This Newsletter aims to promote communication between schools and the Student Health Service of the Department of Health
December 2010 Issue No.49
Published by the Student Health Service, Department of Health
From the Editor
We often hear about anorexia from the news. A typical report goes like this: a girl of 18 years old suffering from anorexia and weighing 60 pounds was found fainted at home. Family members got very frightened and called the police. The girl was very skinny and malnourished. She was critical when carried by the ambulance to the hospital and became serious after rescue. In fact, the above problem did not come from a sudden. Should it be detected earlier and prevented, such serious consequence might have been avoided.
There are many causes of anorexia. Unhealthy messages prevailing in the society is also a contributing factor. Weight reduction or slimming is a widespread thinking. Many people are influenced to feel that “thin is beautiful” and slim equals to happiness. Beware that excessive dieting or wrong methods to lose weight may lead to anorexia, so do not go to the extreme. Keeping a balanced diet is the key to healthy living.
Anorexia nervosa is one kind of eating disorder. In this issue of Newsletter, the doctor of the Student Health Service introduced some details of eating disorder to us, including the symptoms and signs, causes, treatment and prevention. Let's gain more knowledge about the issue.
Feature Article - Eating Disorders
Dr. Lee Tat Nin
Anorexia Nervosa and Bulimia Nervosa are two major types of eating disorders. Data from some medical institutions showed that both the number of cases and the number of people put on treatment for eating disorders increased in the recent ten years. According to the statistics, among all students attending the Student Health Service of the Department of Health in the 2008/09 school year, 21 students were suspected to have eating disorder. They were referred to specialist clinics for further assessment and follow-up. From newspaper we read that models, famous people or pop stars suffered from this illness. Eating disorders in fact can happen in all age groups, both sexes, people of different nationalities, social and cultural background. While the majority of people affected are young females of 10 to 35 years old, males and the elderly can also be affected.
Eating disorder is an illness of both the ‘body’ and the ‘mind’. This is a disease characterized by disturbed eating habit and distorted image of the body and weight. The disease not only jeopardizes the health of the body, but also invariably affects the emotional and social well being and the quality of life. Eating disorders are classified into two main groups, Anorexia Nervosa and Bulimia Nervosa. The disease presents with both physiological and psychological features, with related changes in behaviour and body weight.
People with Anorexia Nervosa always think that they are obese, fear to eat, refuse eating or eat only small amount. They may develop some special eating behaviour, like slicing food into small pieces, eating very slowly, refusing all meats and taking vegetables and fruits only. Some of them may do excessive and vigorous exercise, use laxatives and weight control medications inappropriately, resulting in subnormal body weight and wasting. They may present with excessive thinness and weakness, pale look, cold intolerance, hair loss, constipation, osteoporosis, anaemia, absence of menses, infertility, and growth delay in children and adolescents etc. In severe cases, there may be impaired immunity, disturbed metabolism, and functional failure of the gut, kidneys and heart and even coma and death. Besides being anorexic, some may have periodic binge eating in between diet restriction episodes or other food elimination behaviour like self-induced vomiting.
People with Bulimia Nervosa have frequent binge eating behaviour when alone and consume large amount of fattening food in a short time, for example, taking lots of biscuits, chocolates and cakes within two hours. They may feel guilty afterwards and try to reduce weight by induced vomiting, heavy exercise, dieting or using laxatives or weight reduction medications abusively. Frequent binge eating with induced vomiting can lead to tooth erosion, bowel ulceration, abdominal pain, constipation, and other life threatening complications like electrolyte imbalance, irregular heart beat and heart failure.
Psychologically, people with eating disorders often have accompanying emotional problems and disturbed behaviour. These include guilt feelings, anxiety, depression, drugs or alcohol abuse and other compulsive behaviour like stealing, self harm or suicide. Eating problems can also lead to family conflicts, relationship problems, low self-esteem, loneliness or other social difficulties that may affect their academic performance and career prospect.
The causes for eating disorders include genetic influence and chemical changes in the brain. Other possible related factors may include developmental problems and emotional disturbance in adolescence, chronic illnesses, stressful lifestyle, family changes, relationship problems and peer influence.
