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NOT JUST SURFACE DAMAGE

INTRODUCTION We live in an increasingly eating-disordered world. Health issues have gone beyond a person’s well-being and now form the moral code of secular society. As such, food has taken on similarly moralistic definitions. We now hear of good food vs. bad food. Permissible food vs. food you should NEVER eat. Being fat is the ultimate sin. Why has fat become such a despised thing? Stereotypical descriptions of fat people include “lazy”, “stupid” and “ugly”. The reason people get fat, as it is believed, is because they have no self-control. Fat people are stupid because they don’t know that fat is bad for them, that it will lead to high blood pressure, high cholesterol and a host of other diseases. As the media goes into hysterics about an impending “obesity epidemic”, the other end of the spectrum, eating disorders, receives unfair coverage as well. The media assumes that people develop eating disorders because they want to look like models on a fashion runway, that eating disorders are diets horribly gone wrong. The most frequently associated image of an eating disorder is that of an emaciated, bag of bones kind of girl.

The resulting effect is that people with eating disorders have been painted to look like freaks. Anorexia and bulimia are ugly words. No one wants to be called anorexic. No one wants to be known as a bulimic. There is the negative implication that people with eating disorders lack control, because they were too silly to know when to stop. The perception of eating disorders as a superficial problem is the cause of much of the stigma surrounding eating disorders. In this booklet, find out more about eating disorders from those who have struggled with an eating disorder, as well as views from the general public on eating disorders and related.

NOT JUST SURFACE DAMAGE While much has been said on the risks of obesity, very little attention has been paid to the risks of going to the other extreme, such as in eating disorders. The truth is that while the health risks of obesity are just that—risks, eating disorders are a direct route to many life-threatening complications. When dealing with eating disorders, it is important to make the distinction between the individual and the part of her or him that is eating disordered. Within the individual, the eating disorder is a moral struggle, as values of ‘good’ or ‘bad’ are highly linked to food. Eating bad food is wrong, and the person has to punish herself accordingly. In another situation, the emotional value attributed to some types of food causes a person to turn to them as a solution to the pressures of life. The eating disordered-voice is highly adept at turning everything against the person, and even well intentioned comments can even be distorted into an attack on the person’s self-esteem. The battle in recovery, therefore, is never against the individual who is suffering from an eating disorder, but against the eating disorder that is controlling every thought and action of the individual.

I USED TO TO JOG LIKE 10KM A DAY AND PUNISH MYSELF SO BADLY. I WOULD CONTINUE TO JOG EVEN WHEN MY LEGS WERE SORE AND WHEN MY BELLY WAS SO BLOATED WITH FOOD. jenn

JENN The reason why I am sharing my story is because I had been suffering for bulimia for the past 8 years. I had been to psychiatrist, psychologists, dieticians, Alcoholics Anonymous, Overeaters Anonymous, read books, taken Prozac and all but nothing seemed to work. I was being touched when I was a young girl and that feeling started to come back and haunt me when I was in secondary school. Furthermore, it was the ‘O’ levels year and it was very stressful. I became very self-conscious also (guess it was around that age where girls become very self-conscious). Not knowing how to get rid of that feeling, I turned to food for solace. However once I ate, I gained weight. I used to jog like 10km a day and punish myself so badly. I would continue to jog even when my legs were sore and when my belly was so bloated with food. This was when my bulimia started. Everyday, every minute every second, my mind was so preoccupied with food. I would starve myself (thinking I could take it so that I could lose weight) so badly that when I got home, I just couldn’t take it anymore and would start binging. Then I would feel so guilty that I would start to throw up. I was brought up quite a negative person – always dwelling upon things and thinking

the worst. What made it worse was that I did not like to share my feelings, because I felt that it would only show my weaknesses and I would lose face as a result of that. Also felt that people would think that I was crazy and too obsessive with my thoughts, so I did not tell anyone about it. And I guess it slowly manifested to the point that every time I experienced any negative feelings, I will use food to help me get over it because food is like a “friend”. Everytime I felt guilty, painful, angry, hate, fearful, embarrassed, I would start to eat because everytime I ate, I would feel so happy and “high”. All the stress and worries just disappeared and I would feel like I have escaped into another world. However, my story aside, I feel that nowadays, we have all been bombarded non-stop by the media to be as thin as possible. Every where you go, every corner you turn, every magazine stand, every newspaper you flip, every channel you switch, there will be an ad telling you that you are not perfect enough. You need to be thin to be perfect. Thin=perfection, thin=beautiful, thin=happiness, thin=successful. If you are not thin, you are not happy. Skinny models are being plastered everywhere and 48kg, 49kg seem to be the “hip” and norm thing to follow. I mean,

I grew up a plump kid and when I was in primary school, my grades were not very good. I was that mediocre student and further more I was very tomboyish. This did no good to my self-esteem. I felt very inferior because the boys only went after beautiful slim girls. That is why I vowed to be as thin as possible when I grow up because I have associated food with power and control. And I felt that I could only get people’s sense of approval when I’m thin. So I guess this deep craving for a sense of approval and the inferiority created this void in my life. It’s like no matter what I do, this void cannot be filled. That is why I am sharing my story because I know that out there right now, there are a lot of females, especially young girls who are suffering from this disease (be it anorexic, bulimic, body image disorder or any other eating disorders) and they are suffering in silence. I know the desperateness, the fear, the pain, the hurt, the guilt, the anger, you feel so helpless, so trapped and so alone because no body seems to understand what you are going through. However, I want to tell you that you are not alone, because I have been through this path, and I feel that it is only through coming up and sharing our feelings that we can help each other overcome this deadly disease.

