Updated: Jan 12
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The prevalence of eating disorders is increasingly common in Singapore. A study in 2020 has shown that 6.2% of its participants were screened positive for a clinical eating disorder, while 19.5% were at high risk of developing one. 
Eating disorders mostly occur in growing children and teenagers, who tend to have low confidence in their body shape and weight. However, if left unchecked, it can morph into something extremely dangerous that affects the health of the person.
What are eating disorders?
Eating disorders are a health condition characterised by severe and persistent disturbances in eating behaviour, as well as distress over body weight and shape. 
Eating disorders are serious. They can affect the person physically, psychologically and socially. Women, especially adolescents, teenagers and young adults, are more likely to develop eating disorders — although it can also happen to men as well.
What are the different types of eating disorders?
There are different types of eating disorders, such as:
Anorexia nervosa: Anorexia nervosa is a type of eating disorder that is characterised by abnormal weight loss or a lack of appropriate weight gain in growing children.  People with anorexia nervosa typically have difficulties maintaining a healthy body weight for their height and age. They also tend to have a fear of weight gain and place excessive emphasis on avoiding weight gain, which results in self-starvation.
Bulimia nervosa: Bulimia nervosa typically alternates between binge and compensatory behaviour. People who suffer from bulimia nervosa tend to binge on large amounts of food in a short period of time. Binges are followed by compensatory behaviours which prevent weight gain. Compensatory behaviours can include self-induced vomiting, fasting, use of laxatives, strict diets or excessive exercise.
Binge eating disorder: Binge eating disorder is characterised by recurrent episodes of consuming large amounts of food in a short period of time, often to the point of discomfort. People who suffer from binge eating tend to lose control over their eating habits and tend to feel disgusted or ashamed after the episode. 
Other Specified Feeding and Eating disorder (OSFED): Previously known as Eating Disorders Not Otherwise Specified (EDNOS), OSFED is a serious, life-threatening eating disorder that encompasses individuals who have an eating disorder but do not meet the strict criteria of anorexia nervosa or bulimia nervosa. Examples of OSFED include:
Atypical anorexia nervosa: All criteria of anorexia nervosa are met except significant weight loss.
Low-frequency binge eating disorder: All criteria of binge eating disorder are met except at lower frequency and/or occurring for less than 3 months.
Low-frequency bulimia nervosa: All criteria of bulimia nervosa are met except binge eating and compensatory behaviour occurs at low frequency and/or for less than 3 months.
Purging behaviour: Purging behaviour (e.g. vomiting, use of laxatives or excessive exercise) to influence body weight or shape without binging.
Night eating syndrome: Recurrent and excessive food consumption at night
Avoidant Restrictive Food Intake Disorder (ARFID): ARFID refers to the highly selective eating habits, disturbed feeding patterns or both. People who suffer from ARFID have difficulty digesting food and tend to avoid food of specific texture, smell or colours. As such, they tend to have nutritional and energy deficiencies. Growing children may also be unable to gain weight.
Pica: Pica is a type of eating disorder whereby people repeatedly eat non-food items such as coal, paint and dirt. However, they do not have another aversion to other food items.
Rumination disorder: Rumination disorder is when there is repeated regurgitation and re-chewing of food after eating (i.e. swallowed food is brought back to the mouth, re-chewed and then re-swallowed).
What are the causes of eating disorders?
There are many causes of eating disorders, ranging from biological factors such as genetics to environmental causes. 
Genetics: Research has shown that genetics play a role in the development of eating disorders. People whose family members suffer from eating disorders tend to have a higher chance of developing an eating disorder. Studies have also shown that anorexia nervosa and bulimia nervosa are significantly influenced by genetics.
Biological factors: Abnormalities in certain neurochemicals or hormones in the body have been linked to eating disorders. For example, dysregulation of neurochemicals such as 5-hydroxytryptamine or the mutation of estrogen-related receptor has been closely linked to the development of eating disorders. An increase or irregularities of the estrogen hormone has also led to disturbances in eating behaviours.
