CHAPTER ONE INTRODUCTION 1.1 BACKGROUND “Fat or cholesterol” sounds like a very serious issue among most people of any gender, age, or position. We always hear many recommendations or warnings from doctors, health professionals, and organizations about the effects of being overweight. Going to a bookstore, we easily find books concerning health matters such as how to lose weight or what kinds of food should be eaten for slimming. Going to a supermarket, we always see fat-free, low sugar, or 0 calorie food or drinks. On the other hand, the concern about eating disorders is very rare; many people do not even know being underweight is an illness and it can contribute to death. According to Sirimarco (1994, p. 93), “eating disorder is an unhealthy psychological condition that creates physical problems for those afflicted”. International Classification of Disease grouped eating disorders into three kinds: 1. compulsive overeating, 2. anorexia nervosa, and 3. bulimia nervosa (International Classification of Disease- 10th Edition (ICD-10; World Health Organization [WHO], 1992) as cited in Pattanawadee Pattanathaburt, 2005, p. 1). Anorexia and bulimic nervosa was widespread in 1980’s because of the celebrities in mass media (Steinberg, 1999). Both anorexia and bulimia nervosa were characterized by the stress with the shape and weight (Stroebe, 2000). The people who developed eating disorders were always concerned about losing weight. They would believe that being skinny or having a slim shape was the popular trend especially among teenage girls (อมรากุล อินโอชานนท, ม.ป.ป.). Some girls said “women cannot be beautiful without being slim” (Steinberg, 1999, p. 50). Seeing that almost all entertainment personnel in the mass media were very thin, many young people might have believed that being underweight was admirable. This encourages the teenagers to misbelieve that unless they are slim, they cannot be good looking. Many superstars were the models of skinny shape developing anorexia and bulimia nervosa such as Heidi Guenther – Boston ballet dancer, Christy Henrich – Olympic gymnast, and Marisa Horn – Thai star and model (Pattanawadee Pattanathaburt, 2005). However, both male and female students, athletes, celebrities, housewives, businessmen, CEOs,
2
and even elementary school children could develop eating disorders (NEDA, 2008). Tara Hagging, an anorexic patient, began suffering from anorexia nervosa when she was eight years old (Lask & Bryant-Waugh, 2000). Since many people do not know its drawbacks or not know even what this illness is, it is worth noting, “Almost 10 million women and 1 million men in the US are anorexics and bulimics, contributing to the highest death toll among all mental illnesses” (NEDA, 2008). Around the world, 1-2 percent of female adolescents developed eating disorders between the ages of 15-25 (Phillips, 2007). Steinberg (1999) indicated that about 20 percent of anorexic patients died because of selfstarvation. One example is the case of a 21-year old Brazilian model - Anna Carolina Reston, who died because of anorexia nervosa in September 2006. In Thailand, the study of Pattanawadee Pattanathaburt (2005) revealed that over three quarters of Thai actresses were underweight according to the WHO guidelines for body mass index (BMI); more than a half of them wanted to continue losing more weight. Some of them said that they had to be very thin because the television screen would fatten their body size; they looked much fatter on television (Corbis, 2008). Also, many Thais engage the new way, Carboxy or Carbon Dioxide Therapy, to lose weight by injecting carbon dioxide into their body (ศุภรา กันตะพัฒนะ, 2551). This method is still widely used even though some become blind after adopting this method. This means that not only do those in other countries desire to be very thin, but Thai people, particularly adolescents, also assume emaciation as a good value. Although anorexia nervosa was less prevalent than bulimia nervosa, its impact was more severe and its death toll was higher than those from bulimia nervosa (ชอผกา วิริยา นนท, 2547). Some may think the situation of anorexia nervosa in Thailand is not parlous, but Thai children’s idea about physiological disturbances becomes more serious and improper. For example, the mini-size university uniform, low-hip jeans, and over-tight blouses were very admirable among them (ฑิฆมั พร เอีย่ มเรไร, 2549). They will make high efforts to control their weight to fit into these small clothes, and then they feel very sexy and beautiful. Some students are over concerned about their weight contributing to malnutrition which harms their brain functions and other
3
