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Eating Disorders on the Increase in Asia

By Sonni Efron
Los Angeles Times

SEOUL, South Korea -- 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 teen-ager 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 going global.

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 one 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 and Pakistan.

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."

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 salons.

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 pounds.

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-like 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 business is booming.

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, said Lee. "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 decontrolled TV and newspapers, allowing in a flood of foreign and foreign-influenced programming, information and advertising.

"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 their friends."

Dieting by growing teen-agers often leads to inadequate calcium intake and weaker bones. Kim is worried about an increase in osteoporosis cases when this generation of girls reaches menopause.

"The dieting will also result in weaker physiques and lessened resistance against disease," she said.

South Korean psychiatrist Dr. Kim Joon Ki, who spent a year in Japan studying eating disorders, said the increase in eating 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 were right."

Kim said he has seen more than 200 patients, about half of whom were anorexic and half bulimic, in the 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 only made in one small size which 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 dieting."

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."

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 was 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 skinnier."