SEOUL — Thirty miles south of the border with starving North Korea, young women in the South Korean capital are starving themselves, victims not of famine but of fashion.
Dr. Si Hyung Lee has seen this dark side of affluence and modernity. He remembers best the patient who died of respiratory failure. "She was a pediatrician's daughter," said Lee, director of the Korea Institute of Social Psychiatry at Koryo General Hospital in Seoul. "Her father and mother were both doctors."
But her parents failed to realize that their teenager suffered from anorexia nervosa--a disease almost unheard of in Korea a decade ago--until it was too late to save her.
If Asia is a reliable indicator, eating disorders are going global.
Anorexia--a psychiatric disorder once known as "golden girl syndrome" because it struck primarily rich, white, well-educated young Western women--was first documented in Japan in the 1960s. Eating disorders are now estimated to afflict about 1 in 100 young Japanese women, almost the same incidence as in the United States, according to retired Tokyo University epidemiologist Hiroyuki Suematsu.
Over the past five years, the self-starvation syndrome has spread to women of all socioeconomic and ethnic backgrounds in Seoul, Hong Kong and Singapore, Asian psychiatrists say. Cases also have been reported--though at much lower rates--in Taipei, Beijing and Shanghai. Anorexia has even surfaced among the affluent elite in countries where hunger remains a problem, including the Philippines, India and Pakistan.
Doctors in Japan and South Korea say they also have noticed a marked increase in bulimia, the "binge-purge syndrome" in which patients gorge themselves, then vomit or use laxatives to try to keep from gaining weight, sometimes with lethal consequences.
Experts debate whether these problems are caused by Western pathologies that have infected their cultures via the globalized fashion, music and entertainment media or are a generic ailment of affluence, modernization and the conflicting demands now placed on young women. Either way, the effects are unmistakable.
"Appearance and figure has become very important in the minds of young people," said Dr. Ken Ung of National University Hospital in Singapore. "Thin is in, fat is out. This is interesting, because Asians are usually thinner and smaller-framed than Caucasians, but their aim now is to become even thinner."
In the West, the average body mass index, or BMI, which assesses weight relative to height and determines body composition, ranges from 20 to 25 for a healthy young female, Ung said. Among young Chinese women, the average BMI is 20, he said.
Nevertheless, a weight-loss craze has swept the developed countries of Asia, sending women of all ages--as well as some men--scurrying to exercise studios and slimming salons.
Liposuction surgeons have popped up in Seoul, as have diet powders and pills, cellulite creams, weight-loss teas and other herbal concoctions "guaranteed" to melt away the pounds.
Anything to Be Thin
In Hong Kong, 20 to 30 types of diet pills are in common use, including variations on the "fen-phen" combination of fenfluramine and phentermine that was banned in the United States last month for causing heart damage, said Dr. Sing Lee, a psychiatrist at the Chinese University of Hong Kong who has written extensively on eating disorders. Though the Health Ministry has asked pharmaceutical companies to withdraw the offending drugs, "I'm sure new ones will be coming out right away," Lee said.
In Singapore, where the anorexia death of a 21-year-old, 70-pound student at the prestigious National University made headlines last year, dieting itself has become a fashion statement. On Orchard Road, the city's toniest shopping district, a hot-selling T-shirt designed by "essence" bears this stream-of-consciousness essay on modern female angst:
"I've got to get into that dress. It's easy. Don't eat . . . I'm hungry. Can't eat breakfast. But I ought to . . . I like breakfast. I like that dress . . . Still too big for that dress. Hmm. Life can be cruel."
In Japan, where dieting is less a trend than a way of life for many young women, the principle that thinner is better is now being applied to facial beauty. A recent subway flier for a young women's magazine pictured an attractive model complaining, "My face is too fat!"
Drugstores and beauty salons offer face-reducing seaweed creams, massage, steam and vibration treatments and even Darth Vader-esqe facial masks designed to promote sweating.
The Takano Yuri Beauty Clinic chain, for example, now offers a 70-minute "facial slimming treatment course" for $157 at 160 salons across Japan, and reports that business is booming.