Food always on your mind:Could it be an eating disorder?

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What are eating disorders?

Food is far more than fuel — it is woven into our culture, our celebrations, our relationships, and our sense of comfort. It is also normal to have moments of concern about what we eat or how our bodies look, especially in a world saturated with messages about weight and appearance¹.

However, eating disorders develop when thoughts and feelings about food, weight, and body image become so consuming and distressing that they begin to take over a person's life. This goes far beyond dieting or being "picky" about food — it involves a powerful and persistent preoccupation that interferes with physical health, emotional wellbeing, relationships, and daily functioning².

Eating disorders are not a lifestyle choice, a phase, or a quest for attention. They are not about vanity, nor are they simply about food. Eating disorders are serious, complex mental health conditions — shaped by biological, psychological, and social factors including genetics, trauma, body image disturbance, and sociocultural pressure — that affect people of all genders, ages, ethnicities, and backgrounds².

Did you know? In a population-based study of 818 Malaysian adults, more than half reported symptoms associated with eating disorders – making it an urgent but under-recognised public health concern³.

In pictures

Around 1 in 5 Malaysian university students is at risk of developing an eating disorder.

Women were nearly twice as likely as men to engage in disordered eating, in a study of university students in Sarawak.

Around 30.8% of Malaysian children aged 10–11 report disordered eating behaviours.

What to look for

Severely restricting food
Eating large amounts and feeling unable to stop
Purging
Rigidly avoiding certain foods

The clearest indicators of an eating disorder are persistent, distressing changes in eating behaviours and a preoccupation with food, body shape, or weight that feels impossible to control or set aside. These patterns can take many forms – severely restricting food, eating large amounts while feeling unable to stop, purging, or rigidly avoiding certain foods – but what they share is a profound impact on a person's quality of life⁶.

Many people have moments of discomfort with food or their body, but eating disorders are not a phase that passes on its own. They can persist for years, and the longer they go unaddressed, the more serious the health consequences become. Eating disorders are among the most medically dangerous of all mental health conditions — but with the right support, recovery is possible⁹.

Myths and facts

Myth“Eating disorders are a Western illness.”

Fact

Eating disorders occur across cultures.

Read more “Eating disorders are a Western illness.”

Eating disorders are often associated with Western beauty standards, media and lifestyles. This can make them seem culturally distant from life in Malaysia, even when someone is severely restricting food, binge eating, purging or becoming increasingly distressed about their body.

In a population-based study of 818 Malaysian adults, more than half reported symptoms associated with eating disorders³. Another study found that 30.8% of Malaysian children aged 10–11 reported disordered eating behaviours¹⁴. When eating disorders are treated as a foreign problem, warning signs can be overlooked by the person experiencing them, their family and the professionals they turn to for help.

Myth“Eating disorders only affect women and wealthy individuals.”

Fact

Eating disorders affect people of different genders, ages, ethnicities and economic backgrounds².

Read more “Eating disorders only affect women and wealthy individuals.”

The stereotype of someone with an eating disorder is often a young, affluent woman. A man who exercises compulsively or severely restricts what he eats might therefore assume that he cannot have an eating disorder. Symptoms in older adults and people from less affluent backgrounds can be overlooked for the same reasons.

In the same population-based study of Malaysian adults, men and women screened positive for eating disorders at comparable overall rates³. When someone does not resemble the usual stereotype, they might struggle to recognise what is happening or feel that their symptoms will not be taken seriously.

Myth“Eating disorders are not serious illnesses.”

Fact

Eating disorders can cause weakened bones, digestive damage, disrupted periods, electrolyte imbalances and dangerous changes to the heart⁸.

Read more “Eating disorders are not serious illnesses.”

Because eating and concerns about appearance are part of everyday life, harmful behaviours can be dismissed as dieting, fussiness or a passing phase. Someone might continue studying, working or caring for their family while becoming increasingly unwell.

They can also bring severe anxiety, shame, isolation and an increased risk of suicide. Anorexia nervosa has one of the highest mortality rates of any psychiatric illness⁵. Recognising the signs early can reduce the risk of serious medical complications and give the person a better chance of recovery.

Myth“You can overcome an eating disorder through willpower.”

Fact

Recovery is possible – with the right support⁹.

Read more “You can overcome an eating disorder through willpower.”

Advice such as “just eat more”, “stop bingeing” or “try not to worry about your weight” assumes that the person can switch off their thoughts and behaviours whenever they choose. Many people with eating disorders understand that their behaviour is harming them and still feel unable to change it.

Eating disorders develop through a combination of biological, psychological and social influences, including genetics, trauma, body-image difficulties and pressure surrounding weight or appearance². Recovery might require medical monitoring, nutritional support and psychological therapy. Treating the problem as a failure of willpower can add to the person’s shame and make it harder for them to ask for help.

Myth“You can tell whether someone has an eating disorder by looking at them.”