So I’m calling out to everyone right now, if you have any friends, family members, relatives or anybody whom you love and know is suffering from this right now to come along and share your feelings and experiences. Because I know that it is only through sharing that we can overcome this together and go out there and shine and lead the life that we truly deserve! :D

BUT I DIDN’T WANT TO RECOVER BECAUSE TREATMENT MEANS GIVING THE E.D. UP, HAVING TO GET FAT, TO FIND ANOTHER COPING MECHANISM FOR DAILY STRESS. vanessa

VANESSA It is hard to make an impact on people with ED’s (eating disorders) to seek help. They usually don’t think they are worth helping because a large part of EDs is about selfloathing. One doesn’t have to be super thin to have an ED. People with Bulimia Nervosa do not often appear too thin, they can be normal to overweight (I’m a case in point). Same with binge-eaters. Sometimes, that’s the toughest bit of the message to bring across, because people will think that since they aren’t severely underweight, they do not need help for their ‘trivial’ eating disorder. This last part needs the most attention, because the longer the ED behavior goes on without intervention, the harder it is to reverse those destructive habits, which could turn into a crutch so the person does not want to recover (because to them, recovering means getting fat, usually).

What preceded the ED: I was stressed about my studies during school, my friends called me chunky (fat), I hated myself because I wasn’t as good as I liked to be (perfectionist), not eating distracted me from my worries (avoidance), not eating made me feel that I wasn’t an utter failure (low self-esteem), I was riding horses then and I was

like 55kg at 1.63 and the teacher was like you’re too clumsy and fat (sports that require low-ish body weight), and I wasn’t the type to talk about my problems with friends—in fact, I can never express emotions, it feels too weird and too exposed, so… I didn’t. All these I kept inside because I didn’t want to come across as weak and stupid or bothersome (the Asian ‘face’ thing I suppose). I felt that I had to be selfsufficient and solve my problem on my own, which is logical, and it’s what society deems correct. So as a solution, I went on my weight-reducing diet. I felt that if I were healthier and thinner, I’d do better and be happier about myself. Which didn’t happen. I was never happy about my weight, it could never get low enough. Why I don’t want treatment: it has come to the point that I need the ED. I can honestly say I’m addicted to it, without which I can’t function, as in. If I don’t restrict food or binge and purge, I can’t finish schoolwork, go to school, do stuff. I’ve done treatment at SGH’s ED clinic before. But I didn’t want to recover because treatment means giving the ED up, having to get fat, to find another coping mechanism for daily stress. I even threw up in the hospital, and that’s retarded because if you are still throwing up, you’re just

wasting money so I discharged myself. I know it’s bad for my health--throat cancer, heart attack etc but I don’t care, I just need to do this. It sucks because I can’t give up control over this shitty process that’s making me stupid and unable to concentrate as well as I KNOW I can. Like. I love reading. But I just don’t feel up to it, I’ll be like, I’m bored. I’m in constant apathy. It’s a vicious cycle I hate but I don’t want to stop. And it’s true about the loss of personality and fun-ness. Me = recluse. I don’t like going out with friends for pool, badminton, Sentosa etc because 1. I’m too tired 2. My conversation skills have gone kaput since like eons ago so talking is fucking STRESSFUL 3. There’s food, which I want to avoid. In the end, I lose friends because I never actually have any sort of relationship with them beyond class projects and break.

AND I WAS SO OBSESSED WITH FOOD THAT ALL I COULD DO ALL DAY WAS TO LOOK AT RECIPES TO OGLE AT THE FOOD BUT NEVER TO MAKE THEM OR EAT THEM. may ping

MAY PING How it begun: in a sense it began after A levels when I felt like there was a need for a challenge and maybe losing weight should be one of my goals. And I was brought up in a body-conscious family with it being something “natural” to emphasize on a person’s size. Ridiculously, most, if not every single one of my family members (relatives inclusive) just has this obsession to judge people base on outward appearances, some sort of like “you’re fat so you’re stupid and lazy”. I have been called FAT many times but I don’t know why it’s just last year when it really hit me hard. Usually I would have brushed it off. I think the society’s view on body image also plays a huge role because my mother or aunt would compare me with others and then say that if I were to lose some weight I would look better etc. I began to restrict till it became a habit. Initially I would still eat biscuits and stuff but after some time I decided that I should just stop eating altogether, so most of my food were just vege, raw or steamed. I had a job as well and my boss had this habit of skipping lunch so I always used it as a reason to escape eating.

I hid away from a lot of people because they could not stop asking about how I lost all the weight. My weight plummeted really fast. And I was so obsessed with food that all I could do all day was to look at recipes to ogle at the food but never to make them or eat them. I was running after a bus one day when I realized that I really could not run more than five steps. I also felt like I was going to break. I saw a doctor and it didn’t help much. Now: Anorexia is replaced with extreme binge eating behaviors, which I believe could be due to the severe restrictions. I tried purging but it was too difficult. I attend the support group now. Have attained a healthy weight as of today but the mind is still poisoned with eating disordered thoughts which cannot go away. Meeting people is a problem because I still cannot accept myself at a healthy weight and I am sick of explaining to people how I gained weight so fast. Still hiding from family members as well since I am so sure they are going to comment on everything about my weight.

THEY NEVER PRESSURIZED ME TO EAT BUT THEY WERE FUN PEOPLE, THEY MADE ME FEEL VERY RELAXED AND GRADUALLY, I GUESS SLOWLY BUT SURELY, I BECAME A HAPPIER PERSON. cheryl

CHERYL Ever since I was a young girl, I was conscious of my body. I remember looking up to the skinniest and prettiest girl in my kindergarten class. In lower primary, I was rather chubby. I remember my Primary one teacher telling my classmates to move to make room for me because I had “big bones”. I never had big bones, I’ve always been small boned, but with a lot of fat padding. I lost most of my baby fat by the time I reached primary six, in fact, I was underweight for my height. My teacher would conduct weekly weighins for the underweight and overweight girls in my class. Being underweight, I would be weighed weekly and my weight would be recorded. I wasn’t eating disordered then but before the day of the weigh in, I would eat less, hoping to reduce my weight for the weigh in. When my teacher commented that I had lost weight, I would be secretly pleased. I didn’t see myself as fat but I wanted to be thinner. Fast forward to secondary one, I was still conscious of my body but I started eating a lot. Secondary one was a very stressful period for me. I was doing well in primary school but when I reached sec 1, I started failing every subject. My self-esteem plummeted. I continued eating and eating. I weighed about 41kg at a height of 1.54m by the end of sec 1.

