Why So Many South-Asian Women Have Eating Disorders

When I was 15 I had a particularly bad bout of typhoid fever while on a trip to India. One of the main symptoms is a total loss of appetite, and within days of contracting the disease I'd dropped a clothes size. After the typhoid, bits of puppy fat that had clung to my body disappeared. All the Indians around me teased me about needing to put on weight. My body had never been talked about for being too thin, and it became addictive. These encouragements – or what I saw as encouragements, at least – triggered an eating disorder.

Many young people in Britain have eating disorders, but statistically girls from South Asian families are more likely to have one than anyone else. A host of peer-reviewed studies in the 1990s uncovered that South Asian women in the UK had a higher prevalence of clinical bulimia and unhealthy eating attitudes than those from other ethnic backgrounds. In 2003, a study was conducted in a school in east London using BITE (Bulimia Investigation Test, Edinburgh), and South Asians scored the highest over their white and African-Caribbean counterparts.

Part of the reason British women who are part of the South Asian diaspora are particularly at risk is they are exposed to traditionally Western triggers – peer pressure, pictures of thin celebrities and pro-anorexia websites – while, in their home life, they experience confusing and conflicting messages about food and weight.

Some of the main things my mum and dad reiterated to me as a child were that you never left food on a plate and that there were a great number of starving people in India. By my culture's reasoning, food is a sacred, nourishing thing, meaning anorexia is a selfish, ungrateful thing, as it's a "willing" rejection of this gift.

"I remember I went to India in the peak of my eating disorder, and everyone used to literally force-feed me all the time," says Arthi, who had suffered from anorexia since she was 13. "I would just not want to go to guests' houses because they would force food on me and… if I was at someone's house I couldn't just relax. If you eat all the food on your plate then they replace it, or they get really offended if you don't eat anything at their house. All you're doing while you're [in India] is visiting other people's houses. At the time, I remember it was stressing me out a lot. I don't think being Indian triggered my eating disorder, but I think it made it more confusing to deal with and was less understood by the people closer to me."

However, the real concern when trying to understand the scope of eating disorders in Indian and other South Asian communities in Britain is that there is no real way of knowing the extent of it. Cultural stigmas and the secretive nature of these illnesses mean that accurate statistics are near impossible – a problem not helped by a lack of recent research. Currently, BEAT, the leading UK eating disorder charity, estimates that over 725,000 people in the UK suffer from an eating disorder – but how this is broken down in terms of race is unknown. Since anorexia has the highest mortality rate of any psychiatric disorder, these figures are highly worrying.

Pro-anorexia websites never featured heavily in my own illness, but browsing through them, they highlight a community of South Asian girls growing up in Western environments and locating each other for support about their unique experiences. On forums you see how families' conflicting messages about eating lots but staying thin play out.

On one thread on an anorexia messageboard about South Asian eating disorder sufferers, one user named pandattacks wrote: "There is no doubt that Desi girls are never considered or thought about when it comes to eating disorders. That it's some 'gori' [white person] problem. However, most of us have been ridiculed when it comes to our bodies. Our parents saying that we're too fat yet insisting on us too eat, aunties and uncles openly talking about how fat/thin we are, being told that no man will marry us if we're fat."

Another user named WeightlessAngel said: "Also in the culture I was born into mental issues essentially make someone a freak and it seems to be the same at the temple too. I think a few senior members have sussed something isn't quite right and every so often I'll get the odd question, but one or two [of the] people I did trust to tell looked completely confused when I said the word anorexia and it was almost immediately brushed aside as not a mental issue but simply a case of needing to spend more time in religious activities."

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"I thought people would stop bullying me if I lost weight, so I thought, 'I've got to keep losing [it].' It was just a vicious cycle, and there was also a lot of self-hatred. I thought my life would be better if I looked a certain way. The media, even in Bollywood movies, is always centred around the tall skinny girl who's stereotypically pretty – she's got money and settles down, etc. So, for me, seeing those media depictions in Hollywood and Bollywood, didn't help. I just kept losing weight, kept losing weight, dropped down to a size eight. I was addicted to the feeling of it."

The real danger for South Asian teenagers is that their parents may not recognise an eating disorder when they see one, and will be less likely to seek medical help than other groups. In 2008, a group of researchers examined the approaches South Yorkshire Eating Disorders Association used in relation to BME patients, investigating the barriers they faced in getting help and their specific needs when recovering. They found that UK-born individuals were more aware of eating disorders, whereas older individuals – potentially parents – who hadn't grown up in the UK were "poorly informed" about anorexia and bulimia. Among a list of conclusions, it found that many communities harboured a "eating disorders are a white people's problem" mentality, which could hinder their children to receiving the help they need.

Millie said: "The struggle I had was with my grandparents and aunts and uncles. When I was anorexic I got to the point where doctors said I'd have two weeks to live, as my heart would fail. The doctors said to my parents they needed a support network as they couldn't handle it all. My dad's parents are all in India, whereas my mum's family is all here, so she told them, and the first thing they said was, 'It's because you spoilt her; whenever she asked for water, you gave her milk.' So basically, my grandmother visited me in hospital, and – bearing in mind I was so ill – they took me on a wheelchair and she said to me, 'We get it, you want attention, just snap out of it, we're giving you attention.' If I wanted attention I would streak in the middle of a football pitch; I wouldn't be doing this; I wouldn't be near death. So it was that sort of stigma I had to fight against."

Millie isn't the only person to experience ignorant or harmful comments from those around her, either. Arthi also found that her parents thought she just needed to "snap out of it". Eventually, she saw a dietician and a handful of councillors before slowly gaining more weight and changing her relationship with food for the better.

Millie, too, has a far healthier mindset now. At her lowest mental health and physical state, she was a size four and developed receding syndrome, a common illness in many anorexic and starvation cases where the body is unable to suddenly accept regular food and continues losing weight. After being told to either voluntary attend a psychiatric hospital or be sectioned, she agreed to intensive care. She began a more stable route to recovery and is now far happier and healthier.

Through speaking out on outlets such as BBC Asian Network and in her future book, Millie hopes to fight inner-cultural stigma as well as the media's portrayal of eating disorders. "I would say it's a problem with [mainstream media] that we associate eating disorders with middle to upper-class white women, when actually you obviously get men with eating disorders, you get women of colour, you get people from every sort of class, from working up to aristocracy."

Millie isn't the only one speaking out about her own struggles despite the cultural stigma against mental illness and eating disorders in the Indian community.

Priyesh Vyas, 24, successfully applied to be an ambassador for B-EAT, a UK charity supporting those affected by eating disorders. As the first Asian to take up the role – and a man – he's challenging the common belief that eating disorders only affect white women by speaking out on his bulimia struggles.

During the early days of my illness, I remember using the run-up to Diwali to fast, even though no one in my family would. Under the guise of religion and culture, I was doing what I could to get my calories under 800, and telling myself I was making my parents proud.

The reality was that my mum was heartbroken and my dad completely at a loss when they realised what was happening. They had never banked on a daughter so fixated on a cause that would kill her, and had to somehow come to terms with it, even though it contradicted everything they had ever taught me. Initially, they felt betrayed; they'd always given me everything I would ever need.

I'm not sure what changed their approach, but they sought out psychiatrists and doctors as they couldn't tackle it alone. They took time away from work to look after me, and patiently celebrated each kilogram I gained. They worked to change the gratification I felt about losing weight into pride about being healthy. As my mental health and body became stronger, each self-hating thought about eating got weaker, and eventually disappeared when they got their daughter back.

Those concerned about eating disorders can find help and advice at B-EAT.

@RuchoSharma