When the person in the mirror is never thin enough

Kim Jong-du was a young wrestler who badly wanted to get into the right weight class.
He weighed 56 kilograms (123 pounds), but another athlete from his area was already competing in the 50-kilogram weight class. To participate in the 84th National Sports Festival in Jeonju, he needed to come down to 46 kilograms.
So it was that this resident of North Jeolla province went on an extreme diet, and an extreme exercise program, once too often. He passed out on Oct. 10, running while dragging a bicyclist behind him. He died two days later. He was 17 years old.
In a country obsessed with appearance, eating disorders ― to which athletes, according to a recent study, are particularly susceptible ― often go ignored. For the 292 cosmetic surgery clinics in the Gangnam area, there are only a handful of eating disorder clinics.
One of them, Nanum Clinic, is situated above a bakery in Apgujeong-dong. Dr. Lee Young-ho, who opened Nanum Clinic in 1990, did a study on eating disorders in Korea with eight other physicians. Published in 1998, the study suggests that “changes in various sociocultural aspects have increased the risk of devloping eating disorders in Korea, and support the sociocultural hypothesis of eating disorders.”
As a hospital resident in 1970, Dr. Lee saw only one case involving an eating problem. Since 1988, he has seen thousands.
“Has the problem become worse, or was it always here and went undetected? I don’t know,” Dr. Lee says.
The 1998 study found that 8.5 percent of the Korean population has an eating disorder. While the problem is more common in females, men are also susceptible. High-risk groups are models, professional dancers and athletes.
Park Gyeong-hee, a counselor with Kyurim Oriental Medical Center in Yangjae, also works with eating disorder patients. Ms. Park, who was bulimic as a young woman, estimates that about 70 percent of females in Korea are on some kind of diet. Among the dieting population, she says, 70 percent show symptoms of eating disorder.
Worldwide, eating disorders are a relatively new phenomemon. In recent decades, the “ideal” body type has changed from voluptuous to thin. Obsessively centered on this goal, people will starve themselves (anorexia nervosa), or uncontrollably eat large quantites of food (binge eating), or eat and then throw up (bulimia nervosa).
Some doctors consider eating disorders a Western phenomemon. According to the 1998 study by Dr. Lee and his colleagues, reports of eating disorders are more rare in undeveloped countries and among nonwhite races.
One of the problems with eating disorders is perception. Patients have a distorted body image and think they are too fat. Each time they slip from their self-imposed eating regimen, they feel guilty, and become all the harder on themselves.
Ms. Park, at first sight, might seem to fall into the slightly-too-skinny category. Showing a picture of a girl with swollen cheeks, however, she says, “That was me when I was in college. My weight once went up to 73 kilograms, and then I lost 30 kilograms.
“One of the conspicuous signs of bulimia is swollen cheeks. It took about a year for my cheeks to go back to normal after I stopped vomiting,” Ms. Park said.
Ms. Park’s struggle with body image dates back to her teenage days. Ironically, she was a nurse at an eating disorder clinic while she was still fighting her body image. “I hated to see my patients, because I knew how bad it feels.”
“Bulimia is addictive,” Ms. Park says. “Although you may try to stop vomiting, your brain already recognizes it as a way of relief and, moreover, a refreshing activity. It is medically proven that serotonin, which makes you feel good, is released when you throw up, which is why it can be addictive.”
Another survivor, in her early 20s, is wide-eyed and hopeful in the way that young women often are. Her downward spiral began with a desire to lose weight. She was 19 years old when she first started dieting. She would eat breakfast and then work out for four hours. Sometimes she ate lunch, sometimes not.
In a month and a half, she lost 20 pounds. But when she went to college, she gained the weight back in two months. After her first year in college, she enrolled in a body care center, became a vegetarian and watched everything she ate. “I counted the amount of cereal flakes I ate, and allowed myself no more than 5 spoons of porridge,” she recounts.
In her junior year, she lost control and started binge eating. “I just couldn’t stop when I started,” she says.
She began to hide from people. “When you’re hanging out with your friends, you can’t avoid eating. So I lied. I said I wasn’t feeling well, or that I had already eaten.” To make matters worse, at least for her, she was a psychology major, and was leading a Bible study. “I was supposed to help people, but I had my own problems.”
When she began losing weight, she was at 145 pounds. Her ultimate goal was to weigh 100 pounds, but she says she would have been happy with 115 pounds.
The summer after her junior year, after waterskiing with friends, she collapsed. Lying in bed for two weeks, she began to think that she needed help.
She walked into a clinic and, after talking to a doctor, began to reconsider her self-image. She decided, “I want to let go of everything.”
Instead of counting calories, she concentrated on nurturing herself. In the process of letting go, she put on weight until she was back to where she’d started from. But now she didn’t mind. She tried to eat regularly, and worked out for fun.
Her friends, who weren’t aware of her problem, were unknowingly unhelpful. “Why are you putting on weight?” they would ask. “You looked better before.” Her mother asked her not to use her medical insurance. “She was supportive, but she didn’t want any permanent record that I had seen a psychiatrist.”
Gradually, the unexpected happened: She began to lose weight. She now weighs 110 pounds, and says she is much happier. “Yes, I did lose weight, but the number isn’t necessarily what makes me happy,” she says. “I’m happy with who I am as a person.”
She says she’s at peace with her body and with her self-image. She also says she doesn’t know anyone in Korea who’s been through what she’s been through.
According to Dr. Lee, only a few of his patients seek help on their own. Most are accompanied by family or friends; even then, he says, “They’re afraid I’m going to make them fat.”
Ms. Park agrees. “Patients that come seeking help are still very few. One of the most distinctive characteristics of bulimia patients is lack of belief in themselves and others. They don’t trust anyone, hence seeking help is probably the last choice they would ever make.
“However, once they seek help, about 50 percent are competely cured,” Ms. Park says.
“Treatment for bulimia is like dominos,” Ms. Park adds. “It takes a long time to build, but once it crumbles, everything falls down. However, that doesn’t mean that all the effort has gone to waste.
“Yes, it may take some time, but when you build upon the remaining blocks one by one, eventually, you will complete a full work of dominos,” she says.
Without help, eating disorders have a 10 percent mortality rate. To create public awareness and to battle her memories of patients who died ― through suicide or internal injuries ― Ms. Park is writing a book about her experiences.
Dr. Lee has been trying to create a support network. But he finds that coming out in the open is very rare among Koreans. “Who in Korea wants to admit they go to a psychologist, or have anything that even hints at having a mental problem?”
Kim Jong-du, the wrestler, kept an online journal. On Oct. 4, he wrote, “I thought I was going to die today. I was going to hang out with some people today, but I couldn’t because I have to lose weight. I worked my butt out today but I only lost 1.3 kilograms. What is 10 kilograms? I think I’m going to go crazy, but I’ll deal with it. There are only five kilograms left.”