Researches also found that some sufferers of eating disorders had been excessively controlled or over-protected by their parents, or the scapegoat in the family. They then resorted to food refusal as a tactic to fight for their requests or to take control, and develop anorexia nervosa gradually. On the other hand, the binge-eaters may eat excessively to compensate psychologically for their loneliness or dissatisfaction in life.
Nevertheless, the popular slimming culture has resulted in over-consciousness on body image and weight, and distorted people's perception on body size and shape, thus exacerbating the eating problems in the community. In accordance with the statistics from the Student Health Service, 77336 students completed the health screening questionnaire in the 2008/09 school year. One item in the questionnaire enquired specifically about students' own appraisal on their body weight. 19476 students (25.2 %) indicated satisfaction with own body weight, 10355 students (13.4 %) wished to increase weight while 30326 students (39.2 %) preferred weight reduction, with the remaining 17179 students (22.2 %) expressed no opinion. However, the fact was, among these 77336 students, only 13179 (17.0 %) were in the overweight or obese range.
Diagnosis and Treatment
To diagnose eating disorders, apart from assessing the eating habit and the body weight, professionals will do a complete body check, blood tests and comprehensive assessment on the psychosocial aspects of the client. When Anorexia or Bulimia are recognized, the dual 'physiological and psychological' illnesses have to be managed with optimal care.
Professionals will formulate individualized treatment plan for people with eating disorders according to their specific situations. Psychological interventions are the mainstay of treatment. For the cognitive-behaviour therapy, clinical psychologist will help clients to correct their distorted perceptions about food and body, to improve their self-image, to rectify the disturbed eating habit, and to attain healthy eating and weight control. In motivational therapy, the counselor will help clients to recognize the negative effects of their eating style, to understand their worries for making changes and to enhance their motivation for improvement. Family therapy targets at the family dynamics and helps to resolve relationship difficulties among family members.
Drug treatment can be used to treat the co- existing mental health problems like anxiety and depression, and to improve the nutritional state in clients with nutritional deficiencies. Dietitians will help to formulate individualized dietary plan for clients to step up their food intake gradually and get enough nutrients to improve body health. For clients who are seriously underweight or nutritionally deprived, treatment in hospitals may be more appropriate.
The follow-up treatment aims to help clients to establish a healthy eating pattern and behaviour in stages. Possible causes leading to their eating problems may be explored and these may include family and school issues, peer relationship problems and other psycho-social difficulties. Professionals will help clients to correct their negative thinking and disturbed eating behaviour and to help implement an agreed plan for achieving healthy eating habit.
Eating disorders are treatable illnesses. With appropriate psychological and nutritional care and sometimes supplemented with drug treatment, more than 80% of the sufferers will recover or get better. The family and peer relationships can also be improved significantly. Most clients will be able to enjoy active and happy lives.
1. Be aware of personal emotions and eating behaviors
When under tension, stress or negative emotions like sadness or loneliness, some people will refuse to eat while others eat excessively. When these eating behaviors become habits, eating disorders may emerge gradually. Therefore, in order to prevent eating disorders, we should not use abnormal eating or weight loss as habitual ways to evade problems or to respond to life stress.
2. Change negative thinking and learn to accept ourselves
We may sometimes have negative thoughts and unrealistic assumptions, such as "I am total failure if weight loss is not successful". This unsound assumption can shatter our self-confidence. If we have unreasonably high expectation on ourselves, we will be constantly in tension and this will make us prone to abnormal eating. We should therefore pay special attention to negative thoughts in us and to address them accordingly. Moreover, if we wrongly link up our body shape to self-confidence, and to reclaim our confidence or satisfaction merely by successful attempts to control body weight, we are paradoxically under the control of our own body weight. Provided that there is no underlying health problem, we should manage our body weight by adopting a healthy lifestyle, mainly through balanced diet and regular exercise, and to learn to accept our body size and shape, whether it is thin or fat.