I thought it was fat but I didn’t do anything about it until one day, my mum commented my butt was getting bigger. I took that comment to heart. That comment was what triggered the eating disorder. It was in December 2000. By February 2001, I weighed 32kg. My parents dragged me to the psychiatrist. I hated him to the core. My parents and I made a deal. The moment I hit 40kg, I could stop seeing him so I binged my way up to 40kg and stayed that way until Sec 3. I did badly in my sec 3 EOY exams, as a result I had to be retained a year. I started bingeing and purging. My B/P habit didn’t help me lose weight. By June 2003 (my sec 3 repeat yr), I weighed a hefty 50kg at 156cm. When I saw photos of myself at 50kg, I decided to do something about my body. I alternated between eating 200 cals a day and B/Ping. I also took a lot of laxatives. At my peak, I was taking 60 laxatives a day. I lost weight slowly but steadily. When my weight hit 38kg, my mum took me to see another psychiatrist. She was really nice. I liked her. She didn’t force me to gain weight, unlike the first. I hit 35kg on August 04. Everyone noticed my weight loss. Teachers expressed their concern but I took it as a compliment. I liked my body and wanted to be even thinner. My goal was 25kg.

Unfortunately, something snapped and I began bingeing full force again. By the time of my O levels in 2004, I weighed 45kg. Depressed, I couldn’t study. I refused to attend lessons and I didn’t have the mood to study at all. I did badly for my O levels. However, I lost weight again. By March 05, I weighed 37kg. I maintained that weight for a few months and gradually, I began the road to recovery. My weight went up to slightly over 40kg through healthy eating habits. I have been maintaining my weight at 40-44kg since late 2005. I don’t know if I have recovered 100% from my eating disorder. Today, my BMI is 17.2. I appear healthy. I look normal. I hate looking healthy and normal. I want to be literally skin and bones but I no longer have the willpower to starve. I feel fat all the time. I think my body is disgusting but I try to live with it. I eat a healthy 1300 calories a day. I tell myself that I’m doing it for my parents, I don’t want to continue their agony by staying sick. I admit, I am a lot happier, I have more friends, I can eat and socialize now, I’m a lot more easygoing. But every single moment, I hate my obese body. Whenever I see another anorectic on a street, I stop and stare. I get extremely jealous because she was what I used to be and still want to be.

I guess what caused me to let go parts of the ED was entering a less competitive school, the environment there was very relaxed. I was from an all-girls school and there were lots of silent competition between bitchy girls, pressure to do well so entering my current school where girls were less bitchy and not so much emphasis was placed on academic work was a great help. Also, I made two very good friends. They don’t know of the ED but they know I have weight issues and they were very supportive. They never pressurized me to eat but they were fun people, they made me feel very relaxed and gradually, I guess slowly but surely, I became a happier person. They were unlike the friends I had in sec school who were always complaining that they were fat, that they’re on a diet and so on. I suppose mixing with people with a healthy mindset eventually influences you as well.

SOMETIMES I CAN SPEND A WHOLE FIFTEEN MINUTES JUST SITTING THERE AND SPEWING EVERYTHING OUT, AND I’LL FEEL BETTER AFTER THAT. syima

SYIMA I’ve been bulimic for the past four years. It was few months after I entered JC and my weight plunged to a sickly 41kg and I still think I was fat then. It was more of the desire to be accepted and liked, my mentality was that if you’re skinnier, you’ll be liked by people, people will see it as a beauty and how wrong I was back then. I started binging and eating everything I can get hold of (I snacked too much for my own good) and then vomiting them out. I usually do that either by my fingers or just gagging, it’ll come out naturally especially when I ate a lot. To me, I’ll feel restless if I don’t vomit after I eat, and somehow after binging it out, I felt so much better. To be honest, my friends knew about it and no one said anything. I don’t know if I have friends who respect what I do or they just don’t seem to care. And upon graduation, I realized how superficial some people are, and they were of course my JC friends. I was bulimic so that people will like me more, it’s pathetic and hugely superficial, but I guess it works that way in our society. Somehow fat people are being criticized behind their backs, well I don’t know, that’s usually the culture in the JC I was from anyway. Somehow, we make fun of fat people and I can’t help looking back because my weight before being bulimic was 45kg and I pushed myself to a pale sickly 41kg.

Usually I used the toilets in school, they’re rather clean and it’ll always be vomiting into the toilet bowl. Sometimes I can spend a whole fifteen minutes just sitting there and spewing everything out, and I’ll feel better after that. My mother was concerned that I kept losing weight unhealthily but I always made sure that I don’t vomit at home. I don’t wish to make her worry and that’s why I hardly eat at home. Bulimia was a hidden phase from my family, so my story has nothing inspiring that involves any particular individual. Sometimes things just got complicated, you don’t wish to show it to people. I hate how my cousins will say I look ok and when I look into the mirror, I see so many physical flaws. I got through the phase when I stumbled upon a page on Wiki, this is like an inevitable discovery. I read that being bulimic can lead to corrosion of gums and the picture freaked me out till today. It was a slow and painful end, in the sense that it’s difficult for me to stop being bulimic entirely. I managed to end late last year when I realized I’m not doing myself any good. I’m convinced that JC years are probably the worst years of my life, everyone knows

everyone and the networking is strong but it’s just so superficial, it’s like being nice to people in the vicious rat race. I’m in my second year in uni now and I have to admit that I’m not living the most healthy life, but at least I could finally control the urges to spew my dinner out. I realized it’s all in the head, if I tell myself I need to vomit to make myself feel better, I will somehow gag and force vomit, it’s draining. I’m 46kg now standing at 1.55m, for a petite girl I’m convinced that I’m overweight but I’m happy. It’s like, I have other motivations to look forward to, I have desires to lose weight the right way. My idea of a “right way” involves plugging into my iPod and just dancing to the shuffle songs, that’s my form of exercise, coupled with 25 sit-ups and crunches before sleep. It’s a slow process but I’m trying, and for once I feel better without vomiting, I never thought I could actually say that. =)

