With the help of therapists and support communities, many are looking beyond the scales and making progress

Bao Guang stood before the snack aisle, his fingers tracing the edge of a potato chip bag.

His eyes were fixed on the first line of the nutrition facts panel:2,228 kilojoules per 100 grams. Eating the contents of the bag would push his daily calorie intake over the limit he'd set for himself. In the end, he walked away.

His friends called him fat, and he agreed. Using the internationally recognized Body Mass Index, he admitted he was "beyond the range generally considered healthy".

Disliking exercise, Bao believed he could only restrict his eating. However, long-term dieting hadn't led to significant weight loss. Instead, it took a toll on his mental health.

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"I've become a weirdo now," Bao confessed. "The more I fail to lose weight, the more I deny myself proper meals. But seeing all this delicious food, I crave it so much. Sometimes I hate myself, and I hate people who are naturally thin."

Rising trend

Approximately 41.9 million people worldwide with eating disorders remain uncounted, according to a study published in The Lancet Psychiatry in 2020.

In China, a 2017 survey by the Shanghai Mental Health Center indicated that 25.3 percent of new university students exhibited tendencies toward eating disorders.

Yet, this illness is often misunderstood as an affectation of extreme dieters.

"Eating disorders easily evolve into psychological issues," said Shi Yu, founder of Beijing's Mentaverse Psychological Service Studio.

"And they are often hidden. Many feel shame about their eating disorder and are reluctant to speak up; some with milder symptoms don't even recognize it as a psychological problem requiring professional help; and many others mask their eating disorder behind other psychological conditions, not presenting it as their primary complaint."

Shi, a former psychological doctor at the Medical Psychology Department of the PLA General Hospital Third Medical Center, said the flip side of a restrictive eating disorder is a binge eating disorder. This illness is characterized by an inability to stop eating, which also has psychological roots, Shi explained.

"The digestive system is the body's second-largest emotional organ, after the brain. Control over eating is directly linked to a person's emotions," she said.

Li Yao, 27, works in Shanghai's central business district. Two years ago, work pressure contributed to his weight ballooning to over 90 kilograms within two years, too much for a person of average height.

To lose weight quickly, he started a strict diet. However, the regimen was too stressful and he began binge eating.

"After bingeing, I used laxatives, vomiting, and liquid fasting to purge the food," Li recalled.

"And after successfully losing weight, I started going to the gym to tone up. It became a daily battle and I was constantly fixated on my weight. If the number (I weighed) wasn't ideal, anxiety would overwhelm me."

When anxiety struck, Li felt compelled to calm himself through eating. "Once, I ordered a huge pile of fried chicken, stir-fried rice cakes, noodles — all kinds of takeout I normally avoid. I ate until my stomach felt like it was about to burst. I sat on the sofa, struggling to breathe, before I finally stopped," Li said.

Shi said rigid self-scrutiny is the most common behavior of people with eating disorders.

"But excessive self-scrutiny often leads to self-denial and self-loathing," Shi said. "Eating disorders are not a private 'inconvenience'; they are a psychological phenomenon requiring societal attention."

Anxious for profits

"Discipline is freedom" is the mantra Bao used most to motivate himself while dieting.

It's also the advertising slogan of many companies selling fitness products.

Many businesses profit from this anxiety. Euromonitor International, an information consulting company, predicted that China's "light food" market will exceed 900 billion yuan ($125 billion) by 2027.

"Young people today are indeed willing to pay higher prices for healthy eating," said Wang Dan, head of a Beijing-based chain of light food restaurants.

"Most consumers are women, primarily seeking to complement fitness routines with proper nutrition while reducing sugar and carb intake. The universal desire for beauty means this market is likely to expand further."

However, there are real financial health costs if nothing is done to reign in obesity numbers.

By 2030, medical costs attributable to people being overweight and obese could reach 418 billion yuan, accounting for 21.5 percent of national medical expenses, according to the prediction in a report released by the Lancet Diabetes and Endocrinology journal in 2024.

Nonetheless, this does not change an individual's personal anxiety about weight loss.

Ni Zhe, a doctor from the Affiliated Mental Health Center of Zhejiang University's School of Medicine, said anxiety about weight is essentially an obsession with control.

"The number on the scale becomes the sole measure of self-worth for many eating disorder patients. Healthcare professionals should guide them toward learning to reconcile with their bodies," Ni said.

Bao said constantly worrying about his weight diminished his enjoyment of food.

"To make your body lighter, you must endure hunger," Bao said. "Seeing the numbers shrink on the scale made me feel like my life was still under my control. But the tighter you try to control it, the easier it is to lose control."

"During my dieting, I instantly calculated the approximate calories in any food I saw," Bao said. "Eating stopped being about enjoying food. My mind was filled with screaming calorie numbers."

Lighten the load

Although eating disorders have the highest mortality rate among mental disorders, treatment rates are extremely low, and have only recently shown an upward trend. Few hospitals in China have specialized eating disorder units, and those who do receive proper long-term treatment are in a minority.

Li from Shanghai found solace online. He stumbled upon social media accounts of people who had experienced eating disorders and joined one group chat offering support. Li said he finally felt understood.

Sharing his story, he discovered others in a similar situation still refusing food, struggling between bingeing and purging, and undergoing hospital treatment, or mostly battling the terrifying mental illness alone or in some cases with family support.

In the group chat, members refer to each other as "family".

They offer mutual encouragement during difficult episodes, even accompanying members to medical appointments, and share valuable treatment information.

For patients lacking family understanding, the greatest fear is being misunderstood and abandoned. Li realized that for families, understanding means genuine mutual support beyond words. This helped him understand why family therapy and cognitive behavioral therapy play irreplaceable roles in comprehensive eating disorder treatment.

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After months of psychological counseling and professional help, Li's bingeing declined. Even under immense work pressure, he found new coping mechanisms.

"Food is not my enemy," Li stated. "It just reminds me to stop and see what I truly need."

Li also deleted the weight-tracking app he had used for years. When the confirmation prompt flashed on the screen — "Permanently delete all data?" — he took a deep breath and pressed "Yes".

"I'm going to buy some chocolate tomorrow," he said. "Sometimes, you just have to accept it. Sweetness has nothing to do with calories. It's just sweet."

Shi Yu said: "For eating disorder patients, eating is a process of negotiation with oneself. But that negotiation culminates not in victory or defeat, but in balance and coexistence."

Contact the writer at weiwangyu@chinadaily.com.cn