14/11/2025
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WHEN EATING BECOMES FEAR
(Separate article for Saigon Economic Times, 13/11/2025)
In many families, parents often think their children’s refusal to eat, being too picky, or eating very little is simply a habit or a temporary emotional issue. But in reality, these behaviors can be signs of a serious condition — a group of problems known broadly as eating disorders.
A teenage girl was once brought to the clinic by her parents, hoping therapy would help her “eat better.” She was thin, tired, and clearly unhappy. The family said she had been treated for stomach problems for three months but had shown little improvement. Out of fear that she was too weak, the parents had forced her to eat for a long time. When asked further, they shared that she had been overweight about three years earlier and was teased by friends because of her appearance. Whenever that period of her life was mentioned, she would cry, talk about wanting to die, and refuse to say anything more.
More than just “not eating”
Worldwide, about 9% of people are estimated to experience some form of an eating disorder during their lives (1). In Vietnam, although we lack full statistics, countries with similar conditions are seeing a fast increase — especially among teenagers.
Eating disorders affect both the body and the mind. They can lead to exhaustion, heart problems, electrolyte imbalance, digestive issues, depression, anxiety, and in severe cases, can even be life-threatening if not treated early (3).
In clinical practice, the three most common types are:
Anorexia Nervosa (AN).
This condition affects about 0.8% of women and 0.3% of men (2). It is considered the most dangerous in this group due to its high risk of complications. People with AN severely restrict food, fear weight gain, and often see themselves as “fat” even when they are dangerously thin. For teenagers, it can start from teasing, random comments about appearance, or images online that idealize extremely slim bodies. Restricting food can give them a brief sense of control — but eventually, it takes control of their lives.
Bulimia Nervosa (BN).
About 1.5% of women and 0.5% of men may experience BN (2). People with BN go through repeated cycles of overeating in a short period, followed by attempts to “undo” it — such as vomiting, taking laxatives, fasting, or exercising excessively. Feelings of guilt and shame follow each cycle, trapping them in a painful loop. Because their weight is often still normal, families may not notice early.
Binge Eating Disorder (BED).
This is the most common type, affecting about 2.8% of women and 1% of men (2). People with BED often eat large amounts of food even when not hungry. They feel out of control, then fall into guilt and sadness afterward. This condition is frequently linked to stress, emotional distress, or unresolved negative experiences.
Why do these problems happen?
Although each type looks different, they tend to arise from a mix of biological, psychological, and social factors.
Biologically, people with a family history of eating problems are 6–10 times more likely to develop similar issues (2). Some changes in brain chemicals related to emotion or appetite regulation may also play a role.
Psychologically, children who try too hard to be perfect, worry excessively, are very self-critical, or have experienced emotional hurt or bullying are at higher risk. During puberty, the body changes rapidly, and many teenagers feel they have “lost control,” so they turn to strict dieting as a way to regain it.
Social and environmental pressures also matter. Social media, movies, and advertising often present “slim equals beautiful.” Constant comparison with friends or celebrities can lower self-esteem. Sometimes, parents unintentionally contribute through comments about weight or forcing their child to eat, which may backfire and make the child feel even more out of control.
Other mental health issues often appear together
Eating disorders rarely come alone. About 70% of affected individuals have at least one accompanying mental health condition (3). The most common are depression, anxiety, and obsessive thoughts or behaviors.
Depression makes people lose interest in life and feel drained, which worsens restrictive eating. Anxiety can create intense fear around food. Some individuals may also have difficulties with self-image or personality traits that make them more vulnerable.
Treatment — and hope
Treating eating disorders is a long process that requires close teamwork between the family, therapists, mental-health doctors, and nutrition professionals. In the case of the girl mentioned earlier, she was diagnosed with depression along with her eating difficulties. When she was brought in, she was physically weak, mentally tired, and had lost interest in nearly everything — so treatment required patience and steady support.
Psychotherapy plays the central role. Cognitive-behavioral approaches help young people recognize and challenge distorted beliefs about food, weight, and self-worth. Family-based approaches are especially important for teenagers, because home is where the healing — or worsening — often happens. When parents learn to listen better, reduce pressure, and stop using force or criticism during meals, progress becomes clearer.
Medical support is also essential. Regular checks of electrolytes, heart function, nutrition levels, and other basic markers help detect complications early. Guidance from nutrition specialists helps children eat again safely, rebuild natural hunger cues, and slowly recover their strength. In some cases, doctors may give medication if depression or anxiety is severe.
Above all, parents need to shift their mindset. Eating is not only about nutrition — it is deeply tied to emotions and a sense of safety. Comments about appearance, comparing weight, or forcing children to eat often make things worse. When parents slow down, listen, and help their children build a healthier relationship with food, that is the first real step toward recovery.
Eating disorders are complex and can return if not treated well, but recovery is absolutely possible. Many young people, after months or years of treatment, return to school, regain confidence, and learn to care for their bodies with kindness instead of control. It takes time, patience, and the right kind of love — the most gentle and enduring medicine we have yet to put into a bottle.
, , ,
Pham Minh Triet, MD, MPH, PhD in Psychology
References
(1). Global Burden of Disease Study 2019. (2019). Eating disorders: level 3 cause. The Lancet, 396(10258), 1204-1222.
(2). Udo, T., & Grilo, C. M. (2018). Prevalence and Correlates of DSM-5 - Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biological Psychiatry, 84(5), 345-354.
(3). van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34(6), 515-524.
