How can the self-help guidebook combined with professional institutions help people with eating disorders (15-35) in China establish healthy lifestyles within the family environment?

I arranged interviews with people who suffer from eating disorders from 2nd to 13th Feb in London. Both live meetings and online calls are used, respectively. I have invited 14 people in total. Most of them are students, female, and the age scope from 20-30.

The Interviewers List

(Translate by DeepL)

At first, I was under pressure to study and lose weight. When I was in high school, I would get a lot of compliments on my body, complimenting me on my thin legs and so on, and at that time, I was 168cm tall and weighed 52kg, which was in line with the current aesthetic standards, so I would subconsciously try to maintain my body. I would control my diet from Monday to Friday at school, but when I came home at the weekend, I would engage in overeating behaviour. By the time I was a freshman, the symptoms had worsened because I didn't like my major at the time, and I was sad when I arrived in Beijing because I wasn't used to the climate there and it got dark early, and I didn't make any friends at the time, I was on my own. One of the moments I remember the most was when I went to buy an omelette by myself, and on my way back to the dormitory, I passed by the overpass, and I just stood on the overpass and ate all the omelette by myself. I would watch food podcasts on the internet and see the vomiting bar, but I clicked on it and thought it was too painful, so I didn't vomit either.At first, I was under pressure to study and lose weight. When I was in high school, I would get a lot of compliments on my body, complimenting me on my thin legs and so on, and at that time, I was 168cm tall and weighed 52kg, which was in line with the current aesthetic standards, so I would subconsciously try to maintain my body. I would control my diet from Monday to Friday at school, but when I came home at the weekend, I would engage in overeating behaviour. By the time I was a freshman, the symptoms had worsened because I didn't like my major at the time, and I was sad when I arrived in Beijing because I wasn't used to the climate there and it got dark early, and I didn't make any friends at the time, I was on my own. One of the moments I remember the most was when I went to buy an omelette by myself, and on my way back to the dormitory, I passed by the overpass, and I just stood on the overpass and ate all the omelette by myself. I would watch food podcasts on the internet and see the vomiting bar, but I clicked on it and thought it was too painful, so I didn't vomit either.

ED stems from the fact that when I was at university in China, my ex-boyfriend would say things like I was out of shape and had thick legs. Maybe he was unconscious, but I listened. I fell in love with him at first sight, so I was the one who chased him first. At the same time, one of my housemates had to start losing weight, so I went on a diet with her because two people do things better than one, so we both didn't eat dinner for a whole year and kept dropping the scales. But then, she bounced back, and I got an eating disorder. I would induce vomiting because it was a simple act. Other people might need to pick their fingers in their throat or press their tongue with a toothbrush to induce vomiting, but I didn't need to. I could bend at the waist and vomit. It was so easy for me.

When I'm alone, I feel anxious about everything around me, such as work, school, and the current aesthetic standards of society. I feel insecure about my appearance, and although health consciousness is engraved in my head, ED has become a habit.

My boyfriend knows about ED and he is actively helping me to adopt a healthy lifestyle.

I became aware of my ED about six months ago.

I am now ripped, thin and then fat again. I used to be 110 pounds before, which I thought was an average weight, but I suffered from verbal violence in high school, where people around me would comment that I had thick legs, and they would say that I was pretty but just had too thick legs. I also thought I had wide legs because I couldn't buy trousers that fit them. In February last year, my friend wanted me to wear her pants, and I knew before I even tried them on that I was sure they wouldn't fit. Unsurprisingly, I really couldn't fit into these trousers, and this incident triggered me to start losing weight just by not eating dinner. By the time the epidemic hit, I was staying at home and not going out, which created a perfect environment for dieting.

I controlled my calorie intake to around 1,200 calories a day, and my physiology was severely affected by overreading the diet, which is when I realised that long-term dieting was hurting my body. Then I got sick when I arrived in the UK, and my intestines lost their ability to digest, and the doctors started forcing me with medication to help me digest. During this time, I had to eat only liquid food and went from active to passive dieting. I realised that I might not be able to eat correctly for the rest of my life if I continued like this, so after I recovered, I started eating normally. However, I would occasionally have binge eating episodes and reassure myself that I was having a craving because I used to be too controlling and needed to take in a lot of nutrients. The frequency of binge eating was about once a week.<br>Once. My taste buds are turned on. I can't stop.

