Editor—I support the urge for a more responsible media attitude on body image,1 not only in the United Kingdom but in Asian countries as well. A decade ago anorexia nervosa was rare outside the developed West. Now, however, it is becoming a common clinical problem among young women in Hong Kong and other high income Asian societies, such as Japan, Singapore, Taiwan, and the Republic of Korea. At the same time as economic liberalisation has led to the deregulation of media advertising, eating disorders have also appeared in major cities in low income Asian countries, such as China, India, Malaysia, the Philippines, and Indonesia. Community studies in Hong Kong indicated that 3-10% of young women had disordered eating of a degree that warrants concern.2
Patients with eating disorders often attend several practitioners before they receive some sort of psychological treatment; these referrals have increased considerably since the late 1990s, and ever younger subjects are referred. It is alarming that this condition has appeared even though young Asian women are constitutionally slim by the standard of Western women. The depiction of ridiculously slender women in advertisements for virtually all kinds of commercial products must necessarily contribute to dissatisfaction with the body and disordered eating, especially in vulnerable individuals.3
Media advertising cannot be the only social determinant of eating disorders. In all likelihood, societal modernisation intensifies vulnerability to eating disorders in women. If patriarchal sociocultural influences that are disempowering to women have a substantial role in eating disorders, we must remember that these forces are strong in Asian societies.
The rising rate of eating disorders will pose a public health challenge in the East. A change of media attitudes can almost certainly help, but Asian women may find the economic forces that maintain those attitudes simply insurmountable.