[Bài này thử nghiệm tiếng Anh do FB gợi ý, với sự hỗ trợ của ChatGPT - dĩ nhiên là tôi có xem lại]
WHEN EATING BECOMES FEAR
(An exclusive article for The Saigon Times, 13/11/2025)
In many families, parents often think their children’s refusal to eat, being too picky, or eating very little is simply a habit or a temporary emotional issue. But in reality, these behaviors can be signs of a serious condition — a group of problems known broadly as eating disorders.
A teenage girl was once brought to the clinic by her parents, hoping therapy would help her “eat better.” She was thin, tired, and clearly unhappy. The family said she had been treated for stomach problems for three months but had shown little improvement. Out of fear that she was too weak, the parents had forced her to eat for a long time. When asked further, they shared that she had been overweight about three years earlier and was teased by friends because of her appearance. Whenever that period of her life was mentioned, she would cry, talk about wanting to die, and refuse to say anything more.
More than just “not eating”
Worldwide, about 9% of people are estimated to experience some form of an eating disorder during their lives (1). In Vietnam, although we lack full statistics, countries with similar conditions are seeing a fast increase — especially among teenagers.
Eating disorders affect both the body and the mind. They can lead to exhaustion, heart problems, electrolyte imbalance, digestive issues, depression, anxiety, and in severe cases, can even be life-threatening if not treated early (3).
In clinical practice, the three most common types are:
Anorexia Nervosa (AN).
This condition affects about 0.8% of women and 0.3% of men (2). It is considered the most dangerous in this group due to its high risk of complications. People with AN severely restrict food, fear weight gain, and often see themselves as “fat” even when they are dangerously thin. For teenagers, it can start from teasing, random comments about appearance, or images online that idealize extremely slim bodies. Restricting food can give them a brief sense of control — but eventually, it takes control of their lives.
Bulimia Nervosa (BN).
About 1.5% of women and 0.5% of men may experience BN (2). People with BN go through repeated cycles of overeating in a short period, followed by attempts to “undo” it — such as vomiting, taking laxatives, fasting, or exercising excessively. Feelings of guilt and shame follow each cycle, trapping them in a painful loop. Because their weight is often still normal, families may not notice early.
Binge Eating Disorder (BED).
This is the most common type, affecting about 2.8% of women and 1% of men (2). People with BED often eat large amounts of food even when not hungry. They feel out of control, then fall into guilt and sadness afterward. This condition is frequently linked to stress, emotional distress, or unresolved negative experiences.
Why do these problems happen?
Although each type looks different, they tend to arise from a mix of biological, psychological, and social factors.
Biologically, people with a family history of eating problems are 6–10 times more likely to develop similar issues (2). Some changes in brain chemicals related to emotion or appetite regulation may also play a role.
Psychologically, children who try too hard to be perfect, worry excessively, are very self-critical, or have experienced emotional hurt or bullying are at higher risk. During puberty, the body changes rapidly, and many teenagers feel they have “lost control,” so they turn to strict dieting as a way to regain it.
Social and environmental pressures also matter. Social media, movies, and advertising often present “slim equals beautiful.” Constant comparison with friends or celebrities can lower self-esteem. Sometimes, parents unintentionally contribute through comments about weight or forcing their child to eat, which may backfire and make the child feel even more out of control.
Other mental health issues often appear together
Eating disorders rarely come alone. About 70% of affected individuals have at least one accompanying mental health condition (3). The most common are depression, anxiety, and obsessive thoughts or behaviors.
Depression makes people lose interest in life and feel drained, which worsens restrictive eating. Anxiety can create intense fear around food. Some individuals may also have difficulties with self-image or personality traits that make them more vulnerable.
Treatment — and hope
Treating eating disorders is a long process that requires close teamwork between the family, therapists, mental-health doctors, and nutrition professionals. In the case of the girl mentioned earlier, she was diagnosed with depression along with her eating difficulties. When she was brought in, she was physically weak, mentally tired, and had lost interest in nearly everything — so treatment required patience and steady support.
Psychotherapy plays the central role. Cognitive-behavioral approaches help young people recognize and challenge distorted beliefs about food, weight, and self-worth. Family-based approaches are especially important for teenagers, because home is where the healing — or worsening — often happens. When parents learn to listen better, reduce pressure, and stop using force or criticism during meals, progress becomes clearer.
Medical support is also essential. Regular checks of electrolytes, heart function, nutrition levels, and other basic markers help detect complications early. Guidance from nutrition specialists helps children eat again safely, rebuild natural hunger cues, and slowly recover their strength. In some cases, doctors may give medication if depression or anxiety is severe.
Above all, parents need to shift their mindset. Eating is not only about nutrition — it is deeply tied to emotions and a sense of safety. Comments about appearance, comparing weight, or forcing children to eat often make things worse. When parents slow down, listen, and help their children build a healthier relationship with food, that is the first real step toward recovery.
Eating disorders are complex and can return if not treated well, but recovery is absolutely possible. Many young people, after months or years of treatment, return to school, regain confidence, and learn to care for their bodies with kindness instead of control. It takes time, patience, and the right kind of love — the most gentle and enduring medicine we have yet to put into a bottle.
, , ,
Pham Minh Triet, MD, MPH, PhD in Psychology
References
(1). Global Burden of Disease Study 2019. (2019). Eating disorders: level 3 cause. The Lancet, 396(10258), 1204-1222.
(2). Udo, T., & Grilo, C. M. (2018). Prevalence and Correlates of DSM-5 - Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults. Biological Psychiatry, 84(5), 345-354.
(3). van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34(6), 515-524.
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