality rate of eating disorders at between 5 and 20 per cent. But even if you do not die from it, there could be long-term effects like brain atrophy, osteoporosis and infertility.
Dr Ken Ung, of Adam Road Hospital, says 10 to 20 per cent of those afflicted never recover.
'Every time I see a case, I pray and try every trick in the book. Sometimes it works, sometimes it doesn't,' said Dr Ung, who treats up to 50 new cases a year. 'You can say, 'You're not getting out of here until you put on 5kg'. But when she leaves, she stops eating again.'
One 13-year-old sufferer who is determined never to starve herself again is June (not her real name).
Last year, the 1.53m-tall teen ate only bread and hit her condo's gym every day. 'I would look in the mirror and still think that I was fat, although I was actually very skinny. I wanted to eat, yet I told myself I hated food because I was afraid that I would get fat.'
She was always tired, getting styes and coughs that would last for months.
After her weight plummeted from 40kg to 32kg in the first four months of last year, she started to will herself to eat and is now 43kg.
The youngest of three children of a university lecturer and housewife can proudly say she wolves down four slices of pizza at one sitting. 'And I feel like a whole new person,' she said.
SELF-DELUSIONAL
'I would look in the mirror and still think that I was fat, although I was actually very skinny. I wanted to eat, yet I told myself I hated food because I was afraid that I would get fat.' JUNE, 13
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