Five years ago, Cheung Man-ling was the picture of ill health. At age 29, she no longer menstruated, could not sleep, felt depressed and had headaches. She was also gaunt. Standing 1.51 metres tall, she tipped the scales at just 32 kilograms. Still, when the Prince of Wales Hospital's Dr Sing Lee told her she was anorexic, she could not believe her ears.
After seven years consulting other doctors, psychiatrists, gynaecologists and Chinese herbalists, she did not think she would ever recover her health or the weight she had progressively lost since her teens.
'All they told me was that I was depressed, and they drugged me with medicines that made it even harder for me to sleep,' said Ms Cheung, who asked that her real name not be used. 'I was not even aware there was a disease called anorexia.' She was not the only one. According to Dr Lee, a psychiatrist specialising in eating disorders, as recently as 10 years ago anorexia nervosa was thought to be a 'Western disease'.
But since its acceptance, there have been an increasing number of clinical referrals. At the same time, there has been a growing incidence of anorexia among Asian females in their early teens to late 20s. The problem has also been found in women in their 30s. 'I used to treat one to two anorexic patients a year, and now I see one to two a month,' Dr Lee said.
While the main symptom of anorexia is a refusal to eat, the problem can be harder to detect in Chinese women as they naturally have a thinner body frame, according to Dr Lee.
'If you don't ask enough questions, it is easy for GPs and family members to miss earlier forms of anorexia that are more treatable,' he said. 'Most people don't consider anorexia seriously enough, which is why by the time a patient comes to me they have already lost around 32 per cent of their body weight and the cases are much more severe.' But not all anorexics give up eating because of vanity. For example, Ms Cheung's eating disorder arose not because she feared being fat, but as a result of other pressures. Her father was an alcoholic and a compulsive gambler. And he was tyrannical. Depressed and without any direction in life, Ms Cheung said she twice attempted suicide. 'I lost interest in everything, even in food,' she said. 'I had no appetite and my self-esteem was low.' She was hospitalised several times in the psychiatric ward of the Prince of Wales hospital. She came out feeling worse and lost even more weight. 'I did not belong there because I was not mad.' Since meeting Dr Lee, Ms Cheung has progressively put on eight kg. 'Dr Lee understands my problem goes beyond food. My treatment involves no medication,' she said. 'He counsels me and I also get nutritional advice from the dietician and behavioural therapist.' Dr Lee came across his first anorexic patient in Hong Kong 10 years ago. 'A 16-year-old girl was referred to me by her gynaecologist,' he said. 'Although she had stopped menstruating, they said there was nothing wrong with her body, and she was just weak and needed to take more vitamins. That was when I first started noticing a trend.' Since then, anorexia has become more apparent in the Chinese community. One likely cause is the preoccupation with weight.