GIVEN Malaysia's high obesity rate, it's clear that we have a problematic relationship with food.
But there is a small group for whom this relationship is tilted in a very different direction, one that's equally damaging.
In a 2022 study looking at the prevalence of eating disorders among Malaysians, more than 50 per cent of the subjects surveyed reported having symptoms of the condition.
The study, entitled "Estimated prevalence of eating disorders in Malaysia based on a diagnostic screen", also noted that these disorders included anorexia nervosa, bulimia nervosa, binge-eating and avoidant/restrictive food intake.
An eating disorder is a mental health condition where one uses the control of food to cope with feelings and other situations, says KPJ Johor Specialist Hospital dietitian, Lim Zetong.
This can include eating too much or too little, or worrying excessively about one's weight or body shape.
Although anyone is at risk of getting an eating disorder, teenagers and young adults are most affected, says Lim. Eating disorders also affect females more commonly than males.
Lim adds that these disorders can be successfully treated, especially when they are detected and treated early.
The impact of eating disorders on the body can be huge and far reaching.
Anorexia nervosa for example can result in thinning of the bones (osteopenia or osteoporosis), muscle wasting and weakness, brittle hair and nails and even brain damage and multiple organ failure.
Bulimia nervosa meanwhile may cause intestinal distress and irritation from laxative abuse, severe dehydration from purging and electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to a stroke or heart attack.
MANAGING EATING DISORDERS
Lim says treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counselling, medications or a combination of these approaches.
Treatment goals include restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise habits and stopping binge-purge and binge-eating behaviours.
Lim says it is also important to address underlying mental disorders or problems with substance use amongst those with eating disorders. Co-treatment of these other conditions should be included as part of the treatment plan.
Patients are usually put through a structured eating programme to help restore healthy eating habits and improve weight, she says.
Severe cases often warrant hospitalisation during the treatment period as there is a need for careful monitoring.
Less severe cases can be treated as outpatients. Eating programmes will typically include nutrition education, where a person learns how nutrition affects one's body and recognising how eating disorders cause both nutrition issues and physical problems.
"Patients will also be taught how to practise meal planning and establish regular eating patterns, which includes three meals a day with regular snacks."
Adequate calories, protein and other food groups will be included in the meal plan to ensure sufficient nutrition.
Accompanied eating might also be carried out as part of the therapy to provide support in normalising eating.
Lim adds that dietitians work as part of a multidisciplinary team when intervening in cases of eating disorders.
Successful treatment should include regular supervision and training, which is key for safe and effective support, as well as prevention of relapse.
Common Eating Disorders
Anorexia Nervosa
Patients avoid and severely restrict food intake. They often have an intense fear of gaining weight and a view of weight and body shape that is not realistic. Even when dangerously underweight, they may see themselves as overweight.
Bulimia Nervosa
A condition where a person has recurrent and frequent episodes of losing control over how much he or she eats, followed by purging or exercising excessively to avoid putting on weight.
Binge Eating Disorder
Sufferers lose control of their eating and consume large portions of food until they are uncomfortably full. As a result, those with this disorder are often overweight or obese.