External aesthetics were the most direct cause of my eating disorder.

I used to confide in my best friend at the time about this pain, but it was not understood, and my friend thought I was spreading negativity instead.

In my first semester of undergraduate studies, I joined a dance company where all the girls were skinny, and I felt fat and slow compared to them. I felt like every time I emptied my stomach, and I felt clean. At first, I thought I was the only one who was like this, but then I found overeating and vomiting posts on the internet and found that many people were like me and had been overeating and vomiting. One girl would upload her food diary daily; if she didn't devour that day, she would write "clean". I sometimes post my thoughts online to encourage other girls not to use binge eating to solve their problems. I stopped posting on that thread afterwards. I could feel that one of my roommates knew of my condition, but she didn't talk to me about it. I didn't think about seeking counselling, and I thought I would get better later.

My mum didn't understand eating disorders, so she thought I just had a sour stomach, and when I emptied the fridge at home, she thought I just ate severely at school. She was a doctor but didn't realise I had a mental illness. I was just advised to go to the hospital to check my bowels. She cooked heavily and would force me to eat, thinking that eating less was terrible for my studies. When I was in high school, I weighed 65kg, and she still considered me the same, and I felt bad because if my relatives found out we weighed so much, they would judge me. So I planned to go to university in another city and get serious about losing weight.

I was using a calorie counting app (Mint App) for a while, and other users would share their extreme diet recipes in the community, and I felt so stressed that I uninstalled it.

Then I stopped being disgusted with myself when I received an offer to study in the UK. The general environment changed when I arrived in the UK, and I gradually returned to a regular diet.

When I came to the UK at the age of 15, they made mean comments about my size because I was taller than some of the boys, which made me feel inferior, so I started extreme dieting in April 2021. I was 75kg at my heaviest before. Then I dieted for too long. I started overeating and then dieting again. While dieting, I would lose sleep and stay up all night to buy food at the supermarket.

I used to love buying snacks, but I didn't eat them. I just hoarded them. Then one night, I suddenly ate all two boxes of desserts. Then I started to "chew and spit, " meaning I would just chew the food but not swallow it. I would buy two big bags of food and chew and spit for three hours. For a while, I did this every day.

Quite a few of my friends knew about it, and I think my family knew about it too. My dad was distraught when he saw me not eating, he would buy a bunch of things and force me to eat them, but when I didn't want to eat, he would get furious and drop items. My mum would take me for walks and to the hospital for a medical check-up. They didn't know that I had a mental illness.

When I want to overeat, I talk to my boyfriend and take him with me to eat so I feel better, and he comforts me and makes me happy.

I occasionally crave but don't overeat as much as I used to. I have a weight loss partner, and we talk about what we eat daily, but she fills in less often than I do. She only eats 4-5 strawberries and a small piece of cake daily.

My worst binge was in 2021, when I was still on lockdown, alone in the UK, and it was very much like eating, but now I feel much better with my friends and boyfriend.

My habit is that I don't eat if I have a date with friends that day, so I starve myself for the day. I had a friend who had a dinner date for her birthday, and I was so hungry that day that I ate a lot of food.

I used to be particularly anxious because of my weight, and if my weight went up, I couldn't do anything but lie in bed all day.

I used to confide in a male friend about this pain, but he said, "You're in your 20s, and you can't even control what you eat. What's the difference between you and a beast?" He also said, "Do you think you'll look good if you're skinny? But I don't think you'll look good if you're skinny." It's better to talk to girls about this. Guys rarely manage to empathise.

I did ask for counselling, but the caller just asked my height and weight and told me I wasn't fat. It didn't help me.

Then I realised I could lose weight quickly even if I gained it, so I became less obsessed with it and started eating normally again. Also, if I had to skip a dinner with my family and friends because of my weight, it would impact my mental health.

