Eating Disorders in Singapore

Citilink Mall, Singapore

Recently, Childhood Obesity News mentioned research indicating that children in Pakistan are more likely to be overweight and more at risk for obesity if they have few or no siblings, and if their parents are wealthy and educated.

Around the time that study was released, it was announced that students in Singapore are “less than half as likely to be overweight than their peers in South-east Asia.” In the entire region, 23% of kids are overweight, but in Singapore, only 10.9%. That is an impressive number. But how was it accomplished? Journalist Lim Yan Liang tells us that the credit goes to the Ministry of Education:

Attributing the good result to increased physical education (PE) curriculum time and the optimal deployment of qualified PE teachers in primary and secondary schools here, [a high government official] also said that MOE’s efforts to inculcate mental health literacy went beyond the school curriculum.

In other words, gym class and psychological well-being. As an ancient philosopher said, “Mens sana in corpore sano” — a sound mind in a healthy body. Nothing wrong with that.

But wait. What exactly constitutes mental health literacy? (Link is PDF.) In “Psychiatric and Psychotherapeutic Literacy: Attitudes to, and Knowledge of, Psychotherapy” Adrian Furnham lays down a definition:

The term mental health literacy refers to knowledge of, and beliefs about, mental disorders that assist in the recognition, prevention or management of these disorders… Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected

Let’s take a look at a typical example of mental health literacy as practiced in Singapore. A 2010 study by Anna Chen, Jonathan M. Mond, and Rajeev Kumar was created to determine the beliefs of female college students about bulimia nervosa. Presumably, the closer the subjects’ answers aligned to the current state of the medical art, the higher the young women’s mental health literacy was rated.

The setup:

A vignette of a fictional (female) person exhibiting the characteristic features of bulimia nervosa was presented, followed by a series of questions concerning the treatment and outcome of the problem described. A measure of eating disorder symptoms was included in the questionnaire… Among participants with a high level of eating disorder symptoms, recognition of an eating problem was poor. A minority of participants believed that treatment would result in full recovery.

In other words, a majority of participants did not believe that treatment would result in full recovery. And, the people with the worst problems are the least likely to realize it. So the research uncovered two pretty bad things. In order of importance, which interventions did the participants consider most helpful to their particular needs?

Consulting a primary care practitioner, counsellor or psychologist; seeking the advice of a (female) family member or friend; getting advice about diet and nutrition; and taking vitamins and minerals…

The authors point out that out that their volunteers rated both psychiatrists and psychotropic drugs low on the scale of helpfulness, compared to these other factors. They, in turn, rated the mental health literacy of young Singaporean women as “conducive to low or inappropriate treatment-seeking.” In other words, these gals don’t know how to take care of themselves very well in this area, and programs for the promotion of health need to be addressed not only to at-risk individuals, but their families and social contacts — in other words, everybody.

Singapore’s Ministry of Education also focuses on “promoting mental wellness at an early age” — and they mean pre-school — “to ensure our children have the coping skills to go through different life stages.” What does this have to do with childhood obesity? In a single word, prevention. This is an area in which other countries might benefit from a closer look at how things are done in Singapore.

Your responses and feedback are welcome!

Source: “Childhood obesity rates in Singapore less than half of region’s,”, 11/11/11
Source: “Psychiatric and Psychotherapeutic Literacy: Attitudes to, and Knowledge of, Psychotherapy” (PDF),, 2010
Source: “Eating disorders mental health literacy in Singapore: beliefs of young adult women concerning treatment and outcome of bulimia nervosa,”, 02/2010
Source: “Speeches,”, 11/17/11
Image by yeowatzup, used under its Creative Commons license.

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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