Date: Sat, 25 Oct 97 11:23:30 CDT
From: rich%pencil@VMA.CC.ND.EDU (Rich Winkel)
Subject: Women's Eating Disorders Go Global
/** headlines: 123.0 **/
** Topic: Women's Eating Disorders Go Global **
** Written 6:39 PM Oct 24, 1997 by mmason in cdp:headlines **
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/* ---------- "[B95: ] Eating Disorders Go Global" ---------- */
From: Varda Ullman Novick <email@example.com>
Women's Eating Disorders Go Global
By Sonni Efron, The Los Angeles Times
Saturday, October 18, 1997
SEOUL--Thirty miles south of the border with starving North
Korea, young women in the South Korean capital are
starving themselves, victims not of famine but of fashion.
Dr. Si Hyung Lee has seen this dark side of affluence
and modernity. He remembers best the patient who died of
respiratory failure. "She was a pediatrician's daughter,"
said Lee, director of the Korea Institute of Social
Psychiatry at Koryo General Hospital in Seoul. "Her father
and mother were both doctors."
But her parents failed to realize that their teenager
suffered from anorexia nervosa--a disease almost unheard of
in Korea a decade ago--until it was too late to save her.
If Asia is a reliable indicator, eating disorders are
Anorexia--a psychiatric disorder once known as "golden
girl syndrome" because it struck primarily rich, white,
well-educated young Western women--was first documented in
Japan in the 1960s. Eating disorders are now estimated to
afflict about 1 in 100 young Japanese women, almost the same
incidence as in the United States, according to retired Tokyo
University epidemiologist Hiroyuki Suematsu.
Over the past five years, the self-starvation syndrome
has spread to women of all socioeconomic and ethnic
backgrounds in Seoul, Hong Kong and Singapore, Asian
psychiatrists say. Cases also have been reported--though at
much lower rates--in Taipei, Beijing and Shanghai. Anorexia
has even surfaced among the affluent elite in countries where
hunger remains a problem, including the Philippines, India
Doctors in Japan and South Korea say they also have
noticed a marked increase in bulimia, the "binge-purge
syndrome" in which patients gorge themselves, then vomit or
use laxatives to try to keep from gaining weight, sometimes
with lethal consequences.
Experts debate whether these problems are caused by
Western pathologies that have infected their cultures via the
globalized fashion, music and entertainment media or are a
generic ailment of affluence, modernization and the
conflicting demands now placed on young women. Either way,
the effects are unmistakable.
"Appearance and figure has become very important in the
minds of young people," said Dr. Ken Ung of National
University Hospital in Singapore. "Thin is in, fat is out.
This is interesting, because Asians are usually thinner and
smaller-framed than Caucasians, but their aim now is to
become even thinner."
In the West, the average body mass index, or BMI, which
assesses weight relative to height and determines body
composition, ranges from 20 to 25 for a healthy young female,
Ung said. Among young Chinese women, the average BMI is 20,
Nevertheless, a weight-loss craze has swept the
developed countries of Asia, sending women of all ages--as
well as some men--scurrying to exercise studios and slimming
Liposuction surgeons have popped up in Seoul, as have
diet powders and pills, cellulite creams, weight-loss teas
and other herbal concoctions "guaranteed" to melt away the
Anything to Be Thin
In Hong Kong, 20 to 30 types of diet pills are in common
use, including variations on the "fen-phen" combination of
fenfluramine and phentermine that was banned in the United
States last month for causing heart damage, said Dr. Sing
Lee, a psychiatrist at the Chinese University of Hong Kong
who has written extensively on eating disorders. Though the
Health Ministry has asked pharmaceutical companies to
withdraw the offending drugs, "I'm sure new ones will be
coming out right away," Lee said.
In Singapore, where the anorexia death of a 21-year-old,
70-pound student at the prestigious National University made
headlines last year, dieting itself has become a fashion
statement. On Orchard Road, the city's toniest shopping
district, a hot-selling T-shirt designed by "essence" bears
this stream-of-consciousness essay on modern female angst:
"I've got to get into that dress. It's easy. Don't eat .
. . I'm hungry. Can't eat breakfast. But I ought to . . . I
like breakfast. I like that dress . . . Still too big for
that dress. Hmm. Life can be cruel."
In Japan, where dieting is less a trend than a way of
life for many young women, the principle that thinner is
better is now being applied to facial beauty. A recent subway
flier for a young women's magazine pictured an attractive
model complaining, "My face is too fat!"
Drugstores and beauty salons offer face-reducing seaweed
creams, massage, steam and vibration treatments and even
Darth Vader-esqe facial masks designed to promote sweating.
The Takano Yuri Beauty Clinic chain, for example, now
offers a 70-minute "facial slimming treatment course" for
$157 at 160 salons across Japan, and reports that business is
South Korea is perhaps the most interesting case study
since, until the 1970s, full-figured women were seen as more
sexually attractive--and more likely to produce healthy sons,
South Korea's Lee said. "When I was a kid,
plumper-than-average women were considered more desirable;
they could be a first son's wife in a good house," he said.
But standards of beauty have changed dramatically in the
1990s with democratization as South Korea's government has
decontrolled TV and newspapers, allowing in a flood of
foreign and foreign-influenced programming, information and
By 1994, a study by the Korea Institute of Food Hygiene
found that 90% of high school girls who were of normal
weight, as defined by a BMI of 20 to 25, believed themselves
to be overweight.
A follow-up study the next year found that Korean women
were, in fact, getting skinnier. The institute's 1995 survey
of 6,700 adults older than 20 found that 21.3% of women were
underweight, with a BMI of less than 20, a 2.5% percent
increase from 1994. Some 19.7% were overweight, while only
2.2% were classified as obese.