organs; as a result, their studying or other activities might not be effective (“เตือน นศ.ใสเล็ก รัดติว้ ”, 2549). Because the attitude towards being underweight of adolescents becomes more worrisome and there is no existing study about anorexia nervosa among Thai teenagers, this study will find out whether or not undergraduate students know the drawbacks of anorexia nervosa and to find further suggestions or ways to solve problem about anorexia nervosa in Thailand. 1.2 STATEMENT OF THE PROBLEM This study aims to answer the following questions: 1.2.1 Are undergraduate students aware of the drawbacks of anorexia nervosa? 1.2.2 How much are undergraduate students aware of the drawbacks of anorexia nervosa? 1.2.3 What kind of knowledge do they possess about anorexia nervosa? 1.3 OBJECTIVES OF THE STUDY The objectives of this study are the following: 1.3.1 Main Objective: To investigate whether or not undergraduate students are aware of the drawbacks of anorexia nervosa 1.3.2 Sub-Objectives: 1. To indicate how much undergraduate students are aware of the drawbacks of anorexia nervosa 2. To find out what kind of knowledge do they possess about anorexia nervosa
4
1.4 DEFINITION OF TERMS Definitions Term Age
Conceptual definition
Operational definition
Indicator
The number of years that
The age in years of
The undergraduate students in
someone or something has
undergraduate students
all faculties at Bangkok University, Thammasat
lived or existed
University, Thaksin University, and Hatyai University. Gender
The state of being male or
Both male and female
Both male and female
female
undergraduate students
undergraduate students at Bangkok University,
Thammasat University, Thaksin University, and Hatyai University. University
A place where students
Bangkok University,
Bangkok University (City
study at a high level to get a Thammasat University,
campus), Thammasat
degree
Thaksin University, and Hatyai
University (Taprachan
University.
campus), Thaksin University (Songkhla campus), and Hatyai University.
Anorexia
A mental illness in which
The symptom of a refusal to
The disease when its patients
nervosa
someone refuses to eat and
maintain a normal weight, an
try very hard to lose as much
become very thin
intense fear of gaining
weight as possible
weight, and body image disturbance Drawback
A disadvantage
Effects resulting from anorexia
Effects resulting from anorexia
nervosa
nervosa as follows: physical
symptoms, body affects, physical health implications
5
Awareness
The statement of being
The statement of being aware
Whether or not the
watchful and having full
of the drawbacks of anorexia
undergraduate students are
consciousness of something
nervosa
aware of the drawbacks of anorexia nervosa
1.5 SCOPE OF THE STUDY This study was limited to ascertain the awareness of drawbacks of anorexia nervosa among undergraduate students in every faculty at Bangkok University, Thammasat University, Thaksin University, and Hatyai University. The samples are 252 students (63 respondents from each setting) who are enrolled in the second semester of the 2008 academic year. The term anorexia nervosa is the symptom of a refusal to maintain a normal weight, an intense fear of gaining weight, and body image disturbance. 1.6 SIGNIFICANCE OF THE STUDY The study main purpose is to show the primary result about the awareness of the drawbacks of anorexia nervosa among undergraduate students in order to use as a guideline for the schools, Ministry of Education, and other researchers. For the university, the findings can be used as a guide for teachers to advice the students about the dangers of being underweight. Moreover, they can launch a campaign to encourage the students to know more about the dangers of anorexia nervosa such as displacing a warning-poster. This may help increase awareness of the children. Next, the Ministry of Education can use the result as a key to revise some study curriculum about health. Since anorexia nervosa is a very serious and fatal illness mostly popular among teenage students, the Ministry of Education cannot ignore and should play an active role to educate those students. Finally, other researchers who want to focus on this field of study can use the findings as a guide for further study. 1.7 ORGANIZATION OF THE STUDY The study in this paper is divided into five chapters. The first chapter consists of background, statement of the problem, objectives of the study, definition of terms,
6
scope of the study, significance of the study, and organization of the study. The second chapter is a review of related literature. The third chapter consists of subjects, material, procedures, and data analysis. The fourth chapter shows the results of the study. The last chapter includes the summary of the study and findings, conclusions, discussion, and recommendations for further research.
