Delicacies and Fear: Confessions and Mutual Support from People with Eating Disorders

Delicious chocolate chip cookies, the high-fat trap that triggers the “cycle of fear”, plunging us into one fear-soaked nightmare after another; the “crunch” of eating crisps, where suppressed anger finds its brittle outlet, filling us with a hollow sense of security; zero-sugar cola is “the happiness imposter”, like a false perfect partner pushing us deeper into dietary imbalance……

This is a set of visual science-communication illustrations on eating disorders entitled Devour. The artist chose eight iconic foods, rendered in black and white with twisted, fragmented forms, to convey how patients experience food: to them, what the rest of us see as delicacies seem steeped in dark metaphor, each one concealing a wound behind it.

These illustrations formed part of Love, Food and Life, an eating disorders awareness art exhibition hosted this summer by the Shanghai Mental Health Centre (hereinafter “Shanghai Mental Health Centre”). The venue, Gallery No. 600, sits within the Centre’s grounds, named after its address at 600 Wanping South Road.

Eating disorders (ED) are a group of syndromes characterised primarily by abnormal eating behaviours accompanied by excessive preoccupation with food and body shape, encompassing three main categories: anorexia nervosa, bulimia nervosa and binge eating disorder.

The art exhibition brought this clinical definition to vivid life through images of visceral impact.

DRESSING 1 & DRESSING 2 combines photography with digital illustration: a girl in a beautiful princess dress, her skirt stained with grime and grease, set against a backdrop of mounds of food — hinting at the helplessness and struggle that mark the progression of her illness.

Expiating the Unfounded Guilt captures, through frenzied lines and clashing colours, the experience of a patient with depression caught in a binge-purge cycle: body image anxiety is a guilt imposed upon a person without cause; I hypnotised myself with the mantra “thin equals healthy”; the food was purged, but an ever more voracious appetite and a swelling self-loathing remained within.

The Mask of ED and Deformed Food are two sets of three-dimensional exhibits — twisted, bizarre shapes and chaotic, vivid colours mirroring the turmoil and conflict within patients’ minds, a fissure opening into a painful abyss between self-identity and external expectations……

What intertwines longing with fear is far more than food alone.

Eating disorders typically coexist with other mental health issues, such as depression, anxiety disorders, obsessive-compulsive disorder and self-esteem problems. The latest edition of the Expert Consensus on the Diagnosis and Treatment of Anorexia Nervosa in China states: “The onset of anorexia nervosa is related to biological, psychological, familial and social factors alike.”

One exhibited work gathered the personal accounts of patients with eating disorders. One entry, addressed to the writer’s parents, reads: “You’ve always told me I’m not fat, but how could I, weighing up to 160 jin (80 kg), not care about the way others look at me? Trapped in fear and self-loathing, I stuffed the emptiness inside with food, then force-vomited it all out to stop myself gaining weight. But I’ve always known — it’s only food, and food will never replace love.”

A narrative art book featuring interviews with 30 patients with eating disorders was entitled The Apples — apples being a staple diet food, a metaphor for temptation and obsession, restriction and compulsion. The book was displayed page by page; one spread reads: the progression of the illness can serve to avert family conflict. For instance, when a child refuses to eat, parents are forced to set aside their quarrels and unite around the child’s needs, drawing a family on the brink of collapse back together.

According to multiple epidemiological surveys, eating disorders most commonly manifest between the ages of 14 and 25. The aforementioned Expert Consensus notes: anorexia nervosa has an early age of onset, with a median age of just 16; it predominantly affects adolescent and young women, with a male-to-female ratio of approximately 1:11.

Beyond damaging physical health — causing malnutrition, electrolyte imbalance and organ damage — eating disorders also carry the highest mortality rate of all psychiatric disorders, comparable to substance abuse, with anorexia nervosa alone carrying a mortality rate of 5%–20%.

Yet the dangers of eating disorders remain largely unknown, and the condition itself can be difficult even to identify. Zhang Qinwen, one of the curators of Love, Food and Life, is a six-year survivor of an eating disorder. In 2019 — her third year since diagnosis — she filmed China’s first original documentary on eating disorders. After publicly sharing her experience of anorexia and dropping to 28.8 kg on social media, she received a flood of messages, many from mothers who revealed they had lived with similar symptoms for over a decade without realising it was an eating disorder.

This inspired Zhang Qinwen to take on a role as a communicator. Over the past five years, she has become a health humanities blogger under the handle @少女神婆婆; built a mutual-support community of more than 3,000 people; founded ED Healer — currently the largest peer support organisation for eating disorders in China and one of the co-organisers of this exhibition; served as lead translator of The Golden Cage: The Enigma of Anorexia Nervosa; been invited to deliver talks on eating disorder health communication at numerous universities; and become a curator specialising in eating disorder awareness.

Zhang Qinwen received treatment at the eating disorders unit of the Shanghai Mental Health Centre. When she was making her documentary, the Centre provided support. During the 2021 exhibition, the Shanghai Mental Health Centre unveiled China’s first official public helpline for eating disorders and dispatched doctors on-site for free consultations. Once Gallery No. 600 was established, collaboration between the two institutions on exhibitions became a natural progression.

– Interviewer –

Xianyu

A Sichuanese who loves to cook. Former medical and technology journalist, now a podcast producer. WeChat account “Buried Love, Xianyu”; podcast “The Common Knowledge Kiosk”.