When I first came to the UK, I lived alone in a student flat 95% of the time and ate very little during the day. I was eating healthily at home, but when I came to the UK, I liked to eat chips and drink alcohol, and I started to get acne on my face. I have been adjusting my diet since then, but the symptoms on my face have not improved, or maybe it has something to do with my mood and sleep. I would overeat at night and eat nuts and biscuits, but I would just chew them and not swallow them. I've done this a few nights and find it a bit unbelievable. The reason for the overeating was because of loneliness. The year I lived alone, the insomnia was terrible.

I had contact with a GP and chatted online on average once a week, but that didn't solve the problem because my family and boyfriend were away. That feeling of loneliness was something I couldn't dispel. I take socialising very seriously because when I'm alone at home, my diet is very superficial, and I eat as little as possible. But when I went out to eat, I ate more; that was my usual amount of food. My friends envied me. They thought I ate so much and didn't gain weight. I told them it was actually because I ate less when I was at home.

I haven't hyperventilated because I can't pick it up. On the one hand, I wish I could be subjective about being anorexic because I am a big foodie. During that time, all I could think about was eating all the time, which took up much of my energy. Being in control of my weight was one of the only things I could do during that time.

I came to the UK in October 2020, and for a long time after that, the UK was in lockdown, most public places were closed, and I had nowhere to go.

I get pleasure from being in control of my food, and although eating makes you produce dopamine, I feel guilty afterwards. I think it was because I followed a rigorously healthy diet the year before I went abroad, and I loved it, but it also caused me physical problems. I went to the hospital many times to get checked out. Nothing serious, really, just a bit of an endocrine disorder. I had extreme weight loss in my third year of undergraduate study and was hospitalised after suffering from inflammation caused by malnutrition. This was a cautionary tale; I haven't lost weight since. My family knew I was in the hospital but couldn't understand what was happening.

Then I got a job and lived with my boyfriend, I was no longer alone, and my eating disorder gradually disappeared. When I first came to the UK, I lived alone in a student flat 95% of the time and ate very little during the day. I was eating healthy at home, but when I came to the UK, I enjoyed eating chips and drinking alcohol, and I started to get acne on my face. I have since adjusted my diet, but the symptoms on my face have not improved, or maybe it has something to do with my mood and sleep. I would overeat at night and eat nuts and biscuits, but I would just chew them and not swallow them. I've done this a few nights and find it a bit unbelievable. The reason for the overeating was because of loneliness. The year I lived alone, the insomnia was terrible.

I had contact with a GP and chatted online on average once a week, but that didn't solve the problem because my family and boyfriend weren't around. That feeling of loneliness was something I couldn't dispel. I take socialising very seriously because when I'm alone at home, my diet is very superficial, and I eat as little as possible. But when I went out to eat, I ate more. That was my average amount of food. My friends envied me. They felt I ate so much and didn't gain weight. I told them it was actually because I ate less when I was at home.

I haven't hyperventilated because I can't pick it up. On the one hand, I wish I could be subjective about being anorexic because I am a big foodie. During that time, all I could think about was eating all the time, which took up much of my energy. Being in control of my weight was one of the only things I could do during that time.

I came to the UK in October 2020, and for a long time after that, the UK was in lockdown, most public places were closed, and I had nowhere to go.

I get pleasure from being in control of my food, and although eating makes you produce dopamine, I feel guilty afterwards. I think it was because I followed a rigorously healthy diet the year before I went abroad and loved it, but it also caused me physical problems. I went to the hospital many times to get checked out. Nothing serious, really, just a bit of an endocrine disorder. I had extreme weight loss in my third year of undergraduate study and was hospitalised after suffering from inflammation caused by malnutrition. This was a cautionary tale; I haven't lost weight since. My family knew I was in the hospital but couldn't understand what was happening.

Later on, I got a job and lived with my boyfriend, I was no longer alone, and my eating disorder gradually disappeared.

I started to develop an eating disorder in high school, and my experience would be the same as most people, starting with weight loss and evolving into overeating. My friend had the same experience. My dad didn't know it was a mental illness and didn't know I was hyperventilating and secretly taking diet pills. I was so emotionally unstable after each binge that I cried all the time and couldn't continue my studies. I was under constant psychological pressure because I thought I had to take the entrance exams. My parents were very critical of the details of life.