Psychological factors: Psychological factors such as low self-esteem or body dissatisfaction can result in people engaging in eating behaviours such as purging or extreme dieting in order to achieve their ideal body shapes. This can result in eating disorders. Psychological factors can be influenced by critical comments from parents, peer pressure to conform to societal expectations or even the unrealistic image of ideal body types shown by the media.
Stress or trauma: High levels of stress or the experience of a traumatic event can increase the risk of the development of an eating disorder.
Here are some tips on how to manage your stress.
What are the symptoms of eating disorders?
It is important to be able to identify symptoms of eating disorders so that treatment can be sought. General symptoms that suggest that a person may be suffering from an eating disorder include:
Skipping meals or making excuses not to eat
Excessive focus on healthy eating
Persistent worries about being fat, or constantly talking about losing weight
Specific symptoms differ according to the type of eating disorder that one is suffering from.
Extremely restricted eating
Dramatic weight loss
Relentless pursuit of thinness and unwillingness to put on a healthy amount of weight
Intense fear of gaining weight
Distorted body image
Thinning of bones
Brittle hair and nails
Dry and yellowish skin
Lethargy or constant fatigue
Chronically inflamed or sore throat
Swollen salivary glands around the neck and jaw
Enamel erosion with sensitive or decaying teeth
Acid reflux disorder or other gastrointestinal problems
Intestinal distress and irritation from laxative abuse
Severe dehydration from purging
Binge eating disorder:
Eating unusually large amounts of food in a specific time frame e.g. 2 hours
Eating even though you are not hungry
Eating fast during binging episodes
Eating to the point of extreme fullness
Feelings of disgust, shame or guilt after binging episode
Other Specified Feeding and Eating disorder (OSFED):
Symptoms of binge-eating followed by behaviours to prevent weight gain such as self-induced vomiting or consumption of laxatives
Dieting by reducing the amount of calories or food consumed
Extreme focus on body image
Need to burn off calories consumed through excessive exercise
Extreme purging behaviours such as frequent trips to bathrooms after meals and signs of vomiting
Avoidant Restrictive Food Intake Disorder (ARFID):
Dramatic weight loss
Limited range of preferred food that gets narrower over time
Fears of choking or vomiting
Persistent consumption of non-food items for at least one month
Repeated regurgitation of food for at least one month
What tests are there to diagnose eating disorders in Singapore?
Diagnosis is important in determining how severe someone’s eating disorder is, and to help the doctor to come up with an effective treatment plan.
Firstly, the doctor will carry out a patient assessment. This includes getting information about the patient’s history such as: 
Attitude towards eating, nutrition and appearance
Family history of eating disorders or psychiatric disorders
Family history of obesity
Assessment of other psychiatric disorders e.g. anxiety or depression
Examination of medical, nutritional, psychological and social functioning of the patient
After obtaining background information about the patient, the doctor will carry out a series of medical assessments in order to determine the severity of the eating disorder. This is because eating disorders usually result in medical conditions.
Some medical assessments that the doctor will do include physical examinations and laboratory testings:
You may be referred to the Accident & Emergency department of a hospital for admission if you are deemed medically unstable. Criteria for medical instability include:
Resting heart rate less than 50 beats per minute
Significant changes to blood pressure from lying to standing position
Body temperature less than 35.5℃
The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) is a tool used by healthcare professionals to diagnose and determine the severity of several mental health disorders, including eating disorders. The criteria for being diagnosed with eating disorders are listed in the table below:
What treatments are available for eating disorders in Singapore?
Cognitive-behavioural therapy (CBT)
CBT helps the patient to change their thinking pattern by recognising the negativity in their thinking, and to re-evaluate them in a healthier way. CBT has shown to be effective in patients with eating disorders, especially for those who are diagnosed with anorexia nervosa, bulimia nervosa and binge eating disorder.
Maudsley approach/Family behavioural therapy (FBT)
The Maudsley approach, or FBT, seeks to reduce conflict or distress amongst family members and improve interactions between them. Family encouragement and their active support are important in the treatment of eating disorders as well as the prevention of a relapse. 
The Maudsley approach does not seek to blame the child, but instead to focus on moving forward from the disorder.
