WHEN Mr Fauzi Rassull decided he wanted to be stick-thin for beauty's sake, he got flak from his family and friends.
They worried that the 20-year-old was too thin and pestered him to see a doctor for his eating disorder.
Feeling misunderstood, he set up a group on social networking website Friendster called 'The thinspo Club' and one on Facebook called 'Get thin or die trying' to find more like-minded people.
His are just two of many online groups around the world that preach the idea that 'thin is beautiful'. On Facebook, there are more than 100 pro-anorexia groups. Many count Singaporeans among their members.
Such groups have come under fire for their pro-anorexia stance, in which members tout anorexia as a lifestyle choice rather than an eating disorder. They share extreme diet tips and post pictures of emaciated girls labelled 'thinspiration', usually images of waif-like models or celebrities.
Within a few months of exchanging tips over these sites, Mr Fauzi lost more than 20kg on a diet of mostly vegetables. His Facebook group currently has more than 300 members, the majority of whom are Singaporeans.
The proliferation of these sites has raised concern among doctors and experts, who fear that they can hamper the recovery of those suffering from anorexia or even lead to healthy individuals developing the condition, in which patients starve themselves because they are deathly afraid of gaining weight.
Medical professionals say one reason for the usually hushed-up illness' shift to public platforms is the desire of anorexia sufferers for support and acceptance from others like them. In the case of younger sufferers, it could also be a sign of adolescent rebellion to proclaim their disorder to the world.
Stanford University professor Rebecka Peebles, who co-authored a 2006 study on the link between eating disorders and such websites, said in an interview with Newsweek last November: 'The more types of these sites you use, the higher your risk for disordered eating is.'
She acknowledged that the sites may not lead to an eating disorder. Rather, they preach to the converted. Her study showed that 96 per cent of teens diagnosed with such disorders learnt new dieting and purging techniques on such sites.
On these sites, members - most of them women - pen entries obsessing over the number of calories they consume each day.
Some survive on 500 calories a week through a diet consisting of little more than water and some fruit. The recommended daily calorie intake for a healthy woman is 1,940. When their resolve starts to weaken, other members encourage them to control their hunger pangs.
A former anorexia sufferer, who wanted to be known only as Lena, said: 'These websites talk of nothing but the disorder, hence you think nothing but thoughts about losing weight.'
Having visited such websites during her four-year-long illness, the 17-year-old can well understand their appeal.
'Everyone needs support. Some don't have family or friends here to provide that. So they turn to online sources,' she said.
But the 'support' merely feeds into a vicious circle.
According to Dr Lee Huei Yen, the director of Singapore General Hospital's Eating Disorders Programme, group members often compete with each other to see who can lose more weight.
Some websites also teach younger members how to deceive their parents during meals, or their doctors during regular weigh-ins.
'There is also the danger that these sites frequently glamorise having an eating disorder, touting it as a lifestyle choice rather than an illness.
'This may lead patients to feel that they are 'normal' and not realise how sick they really are,' Dr Lee said.
The clinic now sees about 10 new cases of eating disorders each month, half of which are anorexia.
These sites are also giving doctors a harder time when it comes to treating patients.
Consultant psychiatrist Vanessa Keleher from the National University Hospital said there has been a definite spike in the number of patients visiting such sites, compared with when she started work in the field in 1998.
Now, almost all her patients have been to, or know of, these sites. Most vulnerable are those in the early stages of recovery, when easy access to these sites may drag them back down the slippery slope.
Dr Liow Pei Hsiang, consultant psychiatrist at Alexandra Hospital, calls these sites a 'distraction'.
Patients have to be counselled to understand how their eating disorder prevents them from achieving life goals they set for themselves. Visiting such sites may hinder them from participating actively in their own recovery.
She said: 'It really affects their recovery as they need to stay focused and motivated. Motivation is one of the most important aspects of recovery, and being constantly bombarded by pictures of thin girls doesn't help. These sites have a visual impact that is a distraction.'
So with these sites just a mouse click away, is there anything that can be done?
Most doctors feel that open communication, whether with therapists or relatives, is key. If they notice a person visiting these sites compulsively, they can intervene.
Said Dr Keleher: 'So much of the illness is about being secretive. Part of treatment is challenging the anorectic beliefs and promoting open communication.
'Anything that promotes dangerous health practices or promotes an illness that causes so much distress is worrying.'
kimspyke@sph.com.sg
This story was first published in The Straits Times.