I started receiving counselling at the age of 18 and still do occasionally. I have attended Chinese and British counselling, and there is a big difference. In China, the doctors encourage me to live with my emotions, whereas, in the UK, they offer 'CPT' therapy, which is about changing the way you think about food on a cognitive level, which is a bit like the line from Friends: "It's food, not love. It's food, not love. A big difference between a psychiatrist and a counsellor in that the doctor is more interested in the 'criteria' by which they define what stage you are at. If they feel you are not socially competent, they will prescribe medication. In their eyes, it's the same principle as a physical illness. I've been voluntarily hospitalised for an eating disorder, where I was in a state of panic. The reason I wanted to be actively hospitalised was that I could actively work out while I was there.

My mother is a rigorous person who keeps everything in order around the house but has trouble noticing changes in my mood. Influenced by my mum, I am also a strict person, and it makes me feel bad that my eating disorder affects my daily life so much.

The reason for my ED is that I am too much of a perfectionist, and I am desperate for external approval also because I was doing things that could match what I wanted, such as getting the body I wanted by losing weight.

Then because of my ED, I took a break from school and returned home and met a great counsellor who would give me positive guidance and help from my friends. Now I have recovered.

My eating disorder has been a state that has been coming on in phases since I was in middle school. I started dieting in junior high school and continued until I got to the weight I wanted to be when I started overeating again. All my friends around me were skinny, which put pressure on me internally to keep my body under control. For example, yesterday we went to a friend's house for dinner, and my friend gave me a bag of chips, and my boyfriend told me I could only have one. At home, he would not allow me to eat snacks.

I weighed 57kg in junior high school. I lost weight to 50-53kg. Then I gained it back in high school because of the pressure of studying. I worked out every day but couldn't control what I ate. I could eat a big pot of potato stew and a whole packet of Oreo biscuits at night in addition to my three meals. When I was a freshman, the girls in my dorm were all tall and skinny, which put a lot of pressure on me. I wanted to be a model at the time, so I controlled my diet. Models are very strict about their bodies, and I had health problems because of dieting, and my periods were always irregular.

Now I still work out all the time, but I eat very casually and don't control my diet on purpose. However, I signed up for a modelling course some time ago, and during that period, I could only eat two meals a day, very little at a time, a little staple and an apple for lunch and five dumplings for dinner. My boyfriend later persuaded me to stop modelling and not torture myself like this. I also felt I couldn't accept exposing my life, so I put the idea to rest.

And then my perception changed. "You are what you eat." Eating sensibly will make you healthier. I would watch diet vlogs and be more at peace with food, more comfortable enjoying it than fighting it. I want to be what I like aesthetically more than I want to "be a model".

My boyfriend doesn't stop me from dieting; he likes thin girls. I didn't have a lot of validation of my worth, he was older and had more life experience than me, and he influenced me to be hard on myself and others without realising it. It wasn't until one day, after persuasion from my friend, that I realised I didn't know myself fully. I wanted to identify with myself, find empathy and find my worth.

Because I feel lost in my life plans and career pressure, I eat dessert to vent my frustration, but then I feel guilty afterwards. At the most out-of-control moments, I would eat dessert as a meal. At the same time, one would feel empty, lie alone in a room for a long time, and record self-talk videos.

"I can realise that this is not normal, but without a job, there is no solution, there is uncertainty about the future, the in-country roles and no guidance advice from my parents, but there are also very few job opportunities in the UK, so I plan to back home first."

After returning to the UK, the mood has improved, but there is still eating disorder behaviour as the behavioural mechanism has come to regard 'eating' as a form of comfort. The state was poor, and no social interaction created a vicious circle.

After work, because of the long hours of sitting, sometimes from the morning onwards, I would start looking for food, constantly opening drawers to find something to eat to stay awake. The act of "eating" keeps me "alive".

Lack of "security". I want my work to be meaningful and worthwhile, emotionally stable, and income.

External aesthetics don't affect me much, although I judge myself. Because amiable friends surrounded me, later, when I returned home, my family brought up with me the need to manage my appearance, and the fitness trainer would talk to me about body management. But after work, I didn't care too much. After work, because there was a certain amount of social behaviour and linking with the outside world, it started to taper off. But when I get home from work, I start to overeat again.