THE TEACHERS WHO WERE INVOLVED IN THE TAF CLUB WERE GENERALLY THE P.E. TEACHERS, AND BEING FIT THEMSELVES THEY HAD VERY LITTLE PATIENCE AND TOLERANCE FOR PEOPLE WHO WERE OVERWEIGHT... emily*

EMILY When I was in Primary Three I was placed into the Trim and Fit Club because I was borderline overweight (110%). The problem with being specifically identified and categorized as a fat person at such a young age was that it generated a deep sense of embarrassment about the whole affair, which almost always leads to a self-consciousness that one cannot shake off. The topic came with social stigma and carried a sensitivity even nine year olds could instinctively understand, so the general inclination of all the classmates was to politely avoid mentioning the issue at all. There would almost always be an awkward silence when the topic was brought up, especially if it happened in front of someone who was part of the club. At the start of school years the school had the tendency to announce the names of all the people who needed to attend the TAF Club over the PA system along with the details of the program, so it became a very public embarrassment as well, like a secret that one cannot hide, and it made me feel awful about myself. I used to wonder what my other classmates of normal weight thought about us fat lot of people when the announcement came on. I was afraid they pitied me or felt any such emotion; I didn’t want them to feel anything about it at all, I wanted them to be apathetic and indifferent because I

wanted the embarrassment to fade, and if they were utterly uncaring then the program could feel more insignificant. I wanted them to be deaf whenever teachers had to bring up the topic, so that the damage caused by the program would be known only to me and no one else, so that they would never need to know that there was such a serious flaw about me that needed to be publicly corrected. TAF Club was usually held during recess or after school, and it took up a lot of what was supposed to be our free time. While the rest of our friends would be off playing or talking, we would be forced to do exercise elsewhere. I resented it so much - I could hardly bear being seen going to or leaving TAF Club and I would inevitably look warily around to ensure that no one who knew me could see me before making a very hasty exit. Once, it was brought up that we also wanted our recess time, and the teacher actually had the gall to reply that we should not be having recesses because if we continued eating we’d grow even fatter than we already are. It felt like unrelenting pressure, and although ignoring the problem wasn’t going to make it go away, only by forcing oneself to not pay attention to these comments could one move on.

The teachers who were involved in the TAF Club were generally the PE teachers, and being fit themselves they had very little patience and tolerance for people who were overweight... possibly because the concept of it was foreign to them. Some of them obviously looked down on us. They had sharp and unforgiving tongues and would openly critique the portions of our body that needed to be rectified, like the flabby stomach or those thunder thighs. It is surprising, actually, that students appeared to possess more tact than the teachers. Because of all the critiquing, and the constant bizarre implications that we shouldn’t eat (eg. taking away our recess), I went through a short period of anorexia some time during primary four by skipping meals whenever I could. Thankfully, the anorexia never got to the point where it became truly dangerous to me because my parents were firm believers of having dinner with the family, so no matter how many breakfasts or lunches I escaped from, I always had at least one meal a day as dinner was mandatory. I didn’t, however, manage to escape totally unharmed from that ill-fated dieting attempt - my digestive system was shot through because of the irregularity of my meals, and I suffered a series of rather serious stomach cramps which alerted my parents to the fact that there

was a problem. I was found out and was made to readjust my eating patterns, although the weak gastric system has continued on even till this day, and slight changes such as eating dinner at 8 pm instead of 7 causes immediate havoc in my stomach. I have friends who went in the other direction - binge eating. They were suffocating on all the criticism and their self-esteem was almost non-existent, so they turned to comfort food to soothe the pain they felt. Obviously, that only exacerbated the problem, and therein lay the crux of the awfulness of this entire affair - a vicious cycle of selfloathing and helplessness that eased only in moments where flavours in their mouths could distract them. It is one of the most degrading experiences of my life, and having it happen at age nine and continue until I was twelve meant that my self-esteem never recovered - indeed, although I constantly remained in the 110-120% and was hence less fat than other members (a fact which I took immense, selfish comfort from), I also never managed to break free of the club in my primary school days, and the memory of it still resurfaces at certain moments to cause a rather debilitating sense of sadness.

THE BINGES OF FRENCH FRIES, CHOCOLATE CAKES, FRIED CHICKEN WAS MORE A CHORE THAN PLEASURE BECAUSE OF THE PURGING AND GUILT THAT FOLLOWED. nichol

NICHOL Hi, I am Nichol and I have been battling Bulimia Nervosa for the past 18 years. I became obsessed with losing weight when I was just 11 years old. Being on the side of bigger built than most Asian girls, I’ve always been on the “overweight” percentile from young. I became aware of my size since I was 5 years old when my uncles and aunties would often comment about how “big” I’ve grown or how much fatter I was as compared to my brother who’s only 1 year younger. Those words left a mark in my heart. As my mum was worried that being bigger bugged me, she wanted to help me lose some weight. She brought me to a British Diet Centre (which has since closed down) when I was 11. The centre put me on a no carbohydrate diet, limited me to only water based fruits and vegetables and small intake of protein. Strictly no sugar, no salt, no fats. At 11 years old, I trained myself to remember what are “bad foods”. To make things worse, I didn’t lose any weight after 2 weeks. Feeling down and desperate at 12, I stumbled upon a magazine article in a US tabloid warning young women the danger of Eating Disorders but instead I picked up the wrong tips. I realized I could starve myself to perfection while losing the excess weight.

