Dying to lose weight

In 2019 the emergency department of West China Hospital of Sichuan University admitted a woman patient whose body was swollen due to overeating.

Emergency ward doctors took out more than 10 kilograms of food residue from her stomach. However, she eventually died due to multiple organ failure.

The hospital says the woman, 22, suffered from anorexia nervosa, bringing long-term weight loss, and her digestive function was so weak that her stomach was unable to withstand the stress that binge eating put on it.

Nowadays in China tens of millions of young people pay attention to fitness and weight loss, which is a staple of conversation but can also become an obsession.

A side effect of this, and one that has gained little attention, is eating disorders, which many dieters will develop.

"Many who lose weight have been brainwashed by the prevalent 'calorie balance' theory," says Chen Hanbin, a physician at the department of clinical psychology, Hangzhou First People's Hospital, in Zhejiang province.

"To lose weight they do physical exercise and diet to a crazy extreme. They continue to suffer in a cycle of successful weight loss, rebounds, dieting, binge eating and anorexia."

Many Chinese would recognize the following scenes: A few male university students knock into a female classmate in the street and rather than offering her a courteous hello, one of them blurts out,"What's with the flab? Are you in love or are you just eating too much food?"

In the university canteen the males notice that a woman is being very picky with what she orders, and one asks her,"Are you counting calories or something?" not realizing this could cause offense.

While women are less inclined to talk to each other that way, they do seem to envy anyone they see who has an ideal body shape. There are also women who are obviously prettier and thinner than many internet celebrities whose ways of keeping trim include inducing vomiting in the toilet.

Health experts such as Li Xueni, chief physician at the Institute of Mental Health, Peking University Sixth Hospital, says the influx of diversified fashion information and the resulting social pressure on women has played a big role in shaping people's attitudes to dieting.

"In recent years the number of people with eating disorders coming to our hospital for treatment has soared," Li wrote in Psychology and Health, a health magazine sold nationally.

"Just turn on the TV or pick up a magazine and you're bombarded with information about food, weight loss, body sculpting, calories, supermodels, new clothes and so on. Everyone regards a slender figure as a symbol of fashion, elegance and attractiveness, and this cultural ethos has seriously affected the values of young people. So low weight is favored, and in certain groups, such as actors and models, the prevalence of eating disorders is higher than among the general population."

Dingxiang Doctor, an online platform that provides medical health content and health services, says about 3 percent of young people and adults in the world suffer from severe eating disorders, and the male to female ratio is 1:10.

"There are no official figures for China, and often here treatments cannot keep up with how quickly eating disorders are proliferating," Chen says ."It's often misdiagnosed and sometimes concealed because the patient feels it tarnishes their reputation."

In a country that uses "Have you eaten?" as a common greeting, experts are trying to understand this life-threatening disease to determine how an extended mental health system can ensure proper care.

The eating disorder support project of the clinical psychology department of Shanghai Mental Health Center, one of China's few programs dedicated to the treatment of eating disorders, gives us a glimpse of this disease that was almost unheard of 30 years ago, a complex byproduct of modernization and new media.

Zhang Qinwen's fainting happened in a flash. Opening her eyes in confusion, she found herself lying on the ground surrounded by people, and her head covered with blood. As she was too thin and could not be treated with anesthetics, the doctor could only cut off her head skin, and stitch it later directly.

At the time, Zhang had not eaten normally for more than two years, as if "I had fallen into a huge black hole, and food was the devil in my eyes," she later recalled and told media.

"I really want to eat, but when I eat, I can't think about it, and I want to die. Because there is a voice in my heart saying that it is the devil."

In her early 20 she was losing hair, her skin was peeling, she had age spots and abnormal menstruation, and it was difficult for her to climb stairs. Zhang's parents had kept an eye on her every day to ensure she ate, even if it was only two small pieces of biscuit and half a cup of skimmed milk. She would cry all afternoon, and finally eat while crying. In the tense atmosphere of home Zhang easily quarreled with her parents over trivialities. Disgusted with herself, she often hid under the table, behind curtains or in the corner.

Zhang felt those days were like being in a sandstorm, knowing that her parents were right but all the same not accepting food, and being wracked by contradictory thoughts.

Eating disorders is a general term for a group of diseases such as anorexia nervosa, bulimia nervosa and binge eating disorder. Chen Jue, director of the clinical psychology department of Shanghai Mental Health Center, told China News Weekly that "although eating disorder is a minor disease in the psychiatric department, anorexia has the highest fatality rate among mental disorders, as high as 5-20 percent."

Zhang was admitted to an intensive care unit weighing just 28 kilograms. With tests showing how exhausted her body was, the hospital listed her in critical condition. In the course of treatment she used a pseudonym, Girl God Granny, online to record her state of facing anorexia and gradually recovering, and began to form a mutual aid group with other patients on the internet. The patient explains the condition and popularizes relevant knowledge for the public.

"Pig","Shame","She is better than you","Too fat"... In a gallery space, various notes in which people are evaluated and often humiliated appear in a collage on walls, and the center of the space is a cage in which a string puppet symbolizes a man with an eating disorder. He is sitting at a table replete with delicious food wrapped in dense threads, holding a ruler and a knife in his hand. He is not eating but measuring, calculating and taking pictures. This is one of the exhibits of the Anti Body-Shaming exhibition that Zhang curated at the Himalayas Art Museum in Shanghai in May. It depicted the daily state of patients with eating disorders trapped in their bodies, and food and external evaluations.

Another striking exhibit in the exhibition was an apple made of clay, acrylic and PVC environmentally friendly plastic. The middle part was bitten into by the creator Li Yuyuan. This is said to be the experience of anyone with an eating disorder, the feeling that things "taste like chewing wax". Zhang says food is an angel to the body, but it is a devil in the mind of those with eating disorders.

"They experience the mind and the body being at loggerheads every day," she says.