I think "eating" is a relaxing activity, and I don't overeat in public to maintain a standard image. My negative emotions tend to arise when I am alone, mainly because I doubt the value of my current job.

I am much less stressed now that I am home with my family and have a routine for New Year.

Writing becomes a departure point for emotions.

No one knows ED

I was so stressed out in high school that I dieted to lose weight after my senior year and wanted to eat carbs under a long diet until I couldn't eat anymore. Then I threw up and kept eating until I was tired. It was just weird. I regretted eating them after I finished the carbs. I got what I had to do done every day back then and then relaxed my mind by overeating. Eating would bring me joy, but it didn't make me feel relaxed.

My family and friends didn't know I had an eating disorder. Many reasons trigger my ED: aesthetic standards, internal stress (fear of gaining weight) and anxiety. I loved cooking and eating, which was one of the things that later led to my overeating.

Once I was in a situation that I didn't like, I would 'punish' myself by eating. I started overeating after leaving the country, initially to relieve my emotions, and then it became a habit. I then read papers on the subject, realised that eating disorders are psychological illnesses, and treated myself by understanding them. I also saw a psychiatrist and underwent CPT for 6-8 weeks to track what I ate daily, but it did not work.

The last time I binge ate was six months ago. I had lived alone for a long time and felt disconnected from society, which led to my inability to eat properly. Then I started working, working out every day, living with my boyfriend and being exposed to a new environment, my situation improved, and I slowly stopped overeating.

I started my eating disorder in 2019; before that, I started exercising to keep in shape, I didn't eat any fried food, and once I overate, I would hyperventilate. It constantly alternated between binge eating and dieting, and I couldn't help myself. Then I stopped exercising but kept to a healthy diet.

My boyfriend cheated on my best friend only the year before last. I couldn't accept this and started to self-loath. I stayed in my room, ordered eight takeaways daily, and ate mechanically.

My family and friends didn't know about it, and I felt I would become more stressed if I told them.

Overeating has become a habit, and I never go to the GP.

The latest binge was last Thursday.

I've started exercising again, and hopefully, I'll return to eating normally soon.I started my eating disorder in 2019; before that, I started exercising to keep in shape, I didn't eat any fried food, and once I overate, I would hyperventilate. It constantly alternated between binge eating and dieting, and I couldn't help myself. Then I stopped exercising but kept to a healthy diet.

My boyfriend cheated on my best friend only the year before last. I couldn't accept this and started to self-loath. I stayed in my room, ordered eight takeaways daily, and ate mechanically.

My family and friends didn't know about it, and I felt I would become more stressed if I told them.

Overeating has become a habit, and I never go to the GP.

The latest binge was last Thursday.

I've started exercising again, and hopefully, I'll return to eating normally soon.

It started from my first year of school to my first year of college. I had misconceptions about my body image in primary school when I saw a girl in my class with skinny legs who looked good in skinny jeans, I told my mum about this, and she was surprised at the time, saying that this girl was fatter than you. My parents half-jokingly said I had a big butt, thick legs and a nose like a garlic head. But actually, my nose has nothing to do with a garlic nose. But I believed it because my perception of myself as an adolescent was based on other people's comments, comments that made me think my body was ugly and made me very much without myself, so I would wear fat clothes to cover myself up at that time.

Then I had an illness and dropped to 44kg. Everyone said I had lost weight and wanted to keep it off, I was at about 45kg before that, and it had nothing to do with being fat. I started counting calories when I ate and asked myself to eat less than 1000 calories daily. In the morning, I would only eat oatmeal or red bean and barley porridge, which are high in fibre, at school and only eat a little bit of food. This state of affairs was maintained, and my weight stabilised at under 45kg.

