When Dr Sing Lee first looked into anorexia in Hong Kong 20 years ago, he found it occurring mostly in women who were suffering clinical depression. Eating disorders remain largely a female problem - 10 women for every man - but the main 'triggers' are now more to do with fat phobia and body image issues, says Lee, a professor of psychiatry at Chinese University.
What's more, health professionals in Hong Kong are now observing the condition in pre-teens. Hong Kong-based nutritionist Gabrielle Tuscher reports an increase in the number of children and adolescents with eating disorders being referred to her practice. Tuscher's caseload includes children as young as eight, and even a few boys.
At the Hong Kong Baptist Hospital, paediatric consultant Dr Lilian Wong also finds that her patients with eating disorders are getting younger.
This reinforces a report co-authored by Lee in the International Journal of Eating Disorders last year that found the number of Hong Kong patients suffering from anorexia nervosa or bulimia had doubled over 20 years at a psychiatric clinic they studied. In the first 10 years, the clinic saw 67 patients; during the next decade, from 1998 to 2007, the number rose to 128.
Because of pervasive slimming messages and society's concern with body image, experts say, some children and teenagers become so obsessively afraid of being fat that they severely restrict their eating in a bid for an unrealistic body weight. While these habits may not lead to full-blown eating disorders, the death in November of French model Isabelle Caro, 28, dubbed the international face of anorexia nervosa, was a grim reminder of the extremes such behaviour can reach.
Because sufferers don't fit the usual criteria for diagnosis (female, from 13 to 20 years old), doctors have coined a new term - 'eating disorder not otherwise specified' - for the condition in young children. Failure to menstruate, for instance, wouldn't surface as a symptom in girls who have yet to reach puberty.