Rising trend

Approximately 41.9 million people worldwide with eating disorders remain uncounted, according to a study published in The Lancet Psychiatry in 2020.

In China, a 2017 survey by the Shanghai Mental Health Center indicated that 25.3 percent of new university students exhibited tendencies toward eating disorders.

Yet, this illness is often misunderstood as an affectation of extreme dieters.

"Eating disorders easily evolve into psychological issues," said Shi Yu, founder of Beijing's Mentaverse Psychological Service Studio.

"And they are often hidden. Many feel shame about their eating disorder and are reluctant to speak up; some with milder symptoms don't even recognize it as a psychological problem requiring professional help; and many others mask their eating disorder behind other psychological conditions, not presenting it as their primary complaint."

Shi, a former psychological doctor at the Medical Psychology Department of the PLA General Hospital Third Medical Center, said the flip side of a restrictive eating disorder is a binge eating disorder. This illness is characterized by an inability to stop eating, which also has psychological roots, Shi explained.

"The digestive system is the body's second-largest emotional organ, after the brain. Control over eating is directly linked to a person's emotions," she said.

Li Yao, 27, works in Shanghai's central business district. Two years ago, work pressure contributed to his weight ballooning to over 90 kilograms within two years, too much for a person of average height.

To lose weight quickly, he started a strict diet. However, the regimen was too stressful and he began binge eating.

"After bingeing, I used laxatives, vomiting, and liquid fasting to purge the food," Li recalled.

"And after successfully losing weight, I started going to the gym to tone up. It became a daily battle and I was constantly fixated on my weight. If the number (I weighed) wasn't ideal, anxiety would overwhelm me."

When anxiety struck, Li felt compelled to calm himself through eating. "Once, I ordered a huge pile of fried chicken, stir-fried rice cakes, noodles — all kinds of takeout I normally avoid. I ate until my stomach felt like it was about to burst. I sat on the sofa, struggling to breathe, before I finally stopped," Li said.

Shi said rigid self-scrutiny is the most common behavior of people with eating disorders.

"But excessive self-scrutiny often leads to self-denial and self-loathing," Shi said. "Eating disorders are not a private 'inconvenience'; they are a psychological phenomenon requiring societal attention."