Then I started overeating, eating a lot at a time, but at the end of each session, I would feel ashamed of my behaviour, and when I was at home, I would sneak snacks from the living room or dining room to my room to eat, then take the bag out in my school bag and throw it away. I also had conflicts with my parents over my diet. On the one hand, they wanted me to stay in shape; on the other, they wanted me to eat more, so they kept pushing me to work out, but I didn't have enough time to exercise in junior high. I needed to go to class, do my homework and play the piano. I would sneak off to the toilet to throw up after eating at home, which included the supplements my mother gave me, like fish oil and vitamins, because I thought they were too high in calories. I was always hungry during the day and would sneak in a lot of food at night. I saw one of those overeating posts on the internet where people would buy laxatives, so I went to the pharmacy to purchase laxatives too. The doctor ordered me to take 2-3 tablets at a time, but I was afraid the food wouldn't go out, so I took 7-8 tablets. I would go to the bathroom often at night because of the overdose, and this abnormal behaviour made my parents feel strange. Then they went through my school bag and found the laxatives, which triggered an argument, and they told me that if I retook them, I would not be allowed to study abroad. I never retook these strong laxatives, but I did take enzymes.

When I arrived in the UK, I couldn't help but eat a lot of chocolate and peanut butter bread in the dormitory. After I ate a lot, I would start dieting, then overeating and then dieting again, and the cycle continued. When I was eating in the canteen, my classmate said I ate very little, and I thought she was mocking me. I was so angry that I slammed my plate on the table and left at that moment, and later my classmate apologised to me. I was very unstable and argued with my roommate and broke things.

Later, when I moved to another school, my eating was still very disordered, and I was emotionally unstable, often getting into conflicts with my classmates. My endocrine system was probably not standard then, and I was in a very aggressive mood all the time. At the same time, I had problems with my digestion and had difficulty digesting food.

By my undergraduate years, I had eaten a lot or very little and never ate right. When I was at parties with friends, all I could think about was returning to the hostel and eating a lot. I felt ashamed of eating. Later on, I fell in love, and my partner at the time gave me a lot of encouragement to adjust my diet to a normal state. I occasionally eat a lot when in a bad mood, but I don't feel as guilty as I used to.

I started in 2018 because of dieting to lose weight, but then I couldn't control it and started overeating. Now I have an eating disorder, alternating between dieting and filling, and I no longer know how to eat correctly. Also, because of academic stress, and emotional problems, eating has become an outlet.

This behavioural decompression of eating and the feeling of food filling my stomach comforted me.

My friends and family knew about my situation but couldn't understand it.

I had counselling and had relief from ED, but it didn't last, then read some books on the subject.

Feelings of guilt and self-loathing about overeating.

External aesthetic factors are the main reason for my eating disorder. 

I know what hunger feels like, but I don't understand what fullness means. For an average person's diet, a bowl of spicy ramen noodles can be complete, but I need to know what amount is correct, and I want to eat many things at a meal. For example, when I eat spicy ramen noodles, I will put a lot of balls and vegetables in them, and I will even meet half a roast chicken, cake, fruit, drinks and chips. On top of that, I have a very irregular eating schedule.

My weight was 60kg, an average height, but my body fat percentage was very high, so I started to lose weight the wrong way - by dieting excessively. But the longer I suppressed my appetite, the more I wanted to eat, and finally, one day, it backfired on me, and I started eating non-stop.

Later on, feeling anxious about recruiting for work or emotional problems, there were so many things in my life that I couldn't control that I had to keep eating.

Food satisfied me, and I grew up very thin and ate very little. Many things were out of my control when I was living alone or by the time I was older. Eating is the easiest way for me to get pleasure. Sometimes when I was looking at my phone, I would swipe to some eating podcasts and cooking videos, and I was such a good cook that I would follow the videos and learn how to cook, and it slowly turned into overeating.

Personal stress was the leading cause of my eating disorder, both emotionally and at work.

My family didn't know about ED, but my friends knew, and they worried about me. They would take me to dinner with them and help me adjust my diet. It wasn't until last year that I learned what a regular diet was and that it needed protein, vitamins and carbohydrates. It might also have something to do with our diet, where carbohydrates make up a large part of the Asian diet, so I ignored protein and vitamins. I also started adjusting my meal sizes because I didn't know what it was like to be complete, so I changed my meals to my daily weight.

I can feel myself getting better every day, I've been under a lot of pressure, but I can feel myself improving, and I'm happy every day.