I started starving, taking slimming pills, vomiting, consuming laxatives, exercising excessively as I finished my last year of primary school. In secondary school, the diet became more than just a way to lose weight, the whole eating disorder basically became my life. My moods depended on how much weight I lost or gained in the same day. Binges and purges became the regular diet. I actually starved myself for 5 days straight when I was 14. Consumed 20-30 laxatives and slimming pills daily. Ran around the track while reading my novel. Pushing the limits with each pound that I lost. When I sought help from my GP for gastric pains due to long starvations, he brushed it off and told me I could lose more weight. That comment made me think I was really FAT. By the time I was 15, I hated to eat in front of people and I always assumed that they would like me better if I was slimmer. For every 10kg lost, I could go another 10 more kg. The binges of French fries, chocolate cakes, fried chicken was more a chore than pleasure because of the purging and

guilt that followed. I started going to the toilet more than 10 times a day as I was taking laxatives. I even took MC just to stay home to eat in the comfort of home, usually after days of starvation. Gastric, kidney pains, dizzy spells, depression, colon pain, and perpetual dehydration soon set in. This went on throughout my school life. In university, life became bleak as I fell into depression due to the mental stress from the illness. Sometimes suicidal thoughts even entered my head. My moods became very erratic and I would cry myself to sleep. Good is never good enough for me. I was pushing myself hard to be the best that I can be in terms of looks and everything else in my life. When I started working, I woke up one day only to pass out blood from my colon. I was really scared, as I knew what was happening. I dragged myself to work but on the persuasion of my colleague, I went to see her GP. When I told him my story, he was shocked to hear that Bulimia actually existed in Asia back then because it was such a little known illness. He referred me to Dr Lee Ee Lian whom I had to wait 2 months to meet at Institute of Mental Health.

It was exactly 11 years before I managed to get any help from the right doctor. When she finally diagnosed me, I felt a sense of relief knowing that I was truly ill but most importantly I could choose to do something about it. Recovery began with accepting the fact that I have Bulimia with symptoms of Anorexia. I went for an over all check up to make sure my body was still functioning well. I sought treatment with a colorectal surgeon who told me if it were any later, I would have to wear a bag to replace my colon. I saw a psychologist to manage my internal demons, which was also important. I also started taking Prozac to help stabilize my moods to allow my mind to think better. Most importantly, I had to make significant changes to the only lifestyle that I knew for the past 11 years. I threw away all the laxatives, slimming pills, weighing scales, measuring tape and I prepared myself for the battle of my life. I had to learn how to live again by recognizing hunger, moods, and most of all, putting myself above everyone else. Many people think that eating disorders affect only vain people or gloomy ultra skinny folks but I was excelling

in school in all key leadership positions and with the confidence that I exuded, no one could tell Nichol had problems internally. I was a successful student, successful leader and very promising employee. Everyone knew that I would go far except myself. I was never good enough for myself. I was constantly pleasing others. Perhaps losing weight was an escape for me, a form of control. It was a battle with myself. But since the day I met Dr. Lee at the hospital, I have never looked back. The burden of the illness came down like a wall of bricks. I could see my future ahead of me and I knew that I wanted to get well for the sake of myself and my dreams. The journey towards recovery is a long and tedious one. Which is why I found comfort when I realized there was SEDS, Support for Eating Disorders Singapore. After attending my first support group meeting, I realized I was blessed with many loved ones to help me through this journey of recovery but not everyone is blessed. I also realized the seriousness of the illness, which is why I started playing an active role for the group.

We got together to create the current logo and we started an email support where survivors and caregivers can write to us directly whenever they need help or just a listening ear. I also attend to calls by those who need to speak to someone. We also meet monthly for the support group. Being open about my condition, I have also shared my story with people in the media who are interested to find out more and by doing so, raising some awareness of the problem. It’s not always easy to share such things and initially my family was not too happy that I was this open. However, with time, they realized what I was doing and supported me. Deciding to recover was the best thing I ever did for myself and I hope to spread this “joy” and awareness to as many people as I can. To me, life is not just about fitting into size 0 jeans anymore. It’s all about “Upsizing” now…”Upsizing” my dreams, “Upsizing” my contribution to society and “Upsizing” my happiness…So will you “Upsize” your life today?

A MOTHER’S PERSPECTIVE

MARLYNE

heather’s mom

What saddened me most about the pain that Heather went through during her eating disorder period was that it happened before my very eyes but I was not aware of how bad it was until the day I happened to see her in her gym outfit, getting ready for yet another one of her workout. I cried when I saw her because by then, her bones were sticking out of the tank top she was wearing, her arms were long and skinny and her face wan and pale. I remember pleading with her not to work out any more. She relented and that night was the start of many tense, despairing days that the whole family went through. I think what “fooled” her father and me was that Heather was really overweight. At her heaviest, she was 68 kg. When she started working out and watching what she was eating in her JC 1 year, we were happy for her because we were worried about her weight for health reasons and had constantly advised her to exercise regularly. Her father and I were well aware of the occurrence of eating disorders amongst teenagers. We were therefore both conscious of the fact that we should advise her to lose weight for health reasons and not for the sake of her physical appearance.

We were well aware of the fact that she was controlling her food intake and exercising regularly. At the beginning, she was looking really good and had plenty of energy so we thought nothing about it and praised her for her efforts. Thinking back, the change came rather suddenly. I believe that, in a matter of a couple of weeks, Heather changed from looking well and being energetic to becoming really thin and weak. She also underwent a personality change, becoming increasing irritable and moody. The day that I confronted her with the fact that she could really have a problem with her dieting and exercising was the day we took the first step to helping her to get well again. It took many tearful sessions before she finally realized and admitted that she was facing a real problem. Meal times were the worst. Her brother would eat very quickly and leave the table. Her father and I would try to get her eat more but by then, she had developed a fear of eating. She became irrational. She was afraid about the amount and type of food she could afford to eat without putting back the weight she had worked so hard to lose.

Her poor health started affecting her studies. She had to be excused from PE and had to skip classes because of bad headaches and general weakness. She developed all the classic symptoms of eating disorder syndrome such as fear of cold, constant thirst, etc. We were prepared for the fact that she might have had to postpone her A-level exams until she regained her health. Those were really difficult times not just for her, but the entire family. None of us had any peace of mind and our hearts were heavy with anxiety and the sense of helplessness. We sought specialist care for her and finally tried alternative medicine. With the help of Traditional Chinese Medicine, Heather slowly found the physical and mental energy to cope with her condition. Thankfully, she recovered in time to study for her exams but she had to put everything else aside because she had little stamina. We are confident that she has recovered from the disorder. However, her digestive system has been badly affected and now she has to be extremely careful about what and when she eats. The eating disorder has long lasting physical effects on her and has affected her life in many

ways. She has to forgo many physical activities and this has repercussions on her social life and her ability to participate in pursuits that she finds pleasure in. I am very thankful that Heather willed herself to get well and fought hard to overcome her condition. I am also very grateful to my husband for being there for us all. When I gave up a few times after the many emotionally charged exchanges with Heather, he was always there to reassure both Heather and me, putting a balm over the many emotional wounds inflicted. Heather has come a long way from the physical and mental trauma of the condition and has turned her experience into one that she can continually learn from. For us, her family, we are so thankful that we got our girl back!