A recent newspaper article about the changing dimensions
of Miss Korea beauty queens confirmed what many Korean women
already suspected: While the height of the successful
contestants has risen steadily, from 5 feet 4 in 1975 to 5
feet 7 in 1995, their weight has not budged over 112 pounds.
"The 'be slim' trend starts earlier now, even in
elementary school," said the institute's Dr. Kim Cho Il.
"They shun overweight boys and girls--especially girls--as
Dieting by growing teenagers often leads to inadequate
calcium intake and weaker bones. Kim is worried about an
increase in osteoporosis cases when this generation of girls
"The dieting will also result in weaker physiques and
lessened resistance against disease," she said.
Meanwhile, women in their 20s worry that employers and
prospective spouses will pass them by if they are plump.
Some of Lee's eating-disorder patients started dieting
after being nagged by mothers to lose weight to find a
husband. Most of the anorexic patients tend to be serious,
studious, obedient young women who do not think there is
anything wrong with them and who usually are dragged into the
clinic by frantic parents, Lee said.
"If they are skinnier than average, Koreans decide there
must be something medically wrong with them, so first they
take them to the herb doctor" for a deer-horn powder that is
thought to "build up their spiritual as well as physical
forces," Lee said. A 20-day course of deer-horn treatment
costs about $1,095, he said.
Many of these young women are misdiagnosed as having
stomach problems or other ailments before at last being
referred for psychiatric help, he said.
Many bulimia sufferers never seek medical attention, and
since they tend to be secretive about their condition,
psychiatrists said there are no reliable statistics about
incidences of the condition.
South Korea's only survey of eating disorders, conducted
among college students in 1990, found that 0.7% suffered from
anorexia and 0.8% from bulimia, but those rates "may be a
little higher now," said Han O Soo, a neuropsychiatrist at
Central Hyundai Hospital.
Recent studies in the United States have concluded that
roughly 1% of women ages 18 to 35 suffer from anorexia and
from 6% to 12% may suffer to some degree from bulimia.
Comprehensive studies of the incidences of anorexia and
bulimia have not been conducted in Asian nations.
South Korean psychiatrist Dr. Kim Joon Ki, who spent a
year in Japan studying eating disorders, said the increase in
such pathologies over the past few years has been phenomenal.
"Before I went to Japan in 1991, I had seen only one anorexia
patient," Kim said. "In Japan they told me, 'Korea will be
next, so you should study this now.' And sure enough, they
Kim said he has seen more than 200 patients, about half
of whom were anorexic and half bulimic, in the 2 1/2 years
since he opened a private eating-disorder clinic. "Lately I
have so many calls that I can't even give them all
appointments," he said.
But Kim said his new book on eating problems, "I Want to
Eat but I Want to Lose Weight," is selling poorly. "Readers'
attention is still focused on dieting, not on eating
disorders," he said.
Dieting is not only trendy, it's a necessity for many
South Korean women who want to fit into the most fashionable
clothes--some of which are made in only one small size that
is the equivalent of an American size 4, said Park Sung Hye,
27, a fashion editor at Ceci, a popular monthly style
magazine for 18- to 25-year-old women.
"They make just one size so only skinny girls will wear
it and it will look good," Park said. "They think, 'We don't
want fatty girls wearing our clothes because it will look bad
and our image will go down.' "
As a result, "If you're a little bit fatty girl, you
cannot buy clothes," she said. "All of society pushes women
to be thin. America and Korea and Japan all emphasize
Park said eating disorders are increasing but still are
relatively rare. "If, say, 100 people are dieting, maybe two
or three have bulimia or anorexia, so it's not enough to
worry about," she said. But in the articles she writes on how
to diet, she cautions readers against excess, warning, "A
model's body is abnormal, not normal."
'Everything Has a Price'
Park said young Koreans' attitudes toward food differ
from those of their elders, who remember hunger after World
War II and the old greeting, "Have you eaten?" and fat as a
sign of prosperity. "Now skinny [means you are] more wealthy,
since everyone can eat three times a day," Park said.
Young women interviewed in Seoul's swanky Lotte
department store said dieting is a necessary evil.
"Boys don't like plump girls," said Chung Sung Hee, 19,
who at 5 feet and 95 pounds considers herself overweight. "I
don't know whether they are serious or not, but sometimes
they say I'm plump. . . . So I try to lose weight. I go
without food, and my friends use milk diets or juice diets,
but we don't last that long."
Han Soon Nam, 29, an advertising company employee, said
of dieting: "I don't think it's good, but it is the fashion.
Everything has a price. You lose your health to get
Several psychiatrists blamed the global media's
ubiquitous use of hyper-thin supermodels, movie stars and pop
music figures for broadcasting an unrealistic female beauty
ideal around the globe--and said they think it is
"The women's magazines do run articles about the dangers
of dieting, but in the same issue they run stories about how
to lose weight," said Kozo Shimosaka, a Japanese psychiatrist
who has been studying eating disorders since 1961.
"Apparently, if you don't have a diet article in your
magazine, it won't sell."
Singapore's Ung observed: "I don't think you can block
the media message. Singapore is pretty good about censoring
stuff, but there's a limit to what you can control."
But Hong Kong's Lee believes that it is not the media
that are to blame for the increase in eating disorders, but
underlying problems. These can include low self-esteem,
sexual abuse, academic failure, difficulties with parents and
conflicts between women's traditional roles and the growing
demands that they achieve educational and career success as
well, he said.
"The cultural prevention is not to give Prozac or
prescribe psychotherapy, but to find social means to empower
women," Lee said. "Society judges women far too physically."