Tweens starving for perfection (Anorexia) (by Sandra Davie)

The following is from the Sunday Times dated 28 November 2010:
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Tweens starving for perfection
Anorexia is on the rise among pre-teens as young as eight, reports senior writer Sandra Davie

When her eight-year-old daughter fainted in school last year, Mrs S. Ong thought it was because the Primary 2 pupil had missed her lunch as she was busy finishing her homework.

At least, that was what her daughter, who is from a top school, told her.

But Mrs Ong soon noticed that the girl would complain of a bloated stomach during meals and would stop eating.

She also became an exercise buff and would insist on taking her pet dog, a silky terrier, for several walks a day.

Once, when Mrs Ong went to check on her in the wee hours of the morning, she found her on the floor, doing sit-ups.

The girl fainted again in school a week later, after having refused to see a doctor the first time around.

She was hospitalised as her heart rate had dropped to a dangerously low level, and was put through a psychiatric assessment.

That was when Mrs Ong found out that her daughter suffered from anorexia nervosa.
Said Mrs Ong, a business development manager: 'I could not believe it. I remembered thinking, 'wait, isn't that something that hits 15-, 16-year-olds?' Not my Primary 2 girl.'

The doctor had news for her. Not only was anorexia nervosa on the rise among teens, it was also afflicting pre-teens as young as eight.

Doctors from three hospitals - Singapore General Hospital (SGH), National University Hospital (NUH) and KK Women's and Children's Hospital (KKH) - as well as three psychiatrists in private practice told The Sunday Times that this is true.

The figures they gave show that in 24 of an estimated 200 cases of anorexia, the patients were primary school pupils aged 12 and below.

Eight of them were aged between 8 and 10. The youngest, treated by a psychiatrist in private practice, was a six-year-old in Primary 1.

All were girls, except for a 12-year-old boy.

Anorexics and bulimics suffer from body-image distortion - an intense fear of weight gain. But while anorexics refuse to eat certain foods, make excuses to avoid meals and exercise excessively, bulimics binge-eat, then purge by vomiting or using laxatives.

Both eating disorders are 10 times more common in females than males. Doctors and psychiatrists interviewed say their younger patients are mostly girls and suffer from anorexia.
They cite several reasons for the increase in eating disorders in those as young as eight years old.

Dr Kumudhini Rajasegaran and Dr Oh Jean Yin, consultant doctors in paediatrics and adolescent medicine from KKH, say they have seen a sharp rise in teens and pre-teens suffering from anorexia nervosa. They believe the spike is caused by an increased awareness of the illness, which means more cases are being reported.

Parents, teachers and friends are learning to spot those who need help, and reach out to them earlier.

But they say it also has to do with the media idolising thin celebrities.

The usual symptoms that anorexia sufferers display include frequent weighing of themselves, excessive exercising and preoccupation with food and calories.

Dr Kumudhini notes that younger children with eating disorders tend to complain of physical ailments such as tummy bloatedness or gastric pains.

KKH admitted just over 20 teenagers and children last year for eating disorders. Three of them were primary school pupils, the youngest a nine-year-old.

Consultant psychiatrist Lee Huei Yen, who heads the eating disorders clinic at SGH, agrees that popular media is partly to blame.

Even tweens - children between eight and 12 years old - are being bombarded by product and media images of girls who are slim, svelte and pouty.

The pervasive message has given rise to a phenomenon she terms 'social obesity'.

A girl can be healthy in medical terms, that is, her body mass index (BMI) is within the healthy range of between 18.5 and 22.9. Yet by social measurements, she is deemed fat or obese.

'Society has moved the BMI several notches down, to between 17 and 21. This is the level that it considers healthy, when it is not,' said Dr Lee.

She has seen her fair share of truly challenging cases over the years, such as several teenagers with a BMI of nine who were so weak they could not speak or swallow.

Although the eating disorders clinic at her hospital admits only children who are 13 and above, she has seen an increasing number of parents asking the clinic to take in their 11- and 12-year-olds.

Five years ago, none of her patients was aged 14 and below. This year, of the 90 admitted from January to October, 18 patients - 20 per cent of the group - were below the age of 14.

Dr Geraldine Goh, a psychiatrist at the Child and Family Guidance Clinic at Gleneagles Medical Centre, has had a handful of patients in the eight to 10 age group. The girls have some common traits: They are perfectionists and overachievers with a near-compulsion for meticulousness. They often hail from top schools or elite families.

Dr John Wong, senior consultant at NUH Department of Psychological Medicine, said the hospital was in the process of collating data to study the trend, as it is seeing more nine- to 12-year-olds being admitted for eating disorders.

He estimated that there has been between one and two cases of children under 12 admitted to NUH for eating disorders every month.

Anorexia in young children can lead to serious problems - such as a smaller and weaker heart, damaged kidneys and loss of bone mass, he warned.

Treatment for the disorder is multi-disciplinary. If the patient's weight is too low, she has to be admitted to the hospital so doctors can bring her weight back to a healthy level.

As the problem is both psychological and physiological, the patient will have to undergo cognitive behavioural therapy with a psychologist as well as nutritional counselling with a dietician. The patient's family would also be offered family therapy to learn how to help a child modify her diet and exercise habits.

Mrs Ong is hopeful that her daughter will recover, although she has ended up in hospital twice this year.

'I have since realised that it's not just her, but her friends as well. Something's not right when you look at the online chats and eight-, nine-year-olds are discussing diet foods and how long they can go without food,' she said.

'I worry about our kids.'