Although there has been a constant surge in the rate of eating disorders (EDs) across India, there is surprisingly very little scholarly literature available about it, within the country, as the area remains significantly under-researched and poorly reported. The small amount of existing data, recorded mostly by psychiatrists, is further impaired by two factors: it is neither based on substantial nationwide surveys on the issue, nor does it involve a credible official body for data-gathering. Moreover, the differences between cultures and psychology in Eastern and Western countries, further exaggerates the variations in diagnosing and managing ED, making the issue more complex. Let’s explore the reach and impact of this disorder and how it’s being addressed.
Once concentrated among adolescent Caucasian females in high-income Western countries, today, eating disorders (EDs) are truly global. Accurate epidemiological and burden estimates are crucial for understanding the effect of EDs on population health, and planning for the response of health systems, in terms of both prevention interventions and improvement of access to optimal treatment.
According to studies, 70 million people live with EDs worldwide. Out of which, Japan has the highest prevalence of eating disorders in Asia, followed by Hong Kong, Singapore, Taiwan, and South Korea. The manner in which EDs have spread among Asian countries is directly related to the economic transformation of the region. As a result, EDs were initially found less often in less developed, poorer Asian countries such as India, Thailand, Indonesia, the Philippines, Cambodia, Myanmar, Laos, and Vietnam. But now as these countries have grown more industrialised and globalised, EDs have followed, and the gap is closing between several Asian countries and the West with regards to both clinical pathology, as well as more widespread disordered eating, weight and shape concerns, and dieting behaviours.
Furthermore, a critical aspect of the emergence and spread of EDs in Asia is that it has transpired concurrently with rapidly rising rates of obesity across the continent. Similar to many Western countries, obesity rates have reached epidemic proportions in Malaysia, Singapore, Thailand, and other parts of South Asia. Although EDs and obesity have historically been treated as independent public health issues, they share many common etiological factors, and successful strategies for combating one will almost certainly impact the other.
In India’s context, EDs paint a particularly complex picture both historically and at present, perhaps reflecting the enormous diversity of its population. Additionally, awareness and resources are two areas that India needs to desperately work on, for treating EDs. There needs to be more concrete research to identify surrounding factors from all possible tangents to understand this disorder.
While sharing her thoughts on the ED issue in India, Dr N.M. Babina, Chief Medical Officer, Jindal Naturecure Institute says, “Even though eating disorders can be fatal in some cases, data on people affected by eating disorders like bulimia and anorexia are near to non-existent in India. There is also the concern of stigma and lack of awareness surrounding the issue, making recovery even more difficult. In our country, where mental health issues are easily predisposed by society, the problems of eating disorders like anorexia nervosa and bulimia are painfully ignored.”
She further adds, “The study in 2018, examining the prevalence of eating disorders in the student population of Mysore published in the Indian psychiatry journal revealed that 26.6 per cent of participants were prone to eating disorders due to abnormal eating attitudes. However, the surprising thing is that hardly any of these studies have been conducted by official bodies and nationwide surveys are still non-existent. Not much research has been done on eating disorders in India, because it is actually a very, very low priority.”
There are several groups of people well-placed to give us an in-depth understanding of the multiple aspects associated with EDs. These include mental health professionals, patients that are either currently dealing with related conditions, or with a former history of illness, or general physicians, dieticians, nutritionists, gym trainers, etc. But the right environment or ecosystem needs to be built in order to take this forward, and that is currently missing in our country.
“Indian psychiatrists need to document the original research and publish their efforts in reputed journals. The lack of published evidence in the field of ED and other lesser-known psychiatric illness acts as an impedance to frame appropriate policies. The documentation of epidemiological characteristics of various medical illnesses, including ED, is the need of the hour. Furthermore, screening using India-specific questionnaires needs to be employed”, says Dr Anusa Arunachalam Mohandoss, Clinical Associate Professor, Department of Psychiatry, Shri Satya Sai Medical College and Research Institute.
In contrast to India, developed countries are taking several strides towards conducting research and developing policies, aimed at treating eating disorders.
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Mansi Jamsudkar
(mansi.jamsudkar@mmactiv.com)
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