P R E S S   R E L E A S E

        A 3-year follow-up study of 80 Chinese patients with 9 years' history of anorexia nervosa in Hong Kong, jointly conducted by the Department of Psychiatry at The Chinese University of Hong Kong and Tufts University School of Medicine (Boston, USA) revealed that less than half of them fully recovered from the eating disorder. Others continued to exhibit anorexia, bulimia, depression, anxiety, and various unhealthy weight control behavior such as self-induced vomiting, abuse of laxatives and diet pills, and excessive exercise.  Long-term physical complications such as osteoporosis and dental erosion were common.  Three patients died from suicide and severe malnutrition respectively, giving a death rate that is 10 times higher than local females of the same age but without anorexia nervosa. 

        This is the first and largest intermediate term outcome study of anorexia nervosa in Asia. The subjects were a consecutive number of 88 patients who were seen at the Prince of Wales Hospital psychiatric unit and Hong Kong Eating Disorders Centre during 1984 to 2000.  The method of assessment was based on in-depth interview and self-rating scales. Three patients died within 10 years after onset with two died by suicide and one died from emaciation (18.7 kg).  According to official death statistics, the standardized death ratio was 11 to 1.  Two patients refused participation and three were untraceable but confirmed alive, resulting in 80 patients successfully studied.  

        The average onset age of the subjects was 17.9 years, seeking medical help after an average 2.2 years after onset. Their average weight at the presentation was 36.4 kg (BMI=14.5 kg/m ²) with the lightest weight of 23.8 kg (BMI=10.3kg/m² ). Their average age at the study time was 26.9 (Range: 16.2-47.7). The outcome of the study was strikingly similar to those of the western countries. Only 45% of the subjects successfully recovered without any eating disorders, 16% were still anorexic, 20% had developed to bulimia nervosa, 19% had developed eating disorders not otherwise specified.

        Although over half of them recovered their weight and menses at the time of study, most of them still reported disordered eating attitudes and behaviours. 80% were fat-phobic; 40% reported doing willful exercise to lose weight; over 10% reported using diet pills, laxatives or diuretics to lose weight; 45% reported binging; and 20% reported self-induced vomiting.

        Moreover, it was found that 33% had current depressive episodes and over 70% had lifetime depression. Near 20% and over 20% had current and lifetime anxiety disorders respectively. Over half (53.8%) of the patients attempted suicide or had self-harm behaviours. As for employment, over 70 % of patients had full-time or part-time jobs and 20% were students. Only less than 10% were married or co-habiting.

        Being amenorrhic for a long time caused disturbed hormonal cycles which could result in osteoporosis and development of early fractures. Those who had prolonged binging and severely self-induced vomiting may have their stomach, eyes capillaries, internal mouthparts and fingers damaged, resulting in facial swelling or dental erosion.

        Older age of onset and persistent fat-phobia were found to independently predict the poor outcome. Half of the subjects fully recovered from weight and menses after 5 years from onset. Similar to studies in the west, the chance for recovery was slim beyond 6 years after onset. In order to promote awareness and early intervention, the Hong Kong Eating Disorders Centre has opened a new service site in the Central District of Hong Kong Island.