June 11, 2009
Obsessed with being thin
Natalie Tan struggles with anorexia. The 21-year-old has been hospitalised twice and now copes by planning meals three days in advance. JUNE CHEONG reports
Food became a source of both pleasure and loathing for 21-year-old Natalie Tan a year ago.
Her battle is not fully over.
While the National University of Singapore undergraduate is now recovering from anorexia, she still struggles with her weight, which is now 38.3kg.
The 1.54m tall waif said of her conflicted relationship with food: 'I'd visit a lot of food blogs and stare at the pictures in them. I'd tell myself I'll eat when I've dropped 2kg. When I had got to that weight, I'd want to drop another 2kg.'
She added: 'I didn't know how to get out of being anorexic. I just felt stuck and so obsessed with my weight I had no time to worry about anything else.'
Anorexia nervosa, or anorexia, is an eating and psychological disorder. An anorexic patient diets to lose weight and becomes obsessed with losing weight and gaining a sense of control over his or her body.
Miss Tan's wretched journey into anorexia started in February last year. Her then-boyfriend had joined a company selling slimming products. On a whim, she went through the firm's body analysis test.
One of the company's consultants then said she had too much body fat. Miss Tan was flabbergasted as she had always led a healthy lifestyle.
Among other things, she had avoided eating deep fried food, made sure she ate lots of fruit and vegetables at meal-times, jogged and did light weights training.
She recalled: 'After that test, I remember feeling disgusted with myself. I started feeling I was made up of only layers of fat within.'
Miss Tan began dieting, taking meal supplements and whittling down her portion sizes. Soon she became obsessed with counting calories and skipped meals.
By May last year, she was surviving on 200calories a day. The average woman aged between 18 and 29 years with a moderate activity level needs 2,100 calories.
When she attended a sports camp in July, her friends were shocked by how much weight she had lost.
She said: 'They couldn't recognise me. But every time I looked in the mirror, I thought I looked the same.'
Her retiree father, Mr Eric Tan, 53, said: 'It was scary for my wife and I as she just kept losing weight and was not eating.'
Miss Tan's low body weight meant that her body was unable to heal itself when she sustained injuries. A few light knocks she suffered while playing games at the sports camp left her with scars, scabs and bruises which took three weeks to heal.
Her condition also led to insomnia and she would often wake from a night of interrupted sleep with aching bones.
She knew something was wrong with her, yet she still would not eat.
At her lightest, she was 32.9kg. Now 38.3kg, she has a target weight of 43.8kg.
She said: 'When I didn't eat, I had a feeling of control, empowerment and self-discipline.'
When she visited her brother Aaron in Britain in July, she ate but then threw it up.
She said: 'With little body fat, I was freezing even with four to five layers of clothing.' It was summer then and although the weather was not hot, most people wore light jackets.
'I started eating because I was greatly tempted by the food there. Afterwards, I'd feel bad, go to the toilet and throw everything up.'
When she returned to Singapore in August, she deferred university for that semester and was admitted to Singapore General Hospital (SGH) as an anorexic patient for a month.
She had seen a psychologist before she left for Britain at the behest of her parents. The psychologist then referred her to an eating disorder consultant at SGH, who insisted on hospitalising her two weeks after her return to Singapore as she was unable to put on weight.
There, she attended seminars focusing on body image and acceptance of oneself and had sessions with occupational therapists, dietitians and psychologists. Its programme also included cooking sessions to help anorexic patients overcome their fear of food.
Miss Tan said: 'There was something safe about being in hospital. It was a challenge after my hospital discharge because when I ate out, different places served different portions and I didn't know how much oil was in the food served.'
Miss Tan then went back to eating very little. She was re-admitted to hospital for two weeks at her doctor's suggestion.
Leaving the hospital the second time, she was more determined to shake off her affliction.
Anorexia had left her with osteopaenia, a condition where the bone mineral density (BMD) is lower than normal peak BMD. She was also emotionally drained.
She said: 'I lost a lot of time and friendships.
'I became insensitive towards my then-boyfriend because I just felt numb to everything. We broke up eventually and the break-up became another excuse for me not to eat.'
Her road to recovery has not been easy. Miss Tan started skipping meals again when she returned to university in January.
She said: 'If people said I looked fatter and better, my mind couldn't process the word better, only the word fatter. It was overwhelming.'
But she managed to nudge herself back to normal eating habits, thanks to a strict meal schedule.
Now, she and her parents regularly sit down together to plan her meals - three days in advance - and her father acts as her 'minder'.
Even then, it was tough going for her and her parents.
Mr Tan said: 'If we missed a meal or she wanted extras and I told her not to take too much for fear of her bingeing, she'd fly into a tantrum like a spoilt child. She'd throw her food away or scrunch up her bread and stamp on it.'
The hiccups she experienced have led Miss Tan to appreciate her family and close friends even more.
She also started a blog about her journey towards health (http://nattietan.wordpress.com/).
She said: 'I want to eat like I used to. I know my relationship with food may never be the same.
'But I don't want to spend the next five years of my life with my weight yo-yo-ing.
'When you have anorexia, you're just existing. You don't enjoy life, people's company or gatherings. It's not living and I don't want that.'
WHEN FOOD BECOMES AN ENEMY
The motto of most anorexics is 'food is the enemy'.
Anorexia nervosa, more commonly known as anorexia, is a type of eating disorder often characterised by a person losing 25 per cent of his body weight.
An anorexic becomes obsessed with dieting and losing weight and is overwhelmingly afraid of packing on the kilos. He also becomes preoccupied with food.
Ms Geraldine Tan, a psychologist at Centre For Effective Living, said: 'The bottom line is that there is low self-esteem and a lot of insecurities. Anorexics think 'If I just lose a couple of centimetres then I get affirmation'.
It's a vicious cycle.
'Friends will go up to them and ask if they've lost weight. They see it as affirmation and then it becomes an obsession.'
There are two kinds of anorexia - restrictive anorexia and binge/purge anorexia.
Those suffering from the former maintain their low body weight mainly by limiting what they eat while those suffering from the latter restrict their food intake but also regularly binge-eat and engage in purging behaviour like self-induced vomiting or abusing laxatives.
Other symptoms of anorexia include compulsive exercising, absence of periods and a distorted body image.
Anorexia can lead to complications like a smaller and weaker heart, damaged kidneys and loss of bone mass.
The mental disorder is most common in young adults between the ages of 18 and 25.
Ms Tan said: 'Most anorexics are very intelligent. Many are high achievers, like established dancers, yet they feel it's not enough.'
It runs in the family
It is not known what causes anorexia although researchers agree that it is a combination of genetic and environmental factors.
Eating disorders tend to run in families.
The chance of someone developing anorexia is 12 times more likely if a nuclear family member has it.
Treatment for the disorder is multi-disciplinary. If the patient's weight is too low, he has to be admitted to hospital so he can be restored to a healthy weight.
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 dietitian. The patient's family and friends may also attend therapy to learn to help him modify his diet and exercise habits.
Ms Tan said: 'We can't totally eradicate the patient's insecurities but he learns strategies to cope with certain thoughts and situations and to build up his self-esteem.'
For more information on anorexia nervosa or to enrol in Singapore General Hospital's Eating Disorders Programme, contact SGH's Life Centre on 6326-6697 or e-mail firstname.lastname@example.org. You can also call Singapore Association For Mental Health on 1800-283-7019 (9am to 1pm, 2 to 6pm, Mondays to Fridays) or e-mail email@example.com.