HEATHER One of the most painful stages of an eating disorder is recovery. And not just because of the stomach cramps from eating slightly more than usual. It is negotiating that subtle line between half-hearted, but intentional, starvation and tentative, but committed, recuperation. No one else but you knows when you’ve made that subtle switch from suffering to recovery; they continue to badger you about your stick-thin arms and insistence on only being able to eat a quarter bowl of rice. They look at you with disapproving eyes. They won’t invite you to meals, they won’t share food. And those who you meet for the first time post-recovery? I’ve received anger, confusion, pity, fear, disgust, suspicion, curiosity, envy. The truth its, few people know how to handle a person they suspect has an eating disorder. The difficulties with eating large quantities of food during recovery are two-fold: first, your body is no longer conditioned to ingest or digest such large quantities of food so there is often physical pain, bloating and discomfort in your abdomen, which may become headaches and full-blown

gastric; second, there is often intolerance to certain types of food you haven’t eaten in a long time – fats, milk, cold things, beans - so these may not be well-digested and may impede the absorption of critical nutrients from the more easily-digested carbs. Then, there is also the need to slowly erode the “barrier to eating” in your mind. Eating too much too fast may trigger binging or, worse, a relapse to anorexia with fears of gaining weight rapidly. So do understand, we’re trying, one small, slow meal at a time. One of the most obvious signs of an eating disorder is “disordered eating” - the warped pattern of thinking that quantifies, moralizes, mythologizes food, that tells you “stolen food will make you fatter”, “eat negative-calorie food”, “only eat at night/upside down/square-shapes/ mashed food”. Fighting disordered eating post-recovery is often made more difficult by reading conflicting nutritional studies, harboring misconceptions about health and weight gain and suspecting those preparing your food (perhaps Mom added more oil on purpose!).

There is no easy solution. The only thing you can do is to realize how you’re thinking, and realize how lame it is. Food is so much more than carbohydrates, proteins, fats, salts; food is an experience, it is tasting, sharing, enjoying; food deserves to be appreciated and respected. The thing I’ve learnt to do is to simply come clean. Say: “Yes, I had an ED for a few months, but I’m trying to recover now. Still a bit tough to eat large quantities but am loving every bit I’m eating!” Say this without shifty eyes and a shaky voice. Be bold. Be honest. Treat yourself like a normal person. When you do, you’ll find others will too. I’m still trying.

from the “outside�: a range of perspectives on eating disorders and body image issues

ON DIETING I’m sitting here in my dorm and I’ve put up a sign on the board in front of me that says DIET in big pink letters because I put on 3kg in my first term in England and I know the healthiest way to lose it would be to exercise but I hate exercising even more than I hate starving. Not that I’m starving myself, but I guess I’m eating considerably less than I would if this were an ideal world and I had the metabolism rate of a tiger shark. I don’t see anything wrong with dieting. I know this sounds terrible but whenever I hear stories of how so-andso lost ten kilograms in two months on a diet of nothing but diet Coke and tomatoes I don’t feel appalled, I just feel admiring. I know people have ruined their health and their lives over diets but I guess everyone thinks, that won’t be me, and I guess the desire to be thin just

wins out in the end. It’s great that some people are comfortable with their weight, but I’m just not that sort of person. I’m not confident enough. I’ll never achieve self-actualization if I’m not thin. I’ve heard all the arguments that dieting doesn’t work, how people who diet are miserable and insecure and that we should just be happy and eat whatever we want, and I know being thin isn’t going to solve all my problems, but sometimes I feel that my life would be so much more awesome if I’d just lose another five kilograms. I don’t know. I feel like I should be talking about how I have issues of control or this empty gaping hole in my life, or something, but I guess for me it’s all about vanity. I want to look good and if being thin is part of that then I’m just going to have to diet.

hui ying

ON ANOREXIA

I’m generally sympathetic towards eating disorders because they’re so encouraged nowadays by the media, whether it’s television on the Internet (pro-ana websites, ugh) but I think we have to be careful about what we label as an eating disorder. I understand that anorexia is a mental illness that cannot be controlled by the sufferer, but I do think there are loads of girls who think it’s cool to be anorexic and who diet severely anyway, even if they really don’t have any true disease? It’s kind of like how teenagers think it’s awesome to be depressed, when they have no true concept of what clinical depression is, and I think that makes it so dangerous because the line between an actual ailment and a pure mindset blurs.

In all honesty I have a lot of trouble empathizing with anorexics, because my instinctive reaction is, what’s wrong with you - why can’t you snap out of it? It irks me most when girls actually lose weight healthily, then go one step too far. I have lots of trouble accepting it as legitimate, because it seems to me a modern, Western conception. I doubt people in third world countries, or places without access to popular media, ever contract anorexia (I’m not too sure about this and am open to contradiction) and that makes its medical nature even more dubious, in my book. Obviously I have had issues with dieting - right now I still can’t bring myself to eat three meals a day. The idea of consuming dinner makes me feel incredibly fat and awful, and when I have to attend social functions that involve dinner I make sure not to have lunch (although I can’t resist snacks).