3. Establish a harmonious family with healthy eating habits
Parents should set a good model by establishing healthy eating habits and accepting their body shape. Meal table is not a battlefield. Parents should maintain a harmonious eating environment, avoid disputes during meal times and make eating together an enjoyable experience. Communication and mutual trust is always the best way to maintain good family relationship. Every effort should be made to let our children feel being loved, accepted and supported. At times of disagreements, parents can discuss the issues frankly and find ways to resolve them. When circumstances allow, parents may respect and accept their children's choice and decisions. This can prevent them from eating chaotically as a protest against the family.
4. Be alert to the "thin is beautiful" fallacy and unhealthy slimming culture
Slimming and weight loss has become trendy in recent years. Even people have normal body weight, they still wish to get thinner, for they think they will look better. As the value systems of the youngsters are not firmly established, they are easily influenced by peers and the social trends. They tend to believe in the "thin is beautiful" fallacy. Some of them may put themselves on diet or do exercise excessively in order to slim down. Unfortunately, this will endanger their health
and put them at risk of developing eating disorders. Therefore, we should always be alert to media influences. When we encounter some overstated weight-loss advertisements, we should be exceptionally cautious about their genuineness and never follow their advice blindly.
How to detect early if our children have eating problems?
It is desirable that parents develop good communication with their children, understand their daily life, recognize their social and learning problems, and to encourage and support them. Parents can also observe closely the mood and behavior of their children, and whether there are changes in their usual eating and living routine. These include loss of appetite, refusal to eat together, over concern about body shape, keenness to lose weight, unsatisfactory weight gain, or frequent fluctuation in mood. The Student Health Service provides annual health screening for students, including measurement of the body height and weight to check if they are within the normal ranges. For those who are excessively underweight or with slow weight gain, they would be referred to specialists for further investigations and follow-up.
What can I do if I suspect my friends or myself have eating disorder?
Some people are more health conscious about eating and avoid consuming too much foods with high-sugar, high fat, and high cholesterol content. Some people are just choosy in food with special food preferences or not eating certain foods. These are not eating disorders. We can check our eating habit in terms of the amount and preferences. There should be no worries if the principles of balanced diet are followed (refer to the website: http://www.studenthealth.gov.hk/english/health/health_dn/health_dn_hv.html). If there are features that look like anorexia or bulimia, one should seek appropriate professional advice early, so as not to delay treatment.
If you suspect your friends suffer from eating disorders, you can discuss with them about their worries, allow them to express their concerns and feelings, and see whether they have difficulties in their study, family or peer relationship. In case there are alarming features, such as weight loss or emotional disturbances, you should show your concern, support them and encourage them to seek appropriate medical help.
Eating disorders are not simply weight loss and thinness, the disease can have serious consequences on the physical and psychosocial functioning of the sufferers. To prevent the disease, we should practise a healthy lifestyle with balanced diet and regular exercise. We should lead an active and positive life with satisfying relationship with our family and friends through mutual care and understanding. A proper attitude towards body weight is important. Not everyone needs to lose weight. If there is any concern, we can seek professional advice and guidance from dietitians and health care providers for weight control. We must always be alert to some misleading advertisements, and never abuse weight-losing drugs or treatment procedures. Eating disorders are treatable disease and medical help should be sought if we suspect someone have the problem.
References and Sources of information
Hong Kong Centre for Eating Disorders http://www.hedc.med.cuhk.edu.hk/
Hong Kong Eating Disorders Association http://www.heda-hk.org
Ellen S. Rome, Seth Ammerman, David S. Rosen, Richard J. Keller, James Lock. Children and Adolescents With Eating Disorders: The State of the Art Pediatrics 2003;111;e98-e108.
AAP Policy Statement, American Academy of Pediatrics, Committee on Adolescence. Identifying and treating eating disorders.Pediatrics. 2003;111(1):204-211.
Simon G., Gowers and Alison Shore. Development of weight and shape concerns in the aetiology of eating disorders. The British Journal of Psychiatry. 2001;179:236-242.
