Thin is beautiful in Hong Kong, and that's where one of the territory's problems begins. Eating disorders, according to a study to be unveiled in Boston Wednesday, afflict as many as five percent of Hong Kong's adult women, and the numbers of anorexia and bulimia cases are rising.
At 4:00 p.m., the 7-11 convenience stores which occupy nearly every street corner in this school district are packed with boys buying fried fish-balls, barbecued pork buns and chocolate bars. The schoolgirls mill about on the sidewalk, but do not indulge.
"I'm really afraid of getting fat," says one. "Fat girls are ugly," says another, "and they can't attract boyfriends."
Nutritionists in Hong Kong are taking a serious look at the causes of eating disorders among women. Are women paying the price of affluence, are they just blind followers of fashion or victims of deep-rooted cultural demands for thinness? The answers they are finding may contain the elements of all of the above.
In Hong Kong, women commonly use dozens of diet pills, including fen-phen. But what worries nutritionists more are the serious disorders, such as anorexia, self-starvation also known as the Golden Girl syndrome, and bulimia, the binge-purge syndrome in which women gorge themselves and then induce vomiting, often with serious medical side effects. Professor of Nutrition Georgia Goulden at the Chinese University in Hong Kong is among the first to document youth attitudes towards eating in Hong Kong.
"Ignorance combined with affluence are our biggest health risk factors in Hong Kong," she said. "When we ask our teenage girls are you trying to loose weight, maybe more than 40 percent will say they are, but only 13 percent are overweight."
A clinical psychologist at Hong Kong's first eating disorder clinic, Kathleen Kwok, says studies here reveal the rate of anorexia and bulimia is on the rise. Ms. Kwok says in China disordered eating is closely linked to the economic development of the area in which the patients live.
"I think one of the most important factors is the brainwashing by the media, because the Hong Kong people strongly endorse the idea that thin is beautiful and a survey carried out by our center last year revealed that the highest rate of development is correlated to the highest rate of eating disorders," Ms. Kwok said.
Professor Freedom Leung, a Hong Kong based psychologist, acknowledges economic development may be a factor, but he says his studies show there are deep historic roots in Chinese culture emphasizing thinness.
"We have eating disorder in our history, this kind of emphasis on slimness and fragility, and we have this kind of dieting practice to get thin among Chinese women long before they occur in the West."
At the International Conference on Eating Disorders taking place in Boston, Mr. Leung will present a new study showing that bulimia and anorexia are not isolated to Hong Kong's impressionable youth.
Extrapolating from a study of nearly 600 female nurses aged 28-55, he found almost five percent of adult females in Hong Kong admit to suffering from either bulimia or anorexia. He says with more sedentary lifestyles and changes in eating habits, women find it increasingly difficult to fit into the traditional mold of feminine beauty.
"Because Chinese women, their body size has changed because of a change in eating habits, so the current bodey shape of women is having a larger discrepancy between the social ideals and the biological reality, that's the problem."
With the biological reality leading women in Hong Kong and China further away from the cultural ideals of the past, experts fear the problem of nutritional disorders is likely to get even worse.