But I certainly won’t classify it as an eating disorder - I’m ethically not against the idea of dieting, because how you want your body to look is really a matter of what you want, and your personal priorities. But, obviously, when it starts compromising far more important factors like your general health and well-being, something has to be done. I think education will definitely help the situation the world is in, because at least, now people are learning about what anorexia is and its symptoms. I don’t think it applies so much to anorexics themselves as the friends around them, who’re able to identify the problem they’re facing and encourage them to seek treatment. That’s still not enough, though - I think we all need to understand that skinniness is no more than a trend

that will die along with Kate Moss, and be revived again in exuberant zombie form, like all other fads. If we were living in the fifties, girls would all want to be curvy. It’s a ridiculous crowd mentality we might have to buy into by calling for a fashion renewal. Lastly, I think we need to shatter the perception that anorexia only afflicts the female population. I’d say, statistically, girls are more inclined towards it, but that might prevent male anorexics from getting the help they need simply because they don’t want to be viewed as effeminate. I’d also suggest we start linking body imagerelated disorders far more broadly - what about athletes and bodybuilders who become obsessed with popping steroids and gaining an obscene amount of muscles? They need some exposure too.

desiree

BODY IMAGE ISSUES B.M.I. is not an accurate scale of how healthy you are just because of the measurements it take into consideration, and Asians are usually smaller sized than what the B.M.I. accounts for. There are also those who would aim for an unrealistic number on the B.M.I. scale, and it’s just scary. The blind worshipping of fashion and labels without consideration for individual styles and unique body shapes make me quite sick sometimes. Aspirations to be as thin as models you see in runways so as to fit into ‘fashionable’ clothes appear to be pretty common, or squeezing into clothes that don’t fit is horrendous because you see disasters everywhere. The warped advice that thin is good has been pretty much abused by advertisers, and this is kind of built up on expectations and self-esteem humans have. Despite being

consciously aware of traps, it is still difficult for myself to be unaffected by it. Obviously hurtful comments would hurt the less aware people. CNY visiting at a relative’s place brought about comments that I appear to have lost weight. I personally know that it’s mainly in my face (for some strange reason, I’m losing fat in my face only at this age), but still their comments made me feel good. Why-ever not, right? Maybe the world would feel more secure when advertisers just go away, and the schools make growing-up kids feel more comfortable with their body.

pei yu

FASHION & EATING DISORDERS Personally, I think fashion definitely has an impact on eating disorders but it is very important to define fashion in this sense. It is not the fashion of runways or Vogue or even Marc Jacobs and his baby food. It is the fashion of the affluent and that is a very important definition especially since nobody ever accuses Gap or Timberland or Abe & Fitch for causing girls to want to throw up all their tv dinners, it’s the fashion of Galliano and Fendi and Chanel. I think fashion can contribute to a tendency towards eating disorders as a result of a desire to emulate an idealised fashion proportion but this has to be seen in the context of a desire to emulate a model of affluence. In short, we want to be thin not because we want to be fashionable but because we want to look well off and to be well off is fashionable.

sean

DANCE & THE BODY Yeah, of course there’s the pressure to be thin. Technical-wise, plump dancers can’t leap, move across the room/stage as fluidly as slim dancers (although there are some exceptions) and aesthetic-wise, (in my opinion) a silhouette of a slim dancer is more pleasing to the eye.

cherlene

DANCE & EATING DISORDERS Well in the dance industry, there is a certain pressure to be thin, no doubt. However I’m fortunate enough to be part of a group where everyone eats healthily (including junk and snacks!) and there appear to be no eating disorders, and I have no reason to believe that any of the dancers in our company have eating disorders. That being said, I have had friends go on crazy diets that could potentially cause them greater harm in order to fit their ideal of what is considered “beautiful” or “acceptable” as a dancer. A friend of mine from a group I used to dance with was known for subsisting on practically only diet coke and the biscuit snack “hei bai pei” leading up to performances, and occasionally she would nibble at her friends’ food. Other than that, getting her to eat was almost impossible.

By a dancer’s standards, she might have been slightly bigger than usual, but I have seen bigger dancers who still dance beautifully on stage and who are comfortable with their bodies, and that ultimately is what allows them to move so gracefully on stage - understanding their bodies, and working with what they have. Unfortunately, some industries do focus more on the body type than the ability of the dancer, and one genre of dance in particular would be ballet. Having danced ballet for over 15 years, I am fortunate enough to have what some would call a “dancer’s body”. That being said, if I ever did want to become a serious ballerina, I would probably be asked to lose a little weight myself. Unfortunately, I have had friends, serious about entering the dance industry (in particular the

ballet scene), been told that they would “never make it”, simply because they did not have the body type. Ballet in particular focuses on the dancer’s body, besides the dancer’s technique. There was a case once where a dancer in a Russian ballet troupe was fired simply because she had become “too heavy”, regardless of the fact that she was a good dancer, and the extra weight had not affected her ability to dance. That being said, the industry does not always focus on image purely. Especially in contemporary dance companies, or in the hip hop scene, having a less-than-perfect body is perfectly acceptable, as long as you can move and have the technique and performance ability. In fact, a dancer with a sightly larger frame would be chosen over a dancer with a “dancer’s body” if they are a better dancer,

because at the end of the day, the quality of dance is more important than the dancer’s body weight. Ultimately, it is up to the dancer to make the decision about whether they want to bow to the industry’s standards, or accept themselves for who they are and work with what they have. In the company I am with, one of the best dancers has a slightly larger frame than others, yet in our recent recital she was the one in every single piece, save one. The most important thing that is emphasised is health, above all, which is why the company strongly discourages smoking (upon signing up with the company under the scholarship programme last year, we were all told to quit smoking within 3 months, if we smoked). Interestingly enough, our late-night dinners after trainings (around 10pm?) were often

bonding sessions, and nobody went home to gag their dinners out after (we’d all be much too tired to frankly). So in all honesty, as a dancer, maintaining a healthy weight is to help you be able to execute moves more easily, and exercising and conditioning the body builds strength as well, which a dancer needs to do anything from jazz to hip hop and ballet. Being healthy and strong is more important than being stick thin to fit the image of what a dancer “should look like”. We might like to look slim, but you won’t catch the dancers in the company I’m with choking up our food anytime soon (we enjoy food too much). As for myself? I’m too much of a foodie to be anorexic. =) And although we all complain about being fat or flabby, which girl doesn’t have fat days. ;)

sarah

CELEBRITY WEIGHT LOSS Some famous examples of celebrities who put on or lost an extreme amount of weight in a short time for film roles that come to mind are the following: Christian Bale lost a lot of weight for The Machinist, then bulked up for Batman Begins, and later, lost a fair amount of weight again in Rescue Dawn, Charlize Theron for Monster, and Renee Zewellger for the Bridget Jones movies Most of the time, these extreme weightgain/loss are done to make the movie more realistic rather than getting the actors to wear fat suits (like Gwyneth Paltrow in Shallow Hal) and generally achieves the desired effect because they look the role of the character more realistically instead of more like their usual more glamorous selves.