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If you think a friend might have an eating disorder

The National Eating Disorders Association (www.nationaleatingdisorders.org) has these suggestions for people concerned that a friend might have an eating disorder:
Set aside time to talk. Have a private, respectful meeting with your friend to discuss your concerns openly and honestly, in a caring, supportive way.
Communicate your concerns. Share your memories of specific times when you felt concerned about your friend’s eating or exercise behaviors. Explain that you think these things may indicate that there could be a problem that needs professional attention.
Ask your friend to explore these concerns with a counselor who is knowledgeable about eating issues. If you feel comfortable doing so, offer to accompany your friend on their first visit.
Avoid conflict or a battle of wills. If your friend refuses to acknowledge that there is a problem, restate your feelings and the reasons for them, and leave yourself available as a supportive listener.
Avoid placing blame on your friend. Do not use accusatory “you” statements like “You just need to eat” or “You are acting irresponsibly.” Instead, use “I” statements: “I’m concerned about you because you refuse to eat breakfast or lunch,” or “It makes me afraid to hear you vomiting.”
Avoid giving simple solutions. For example, “If you’d just stop, then everything would be fine!”
Express your continued support. Remind your friend that you care and want your friend to be healthy and happy.
After talking with your friend, if you are still concerned, find a trusted adult or medical professional to talk to. This is probably a challenging time for both of you. It could be helpful for you, as well as your friend, to discuss your concerns and seek assistance and support from a professional.

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Eating disorder clinics

Nanum Clinic
(02) 3445-0606; www.diet-clinic.com
Subway line No.3, Apgujeong Station, Exit 5

Baeksang
(02) 3452-9700; www.npspecialist.co.kr
Subway line No.2, Gangnam Station,
Exit 8

Garosero Diet & Oriental Medical Clinic
(031) 715-2530; www.garoserodiet.com
Bundang, Gyeonggi province
Near Sunae Station, Daeduk Plaza

Kyurim Oriental Medical Center
(02) 571-4994
www.kyurim.com
Subway line No.3, Yangjae Station, Exit 3, third floor of T.G.I.F. Building

In addition to these clinics, Park Gyeong-hee offers online counseling at cafe.daum.net/freedietz.

by Joe Yong-hee

Eugine Oh contributed to this report.