Jennifer L., Derenne; Eugene V. Beresin. Body image, media and eating disorders. American Psychiatry. 2006; May-June 30:3. Patrick CH Cheung, Patricia LS Ip, ST Lam, Helen Bibby. A study on body weight perception and weight control behaviours among adolescents in Hong Kong. Hong Kong Med J. 2007;13:16-21
MY View, Your View
Is it true that “eat less” helps you “get slimmer”? Weight reduction and slimming become very trendy. Our students are invited to express their views about: “eat less to get slimmer”. Happily, we find that many students view that “slim” does not mean “healthy”. “Health” is believed to be having a balanced diet, choosing “healthy” foods and doing regular exercise. Below are their views.
- Eating less does not help us get slimmer. We should do physical exercise and have a balanced diet.
- It depends on the type of food we eat. If we eat less high-fat or high- cholesterol food, “get slimmer” may be possible.
- Not just “eat less”, you also need to eat less high-fat, high-salt and high-sugar food.
- It is not necessary to get slim, the most important things are balanced diet, regular physical exercise and adequate rest.
- Disagree. Eating less would make you eat more during the next meal.
- Eat fewer chips to become healthier.
- Eating less junk food and high-fat food will help us get slimmer.
- Disagree. If we eat less, there may be imbalance of diet leading to ill-health.
- Eat less fast-food.
Friends and Health Box
Healthy physical and psychological growth and building self-esteem are of great importance to adolescents. Concern about body height and weight can be normal for them. However, one should have a correct knowledge about the body weight and body shape and follow sound methods to manage the body weight. Below is a question from a student and our reply.
This is my first time writing a letter to you. I am now 15 years old. I have been unhappy about my height and weight. I feel inferior because my height is only 149 cm and my weight is 46 kg. Since I was promoted to Form 2, I saw that other girls were much slimmer, which I wish I could be. I saw an advertisement about slimming drinks and I bought them. I secretly took these drinks at home, but I am afraid that these drinks cause bad effects on health. What should I do, nurse? Can you help me?
Dear Ming Main,
Thanks you for your letter. You told us about your body height, weight and queries. I felt that you are very concerned with your health.
According to the weight for height chart, your weight ranked 75th to 90th percentile among 100 girls of the same height. This was within the normal range and you were not overweight or underweight. Your body height was also in the normal range although you were not that “tall”. So, I hope you can accept your weight and height and understand that health is much more important. No matter we are overweight or not, we should have a balanced diet and do regular exercise, which keep us healthy. I suggest the following two tips of health:
1) eat according to the principles of a balanced diet and avoid foods of high caloric value and high-fat content;
2) do regular and appropriate physical exercise for maintaining good health and preventing fat deposition.
You may find more details in the following webpage:
Moreover, do not take any kind of slimming products without prescription from the doctor.
Wish you health and happiness.
Student Health Service
Interesting Knowledge Q & A
Which of the following groups of people get anorexia more easily?
- ballet dancers
- doctors and nurses
Answer: 1, 2, 5
According to medical research, workers of performing art (like ballet dancers, singers and models) and sportsman/ sportswomen have higher rate of anorexia than other groups because these career groups have greater emphasis on slim body shape and weight control.
Research reports indicated that people with eating disorder commonly develop the problem in their adolescence. This is the critical time for growth and development.
If adolescents lack a balanced diet or eat too little, normal growth may be adversely affected. If dieting is so extreme that it goes out of control, there is the danger of getting eating disorder. The influences can be very extensive. Not only the appearance looks thin, but also the face becomes pale and hair shed off. One could not expect a good look. They may also be tiredness due to under-nutrition, secretive eating and fears for food. All these would not make one attractive to friends. Finally, victims would die from electrolyte imbalance or failure of body organs. It is very regrettable to have it happened. Indeed, we should treasure our body and mind. An appropriate concern about body weight can bring about joyful, as well as healthy eating, but excessive concern can be dangerous.
For enquiries of student's health problem, please write to "Health Box"
Please write your name & address, contact tel. no. in the letter.
4/F, Lam Tin Polyclinic,
99 Kai Tin Road,
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Dr. TONG Nga-wing, Ms. CHIU Wai-fong, Alice, Ms. CHOI Choi-fung, Ms, LAI Chiu-wah, Phronsie, Ms. CHAN Kin-pui
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