It is often quite scary to see, especially in the case of Christian Bale losing so much weight he resembled a skeleton in The Machinist and much of the press surrounding the movie also ended up focusing on how much weight he lost. Unfortunately, what was lost in these reports was the health dangers of attempting to lose so much weight in such a short period of time. On the other hand, it is more common for actresses to put on weight for movies, which makes me wonder why studios don’t use the quicker/easier method of finding a less skinny or plussize actress to play the role in the first place. Eating disorders and body image issues Every now and then, the tabloids will have a feature on female starlets who appear to have gained or lost visible

amount of weight, usually through the method of putting ‘before’ & ‘after’ pictures for readers to compare with their own eyes. Most recent targets of the tabloids include Jennifer Love Hewitt and Tyra Banks. These females celebrities were photographed looking much heavier compared to previously, and made the front covers of tabloids. They hit back, with Jennifer Love Hewitt issuing a statement criticising the press for such excessive scrutiny on female celebrity bodies while Tyra Banks dedicated an episode of her own talk show questioning the tabloids’ definition of “fat”. Unfortunately, such examples are not commonly seen, and it will probably take a lot more than the words of two celebrities to change the media and

the public’s idea of the ideal body figure. Although there have been famous celebrities (Princess Diana, Lindsay Lohan, Calista Flockhart) in the past who have admitted to have suffered/suffering from eating disorders, it is still not a topic that is discussed seriously enough to drive home the real dangers they pose. Neither are there any serious steps taken to build better self-esteem in girls to prevent eating disorders. Furthermore, although many other causes such as environmentalism which have famous ambassadors such as Al Gore and Leonardo DiCaprio to put a face to it and give it a greater profile, I can’t really think of anyone doing the same for eating disorders -- everyone knows about it, but it seems to be something that is regarded as less important or prevalent in a way.

chooi mei

ON EATING DISORDERS I have had a friend who had anorexia. She thought she was just being healthy. Exercised zealously, ate little. Glad she’s already recovered. That was in sec school. Her recovery probably would not be that fast had she been in a girls’ school? It seems to me that girls in single-sex schools really place a lot of emphasis on looks and weight. The media is super hypocritical because on one hand they say it’s ok for gals to be big and there they are scrutinizing the thighs of Britney Spears.... And I think its mostly gals in the impressionable ages who fall prey to these issues.

Grown ups pretty much complain incessantly about these issues but most of them are probably too lazy to take action anyway, I also think health is turning as the primary reason for wanting to change their habits though wanting to look good has got to be definitely on par with health too.

hui qing

Project WiTHIN I guess it’s very much inevitable that everyone will want themselves to look good and presentable. However, there is a difference between looking good, and trying too hard to look good. Being pleasant to the eye does not mean having that super-model body or that stunning smile, it just means being who you really are. We are all made special and if we showcase our unique areas, we look good! Sometimes, people are too engrossed with the belief that so long as they eat less, they lose weight and move one step closer to a modelfigure. However, sacrificing one’s health to gain a facade of beauty is probably the least worth it thing around!

We started Project WiTHIN as we were very much inspired with some personal stories about friends around us. While people shed care and concern for the very young, the very old and the handicapped, many have missed out this group of teenagers who are harming themselves in ways we cannot see. For more information on Project WiTHIN, log on to www.projectthin.com

jianrui

RECOMMENDED BOOKS Wasted by Marya Hornbacher Wasted: A Memoir of Anorexia and Bulimia by Marya Hornbacher pulls no punches in its description of eating disorders. The prose is powerful and emotional, though it might be triggering for some people. Life Without Ed by Jenni Schaefer A pro-recovery book written in bite-sized chapters. Author Jenni Schaefer, through the help of her psychologist Thom Rutledge, learns to separate her eating disorder, named Ed, from herself. A very enjoyable and encouraging read. Gaining: The Truth About Life After Eating Disorders by Aimee Liu Combining her own memoirs, research, and interviews, Aimee Liu investigates the genetic and environmental factors that cause an eating disorder. She also goes into brain chemistry, and finds that people never truly “recover� from an eating disorder.

Perfect Girls, Starving Daughters by Courtney E. Martin Perfect Girls, Starving Daughters: The Frightening New Normalcy Of Hating Your Body explores female body image, dieting and eating disorders in America, and exposes how females are at a cultural disadvantage. The Rules of “Normal� Eating: A Commonsense Approach for Dieters, Overeaters, Undereaters, Emotional Eaters, and Everyone in Between! by Karen R. Koenig Using the science of cognitive behavorial therapy, Karen R. Koenig provides an easy to understand guide on normal eating. A practical, reliable guide that guides the reader slowly towards a change in eating habits.

SUPPORT FOR EATING DISORDERS SINGAPORE SEDS is an open group for people with eating disorders and their loved ones. Support group meetings are held every first Thursday of the month, 7-9pm at Singapore General Hospital’s Life Centre. SEDS is a support group and does not provide professional treatment for eating disorders. However, a treatment programme can be found at SGH Life Centre, the venue of SEDS meetings. SGH Life Centre Bowyer Level 1 Block A (next to Car Park C) Singapore General Hospital

ABOUT THE BOOKLET This booklet was created in 2008 by Chang Pei Ying as part of her Final Year Project in Visual Communication at Temasek Polytechnic, with the kind and generous help of the persons who shared their stories and views. She can be contacted by email at changpeiying@hotmail.com Please feel free to contact her if -you contributed to the booklet but would like to see your section edited or removed -if you would like to contribute stories to an updated version of the booklet -if you have any other concerns about the booklet Thank you for reading.


Not Just Surface Damage