With a high flying job at one of Islamabad's five star hotel's, Aliya says she knows she's not overweight, but is desperate to shed at least another five kgs, having already lost 14 kgs over the past five months. "I look at the girls around me and the girls on television, and I want to look like them too," she told IRIN. The hotel manager is typical of girls and women of Pakistan's upper middle class society. Despite the poverty and malnutrition around them, many are obsessed with the way they look, sometimes leading to eating disorders such as anorexia and bulimia.
"This problem is increasing and is only common in the upper crust of society," a dietician and children's specialist at Islamabad's Ali medical centre, Prof Mushtaq A. Khan, told IRIN. "Many teenage girls these days are more conscious of their figures and they are trying to copy the women they see in the West.
"Keeping that in view, girls get obsessed with the way they look," he added. Most eating disorders for girls under the age of 12 are related to problems of malnourishment. However, bulimia and anorexia develop in the teenage years, he said. Both conditions are a result of a refusal to maintain normal body weight in an attempt to be thin.
Those obsessed with losing weight were, as Khan put it, "keeping up with the Joneses". "Everyone wants to look like super models such as Cindy Crawford and Claudia Schiffer," he said. The consequences, he said, were a very low appetite, vomiting, feeling tired and not performing well in daily duties.
The problem is increasing due to influences from Western society, Khan, who is treating several patients with such problems every per month, said. "Traditionally, in the Pakistani or Indian society, a lady who was fat with a podgy tummy, was seen as being authoritative. She would come from a better off family and carried a certain cloud of prestige over her," he explained, noting that such attitudes had now drastically changed.
He referred to one girl aged 15 from a wealthy family in the country's North West Frontier Province (NWFP) who was taken to the clinic by her parents, complaining of feeling sick and stomach pains. "She looked very pale and ill," Khan said.
"However, when I carried out some tests on her, I found nothing abnormal in her stomach other than the fact that she had not eaten," he added, saying that the parents were completely oblivious to this. "She was surviving on vitamin pills," he said. Following a few months of treatment, reassurance and counselling the girl recovered.
In a country where people are dying from malnutrition every day, and the government cannot afford to provide its citizens with primary health care, Khan said he thought it was ironic that such a problem existed in Pakistan. "The victims are from families that can fly to London at the drop of a hat, and I don't think the government should pay for any campaigns to help these people. They should be feeding the hungry," he asserted.
Malnutrition, he said, was a growing problem for the poorer classes of society, because the purchasing power of the average individual had dropped. "Gas, water, electricity and food is more expensive and unemployment is high, and gradually people are getting poorer," Khan explained, adding that these issues needed to be addressed as a priority.
According to Khan, another common cause of eating disorders in the upper echelons of society could stem from force feeding. "In many cases, the child does not eat because he or she is being forced to eat, and the mother is pushing the children to eat and eat - and pushing to the extent where the child is psychologically sick and tired of eating and is nauseous and vomits every time a bowl of food is eaten," he explained. As a result, the professor said, he spent half his time pleading with mothers to stop forcibly feeding their children.
Stressing that there was no relationship between education and eating disorders, Khan used the late Princess Diana as an example. "She was bulimic. It is a deep-rooted physiological problem, and a person suffering from it cannot rationalise it," he said, adding that the more sophisticated certain sectors of Pakistani society became, the more eating disorders would prevail. "These people are educated and they feel that they know what they are doing. But they don't realise how wrong they are."
Rizwan Taj, a psychiatrist in Islamabad, argued that the problem was further exacerbated by the fact that there was a lack of awareness of eating disorders among doctors in the country. He said the patient would seek medical advise believing that he or she was suffering from an intestinal infection, or some other common disease. "The doctor will put the patient under a large list of investigations and will not find any disease brewing, and the patient just gets worse and worse and then finally the victim will come to us."
Taj said that often the family of the victim was partially to blame for allowing the condition to worsen. "It is usually a pampered child or wife who is suffering, and she or he tends to be very very stubborn," he asserted, adding that most parents were completely oblivious to eating disorders and were thus promoting the child's eating habits.
One of the worst cases he cited was that of a teenage girl from a wealthy family whose weight dropped to 30 kg and had already lost her monthly period. Having advised the parents to admit her to hospital, the girl was sedated at feeding times to enable medical staff to control her eating habits.
The girl eventually recovered and put on 15 kg, but is still under treatment as an outpatient, but Taj warned that eating disorders could be fatal. "We have no recorded figures of deaths. However, there may well have been deaths caused by eating disorders in this country," he said. While admitting that anorexia and bulimia were growing problems in Pakistan, he said there was very little research done on the problem.
Dr Rezzan Khan, a dietician at Islamabad Shifa International Hospital, echoed concern over the growing number of patients with eating disorders. With 10 to 15 patients per day, the number of people she treats has increased three fold over the past five years. "I used to see about five people per day when I first started this clinic seven years ago," she told IRIN, pointing out that Pakistanis were becoming a health conscious society. "The key to losing weight is to have a healthy diet with a mixture of foods balanced with exercise," she said.
While admitting that Pakistanis did need to keep a careful diet - due to the fact that they are prone to diabetes - she said some form of control needed to be exercised. She said most of the girls she had seen obsessed with their weight were in a pathetic condition, and referred to the case of a 17-year-old girl who was not eating, was bed ridden and had to be fed through a tube.
Although it is mainly women from the upper middle class suffering from this problem, men are also becoming more health conscious in this Islamic country, according to doctors and dieticians. Eighteen-year-old Sohail from the capital was recently diagnosed as being anorexic after months of exercise and dieting. He used to weigh 200 pounds but has lost 50 pounds over the past seven months. "I want to look like the men in Vogue and GQ magazine," he told IRIN.
Sohail had drastically changed his diet, was barely eating a meal a day, but exercising daily. Asked how he felt after being diagnosed, he said: "I want to maintain my weight. I am happy with my body now."
When the teenager first sought medical advise from Rezzan Khan, he was suffering from severe back pains, looked pale and ill and was suffering from weakness brought on by his eating habits. Having studied eating disorders in the UK, Taj remarked that there was an unusually high number of Pakistani men trying to lose weight, and that he had recently treated a 13-year-old boy.
Meanwhile, at one of Islamabad's hippest restaurants, two girls sat sharing a plate of salad. They told IRIN there was now more pressure on women to be slim than ever before. "It's all down to the pictures we see in the media," said Asma Niazi, adding that health clubs and beauticians were flourishing these days due to the demand from women who wanted to look good.
According to some, family pressure was also a factor in weight obsession. "My husband tells me that he doesn't want to be holding a cow in his arms," Sadaf Amir said as she put a spoonful of chopped tomatoes and cucumbers into her mouth.