Fact

Someone can be seriously unwell at any body size.

Read more “You can tell whether someone has an eating disorder by looking at them.”

People often expect someone with an eating disorder to look extremely thin. If their weight appears typical, or if they have a larger body, family members and professionals might underestimate the severity of their symptoms.

A person’s appearance cannot tell us how much they are eating, whether they are purging, how rapidly their weight has changed or what is happening to their heart rate, blood pressure and electrolyte levels. Waiting until a person looks visibly ill can delay support while the physical and psychological consequences become more severe⁸.

Causes

Eating disorders are complex, serious health conditions that can significantly affect psychological and physical health. As with many other mental illnesses, there is no single cause. Factors that can increase a person's vulnerability include¹³:

Abuse and trauma
Bullying or teasing about weight and shape
Personality traits such as perfectionism and impulsiveness
Social and environmental pressures to have a certain type of appearance, such as slimness or muscularity

Impact

Eating disorders can have serious effects on physical health. Restricting food can cause fatigue, sensitivity to cold, dizziness and potentially dangerous changes in heart rate and blood pressure. Purging through vomiting or laxative use can cause electrolyte imbalances, dental erosion and damage to the digestive system. Other possible consequences include disrupted periods, weakened bones and, in severe cases, heart complications and organ failure^8,12.

Some of these signs can be attributed to other causes, while a person's weight or appearance might give little indication of how unwell they are. Shame, fear of judgement or difficulty acknowledging the problem can also prevent people from speaking about their symptoms. As a result, eating disorders can go unrecognised for a long time.

Eating disorders can also involve intense shame, guilt or anxiety around food; persistent dissatisfaction with one's body; an overwhelming need for control; and self-worth that becomes strongly dependent on weight or appearance⁷.

People with eating disorders might withdraw from relationships or have difficulty recognising and expressing their emotions.

Common types

Eating disorders take different forms. These are four of the most commonly recognised. A person's experience may not fit neatly into one, and patterns can change over time.

Anorexia Nervosa

Persistent restriction of food intake that leads to significantly low body weight, together with an intense fear of gaining weight or behaviours that interfere with weight gain. Weight and shape can also strongly influence how someone sees themselves or judges their self-worth.

People with atypical anorexia nervosa can experience similar restrictive thoughts and behaviours without being at a significantly low weight.

Bulimia Nervosa

Repeated episodes of eating a large amount of food with a sense of loss of control, followed by behaviours to compensate — such as vomiting, laxatives, fasting, or excessive exercise — and deep distress about weight and shape.

Binge Eating Disorder

Repeated episodes of eating large amounts of food while feeling unable to stop. These episodes are often followed by shame, guilt or distress, without the regular compensatory behaviours associated with bulimia nervosa.

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoiding or restricting food because of limited interest in eating, sensitivity to qualities such as taste or texture, or fear of consequences such as choking or vomiting. The restriction can affect nutrition, physical health and daily life, and is not driven by concerns about weight or body shape.

References

1. National Institute of Mental Health. Eating disorders. nimh.nih.gov
2. Relate Malaysia. Eating disorders: introduction. relate.com.my
3. Relate Malaysia. Prevalence of eating disorders in Malaysia (media statement, 6 May 2022). relate.com.my
4. Cheah WL, Shin LC, Hazmi H, et al. Examining gender difference in disordered eating behaviour and its associated factors among college and university students in Sarawak. Nutrition and Health. 2022;30:587–595. doi:10.1177/02601060221132597
5. Rise Above Treatment Center. Has the mortality rate of eating disorders changed? riseabovetreatmentcenter.org
6. MedlinePlus. Eating disorders. medlineplus.gov
7. National Institute of Mental Health. Eating disorders. nimh.nih.gov
8. Mayo Clinic. Anorexia nervosa — symptoms and causes. mayoclinic.org
9. Eating Disorder Hope. Anorexia death rate. eatingdisorderhope.com
10. Iles IA, Atwell Seate A, Waks L. Stigmatizing the other: An exploratory study of unintended consequences of eating disorder public service announcements. Journal of Health Psychology. 2017;22(1):120–131. doi:10.1177/1359105315595453
11. Butterfly Foundation. Myths about eating disorders. butterfly.org.au
12. National Eating Disorders Association. Health consequences. nationaleatingdisorders.org
13. Barakat S, McLean SA, Bryant E, Le A, Marks P; National Eating Disorder Research Consortium; Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord. 2023;11(1):8. doi:10.1186/s40337-022-00717-4
14. Chong LS, Chin YS, Gan WY, Mohd Nasir MT. Associations between socio-demographic characteristics and pubertal status with disordered eating among primary school children in Selangor, Malaysia. Asia Pacific Journal of Clinical Nutrition. 2017;26(2):326–333. doi:10.6133/apjcn.012016.10 (PMID 28244713)

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