Zhang Qinwen: What I want to say is that eating disorders are far from simple. Take that exhibited work, My 22 Days in the Psychiatric Ward (excerpt) — the cover reads “Wanting to Be Someone’s Favourite”, and there is not a single mention of food.

Zhang Qinwen: So much. A doctor once mentioned in passing: “How is it so hard to get these patients to eat?” Then he saw the photograph in the exhibition — the one with thorns along the chopsticks — and suddenly, very viscerally, he understood that an eating disorder is a kind of pain.

A lot of parents have messaged me in our social media inbox saying they had no idea the suffering caused by eating disorders could be this great, and that it really ought to be taken seriously. Some said that after visiting the exhibition they felt much more open-minded and wanted to bring their children to see it too. That is what moved me most.

Foodthink: In earlier interviews, you pushed back against the idea that eating disorders are a societal disease. Why?

Zhang Qinwen: An eating disorder is a condition of both mind and body. Its causes are enormously complex — it can be linked to personality, genetic factors and family environment alike, and familial clustering is quite high. For instance, if your parents are extreme perfectionists with very strict expectations, and you happen to be highly sensitive by nature, then you already belong to a group particularly vulnerable to eating disorders. And many people develop them after traumatic experiences — school bullying, emotional trauma, being mocked… Everyone processes and reacts to these things differently. A more inclusive wider society would certainly help enormously. But I do not believe eating disorders are caused entirely by body image anxiety born of the external gaze, nor is every patient driven into illness solely by social judgement.

Public understanding is still so limited that people simply do not know how to offer proper help. Telling a patient with anorexia nervosa “just eat more and you’ll be fine” or “just eat properly and you’ll get better” is like telling someone in a wheelchair “try harder and you’ll be able to stand up.”

Foodthink: Organising this exhibition must have taken a tremendous amount of work, and ED Healer’s WeChat account publishes at quite a high frequency, too. How do you all keep it together?

Zhang Qinwen: We started from the ground up. In 2020 I was doing science communication work, and my Weibo account was receiving so many messages from people reaching out about wanting to self-harm or take their own lives. But there were also messages from young women who had already recovered, reaching out privately — people who had grown close to me, some working in media, others in clinical psychology. At that point there were nine of us, and our skills complemented each other perfectly, so ED Healer was born almost overnight. What happened next was a lot like watching a child grow up fast: from those nine people, we now have twenty-three formal members working on this long-term. On top of that we have over a hundred long-term volunteers — university professors and their students, journalists who care about the issue. There are also people from the modelling and luxury fashion industries; they see eating disorders as an occupational hazard in that world and want to offer advice. All sorts of people — an enormous, vibrant little universe of us.

Foodthink: Over the years, have you felt some progress being made?

Zhang Qinwen: When I was ill and searched for eating disorders on Xiaohongshu, there were barely more than a hundred posts. Now topics related to anorexia nervosa, eating disorders and the like have racked up hundreds of millions of views on the platform. That reflects a kind of progress. (Editor’s note: the number of patients seen at the Eating Disorders Treatment Centre of the Shanghai Mental Health Centre has grown from 122 in 2002 to nearly 4,300 by 2021.) From my own experience, I was the first to create a Weibo Super Topic for eating disorders and one of the earliest users to discuss them on Xiaohongshu. Back then, every time I put out health information, I would be flooded with pleas from people wanting to self-harm or even die, and it left me completely shattered. It showed that the need was enormous while the attention and help available were so little.

In 2021, perhaps ninety per cent of the country had never heard of eating disorders. That year, my collaborators and I organised the first exhibition of its kind in China at the Himalaya Art Museum in Shanghai. While we were working in the vaulted cellar — it is set in a former air-raid shelter — curious passers-by would drift over and ask what we were doing, but no matter how many times I explained, they simply could not grasp what an eating disorder was. In the end I had to start talking about crash dieting before they understood even a fraction of it. So I changed the exhibition’s theme from eating disorders to body image anxiety.

This community also faces the risk of privacy breaches — personal stories can be made public without consent, and the media can sensationalise or deliberately mislead. And there is the inequality bred by prejudice and stigmatisation, which can affect career prospects and even cost people their jobs. All of those negative forces can be devastatingly cruel.

The growth and expansion of the ED Healer team I mentioned is itself a form of progress. We hope that through interdisciplinary science communication we can raise public awareness of prevention, offer friends who are struggling an environment of empathetic support, and encourage diverse ways of living — exploring one’s own beauty and worth.

Foodthink: As someone who has been through it, how do you know you have recovered? What experience might you share with others?

Zhang Qinwen: Recovery from an eating disorder is a state you can feel within yourself, and it is unmistakable. You begin to understand yourself. Food stops being a torment. You notice that the way you relate to others and your attitude towards the world are becoming more even-keeled, and you find new ways of coping with pressure. It is, in truth, a vast transformation, but your own feelings are the only benchmark.

In so many interviews I used to say I was perhaps eighty or ninety per cent recovered. After 2021 I knew, beyond any doubt, that I had recovered. On the day we shared the exhibition, I said: the moment you begin to savour every single bite you eat — that is recovery.

Interview: Xianyu Editor: Cao Fan

Images: Xianyu, ED Healer WeChat account