The Maudsley approach consists of 3 phases, namely:
Phase 1 – Weight Restoration:
This is typically conducted over 15-20 treatments sessions, taking about 1 year. The therapist focuses on the dangers that the eating disorder has on the body, assessing the family’s typical interactions and eating habits, as well as assisting the parents in re-feeding their child.
Phase 2 – Returning control over eating to the patient:
In Phase 2, the patient learns to regain individual control over their eating habits again. This will commence when the patient is at 87% of their body weight.
Phase 3 – Establishing healthy adolescent identity:
Phase 3 starts when the patient is able to maintain above 95% of their ideal weight on his or her own, and refrains from disturbances in eating behaviours. Phase 3 also focuses on the psychological consequences that the eating disorder has had on the patient and helps to establish a healthier identity.
A nutritionist or a dietician will help to incorporate healthy eating behaviours into your daily life. The aim is to help the patient lead a healthier lifestyle by consuming healthier food.
Medical monitoring is very common in patients with eating disorders. Your doctor may order you to attend regular checkups that include weigh-ins, blood tests and other health screenings. This is to ensure that you are responding to the treatment.
For those who are suffering from extreme eating disorders, your doctors may ask you to be admitted into the hospital, where round the clock care can be given to you. This can help them monitor your progress and to provide more support in the treatment of the disorder, until you are well enough to continue treatment at home.
What are the consequences of eating disorders?
Eating disorders can have serious repercussions on your health, and can give rise to medical conditions such as: 
Amenorrhea: Absence of menstruation
Bradycardia: Slowing of heart rate to less than 60 beats per minute, which can lead to heart attack or heart failure
Low blood pressure
Gastrointestinal complications such as gastric obstruction or gastric perforation
Brain atrophy: Reduction in volume of brain which can affect judgement, memory and attention
Osteoporosis due to decrease in bone density
Anaemia: Low blood count
Are there any support groups for eating disorders in Singapore?
Having a good support group can contribute to better response to treatment, as well as prevention of a relapse.
Some support groups for eating disorders that are available in Singapore include
WE CARE (phone number: 3165 8017)
Community Health Assistance Team (phone number: 6493 6500 or 6493 6501).
There are also dedicated support groups available at certain hospitals, such as the Support for Eating Disorders Singapore (SEEDS) at Singapore General Hospital. You may call 6321 4377 to book an appointment.
Are eating disorders genetic?
While eating disorders are not 100% genetic, family and twin studies have shown that heredity has a strong link to eating disorders. Those who have a family member that has been diagnosed with an eating disorder are 7 to 12 times more likely to develop an eating disorder. Researchers have also estimated that genetic factors such as heredity are responsible for about 50-70% of the development of an eating disorder.
What can be done to prevent eating disorders?
Eating disorders are serious health issues with serious consequences. Thankfully, there are ways to help prevent eating disorders from occurring, such as: 
Learn about healthy eating and leading an active lifestyle from the right sources e.g. schools or government agencies 
Avoid judging oneself or others based on body shape and weight.
Discourage the idea that a particular diet, weight or size will lead to happiness and fulfilment.
Avoid categorising food as “good” or “bad”. Eat in moderation.
Reassure and reaffirm your child constantly and encourage them to be confident of their bodies.
What are the costs of eating disorders treatment in Singapore? Are they Medisave claimable?
Therapy costs in Singapore can cost anywhere from $60 to $200 per session. Of course, choosing a private therapist or visiting a private clinic can increase the cost of treatment.
If your eating disorder warrants additional attention and you are asked to be hospitalised, that will increase your treatment costs as well — depending on the type of hospital you are admitted in.
Unfortunately, treatment of eating disorders is not Medisave claimable, as they are not included under the Chronic Disease Management Programme (CDMP).
Eating disorders are a serious mental health disorder which can affect both the sufferer and their family as well. We hope that this article has enabled you to gain a deeper understanding of eating disorders.
If you suspect that you may have an eating disorder, it is good to visit a doctor early so that treatment can be provided to you.
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This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.
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