His single Alive is a candid portrayal of his battle; the lyrics and video debunking stereotypes about self-harm and anorexia.

“I was around 14 or 15 when I wrote Alive, a time when I was engulfed in self-harm and thought I didn’t belong on this planet. I used to bruise and cut myself intentionally,” says Markcus, speaking from Singapore.

While anorexia is the most visually identifiable form of eating disorder, others exist, from bulimia nervosa (binge eating followed by induced vomiting) and binge eating disorder (compulsive overeating episodes associated with negative psychological and social problems) to orthorexia, a relatively new and little-known disorder born out of an unhealthy obsession with clean eating. The causes of eating disorders are not clear but research points to factors including biological (irregular hormone functions, nutritional deficiencies) and environmental (dysfunctional family dynamics and cultural or peer pressure among friends and colleagues).

Why Hong Kong needs to start talking about eating disorders

“I’m clinically depressed and anorexia was my coping mechanism,” says Markcus. “One of the most prominent displays of anorexia nervosa is the uncontrollable urge to restrict and be in control of your diet. There were other physical challenges such as feeling tired, cold as well as light-headed all of the time.”

Markcus, who was in Hong Kong last month for the annual LGBT event Pink Dot, says making music helps him deal with his emotions. “Singing is probably my only tool in conveying my emotions. I grew up in a traditional household and was taught that it’s not good to show signs of weakness. We should never complain about what’s wrong because it may affect our productivity in achieving our goals.

“My parents had a hard time accepting it [my eating disorder], and still do to this day, which has driven me to bring more awareness to eating disorders.

“Singapore has a long way to go as far as providing support for people with eating disorders – there’s very little [help] – but I hope people will become more aware and the youth of the future will experience the support I never had.”

Hong Kong’s situation is similar. The government has no specific plan for eating disorder treatments, which means there are no official statistics and very few local studies. (In a 2003 survey of 357 female students who were 15 to 21 years old, 85 per cent wanted to weigh less, although only 4.8 per cent were actually overweight.)

Eating disorders mainly affect young females; about 75 per cent of the patients are between 11 and 30 years of age, according to the Hong Kong Eating Disorders Association.

But Hong Kong-based eating disorder and addiction specialist, Gabrielle Tuscher, says eating disorders impact all demographics, adding that she has seen a rise in cases among the city’s LGBT community.

Tuscher, who is also a licensed psychotherapist and dietitian, says the big problem in Hong Kong is a cultural one that sees thin as beautiful; the high number of weight-loss treatments and pills readily available in the city are testimony to this. “The cultural stigma around eating disorders is ever present in Asia, where eating disorders are seen as a choice versus a mental illness. As a result, families who should be supporting the sufferer end up blaming them instead,” says Tuscher, who has spent 16 years treating patients with eating disorders.

Tuscher wants Hong Kong to start treating eating disorders as a mental illness, and says it was a pity eating disorders weren’t included in the inaugural three-day Mental Health Matters: The Hong Kong Mental Health Conference that ended on Sunday, November 5.

“There’s a lack of professionals [who] specialise in the field, not just in Singapore but globally, and it’s essential that people receive the right help. More damage can be done when someone takes in, or refuses cases, and they have no idea how complex the layers [behind the disorders are],” she says.

“One in six [people] in Hong Kong suffers from disordered eating, body dysmorphia, or a full-blown or developing eating disorder,” she says, citing a 2015 study in the Journal of Eating Disorders.

She says while the recent Netflix film, To the Bone – which tells the story of a 20-year-old woman and her treatment journey for anorexia – got a conversation started about eating disorders, a more accurate portrayal was the recent BBC documentary by Louis Theroux, Talking to Anorexia.

Jenny, not her real name, is also shattering myths about eating disorders which she has battled since she was a 12-year-old growing up in New York. She’s now 30 and lives in Hong Kong. Coffee in hand, Jenny looks healthy, a normal weight – no protruding bones, pale skin or deep-set eyes – as she settles into a chair at a Causeway Bay cafe. She’s dressed to suit her job in the corporate world (she works in media relations) and would seamlessly blend into a morning rush-hour crowd.

And this is the message Jenny wants to spread – those suffering from an eating disorder don’t have to fit the severely underweight female stereotype; sufferers come in all shapes and sizes. “When people think eating disorders, they picture a super-thin bony girl, someone not coping, someone with anorexia,” says Jenny.

How the ideal of a thin body harms Hong Kong women and girls

Her eating disorder started with bulimia, Jenny says, but for the most part it has been obsessive thoughts about eating. Since the age of 23 she has attended support groups. “I met people just like me – some just out of law school, others working in banking … they were my peers. I always thought people in rehab were screwed up, dysfunctional with nothing in common with me. I was wrong,” she says.

During her darkest moments she weighed herself more than 50 times a day and counted calories in advance. “If I didn’t exercise x number of hours per day then I was only allowed x amount of food – it made sense in my head, but to a rational person it would sound crazy,” she says.

Jenny says another misconception is that people with eating disorders are not able to function normally in society. “While battling eating disorders I was thriving at work – even promoted. People were like ‘you’re living in Manhattan, you have a great job and get to buy nice things’. You know, living the dream. But inside I was dying. I was a mess.

An inside view of the world of high fashion models – and eating disorders

“As a mental health issue, eating disorders manifest in different ways in different people: depression, anxiety. Doctors are not that well informed about them – Hong Kong definitely – but it’s also a global problem,’ she says.

Markcus says being in the public eye as well as on social media were factors in his eating disorder, “but were definitely not the cause”.

“There’s always been this expectation to look prim, proper and good when you’re at shows and events, and eventually, you become so used to the image of your made up self that being in rag shirts, with glasses seems to be a little off.”

Jenny says she regrets missing out on moments growing up, not because she wasn’t physically there but because she wasn’t mentally there. “Like the prom and my graduation – all I could think about was ‘Do I look fat in this?’, ‘I ate this for breakfast so I must do this much [exercise]’. When I look back at photos of those times, it makes me mad,” she says.

“I missed so many parties because I didn’t want to drink calorie-filled alcohol and I was always thinking about what time I needed to get up to hit the gym; super-early so I could get the specific treadmill I wanted.

“I had close friends but no romantic relationships because I could not sleep over at someone’s house because I had to wake up at 6am to exercise.”

Cognitive behavioural therapy, a type of psychotherapy that helps a person to change unhelpful or unhealthy habits of thinking, feeling and behaving, has been helpful, she says. (Dialectical Behavioural Therapy – a combination of cognitive and behavioural therapies – and family-based therapy and nutrition rehabilitation can also be used as treatment. ) Meditation also helped, but, she says, there is no one cure for all – each person is different.

Jenny says she is in a good place, but continues to work hard to override irrational thoughts.

And, advice for those silently suffering?

“If you think you have a problem then you probably do. It doesn’t matter what you look like or what you weigh – if your food thoughts are interfering with your life, then it’s a problem,” she says.

As for Markcus, he’s on a mission to raise awareness. “I want to draw attention to eating disorders and mental health. No one should feel like they don’t deserve a life of happiness. I don’t want young people to go through what I did alone. That feeling was terrible,” he says.