Eating disorders on the rise in Japan

OSAKA - Often thought to be limited to young women, eating disorders associated with fasting and bingeing are now being found in a much wider generational range - from primary school students up to middle age adults and even older.

Despite the growing number of patients, only a limited number of hospitals are capable of dealing with such disorders appropriately, and experts in the field are seeking to establish a public institution specialising in eating disorders.

"It's not just the small number of specialists, the problem is amplified by society's lack of awareness. People think eating disorders are just excessive dieting," said Teruko Ikuno, head of the mind-body medicine department at the Naniwa Ikuno Hospital in Osaka and a practitioner with nearly 40 years of experience treating eating disorders.

According to the Health, Labor and Welfare Ministry, the incidence of eating disorders increased rapidly in the late 1990s. Based on a ministry survey in 2008, there are thought to be about 11,000 patients receiving treatment nationwide.

There are three broad types of eating disorders:

- Refusal to eat: acute body or weight consciousness causing patients to drastically cut back on eating.

- Excessive eating: the habit of eating more than necessary.

- Others

Eating disorders sometimes occur together with behavioural issues, including self-injury, and can negatively affect a person's health, such as by causing nutritional deficiencies. They can also be harmful to the sufferers' social lives and relationships.

Recognising the illness

One woman from the Chugoku region who was interviewed had struggled with an eating disorder for about five years. The woman, in her 20s, said it took two years before she could find proper treatment.

As a third-year middle school student, she was once told by her school's track coach that she had gained weight. She started eating less, and not only felt lighter but began performing better in competitions. She became a dieting fanatic.

At first, her parents only thought she looked fit and saw nothing wrong with her new habits. But her 1.55-meter frame soon went from holding 45 kilograms to only 32 kilograms.

Her parents started visiting hospitals looking for help, but were unable to find an effective treatment for their daughter. She later began binge-eating and her weight shot up to 50 kilograms at one point. She was put on medication by a psychiatrist, but her condition did not improve. Her eating habits became a frequent subject of arguments with her parents.

About two years later, she visited Naniwa Ikuno Hospital after reading about it in a book by Ikuno. She and her parents had thought her problem could be cured just by becoming more aware of it, but Ikuno said her cycle of extreme dieting and bingeing was due to a physical illness.

"You have a nutritional deficiency," Ikuno told her.

To help boost her motivation to stick with the treatment, Ikuno referred her to two support groups, one for people with eating disorders and one for patients' families.

The hospital made sure she was eating regularly and sent her to counseling sessions. Three years later, she is now able to eat a regular diet of three meals a day.

Now healthy, she has had difficulty finding a job since most of her high school career was spent struggling with the disorder and she did not get any higher education.

"If there had been a specialist doctor nearby, she would have received proper care earlier," Ikuno said.

According to Ikuno, refusing to eat is becoming more common among fifth- and sixth-grade primary school students. A desire to be thin is one factor, but there are other issues involved, Ikuno said. For instance, refusing to eat can be a way to get attention from their parents, or a reaction to bullying.

Women suffering from the stress of being full-time housewives or the burdens of raising children are also subject to eating disorders.

Such disorders are also sometimes seen in men, usually due to body image issues.

Supportive environment

Ikuno said treating an eating disorder requires cooperation among a wide range of practitioners, including emergency care doctors, psychiatrists, gynecologists and general practitioners. Most medical institutions that can treat eating disorders properly are concentrated in urban areas such as Tokyo and Osaka.

Ikuno has played a key role in launching a preparatory committee to establish an eating disorder centre. The committee was set up in November 2010.

It now has a website and has held a petition drive to show medical institutions and related associations how necessary the treatment centre is. About 21,000 signatures have so far been collected in the campaign, which will be sent to the central government.

The committee gave a talk on Oct. 5 in Tokyo to seek support for establishing the centre. The event had about 400 participants, including patients, their families and medical staff.

Many patients among the participants told similar tales of difficulty finding good treatment, and most appeared to strongly support the establishment of a special centre for eating disorders.

"Anybody could be affected by an eating disorder. Some patients have experienced mental problems and even committed suicide. Others have died from malnutrition," Ikuno said. "As experts, we need to work toward improving the support environment for eating disorder patients."

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