Swipe through photo after photo of legs as thin as matchsticks. Read the comments underneath: “I wish that was me” or “They’re so perfect I could cry”. Feel shock at seeing how an apparently affluent girl’s hipbones stick out from her emaciated belly.

This is one of the dark regions of Instagram, where girls and young women glorify their eating disorders, emulating one another and egging each other on with the most extreme of photos of their skinny selves.

It’s called pro-ana – short for pro-anorexia. Pro-ana is an online movement where anorexic or bulimic women encourage each other to lose more weight. The rule is that you can never be too thin. They elevate their own peculiar ideal of beauty to a commandment.

The community treats their illness not as a disorder but as a brave and enviable state, the more extreme the better.

Pro-ana sites are a space of their own for these women to interact with each other – and it’s happening on Instagram more and more. The internet and apps mean that accessing a network of like-minded women is easy.

That young women post selfies that present the best possible version of themselves has often been commented on. Andreas Schnebel, a German who works on ways to fight an epidemic of anorexia, says such selfies imply that there’s only one physical appearance that is acceptable.

Selfies create a vicious circle which makes everyone want the same body type. The “likes” and followers fuel this beauty addiction.

This internet ecosystem is especially dangerous to young women with eating disorders because the validation they get from other users spurs them on towards sickness and makes them resist pressure from parents and mentors to get back to health.

Instagram brought in new rules a few years ago to stop young women using the portal as a platform to glorify eating disorders. The search function can no longer be used to find hashtags like #probulimia or #proanorexia.

A spokesman for the company explained: “Hashtags promoting eating disorders will be deleted without warning.” For other hashtags which don’t specifically endorse anorexia, a warning is issued before the results are shown – like #ana.

Instagram defends this as useful for some: “For many Instagrammers who are struggling with eating disorders, it’s a great help to be able to talk to others while they’re in the process of getting better.”

They say it is part of a holistic approach to be able to find these hashtags using the search function.

But a lot of the time, those who are looking for pro-ana sites won’t be deterred by warnings or blocks.

The hashtags are often slightly altered to get around this problem – so #bulimia becomes #bulima or #thin is changed to #thynn. And using these hashtags you can find extreme, sometimes disturbing, pictures of emaciated bodies.

There’s one Instagram account taking on the pro-anas.

Amalie Lees was 17 when she developed an eating disorder.

The 21-year-old Briton is thin – but she used to be much thinner. In old photos you can see the matchstick legs she used to have, skinny and frail. Amalie uses Instagram to document her body, her food and her return to health.

“It feels good to find a place online where you can be open about your fight against your eating disorder,” she says. Through Instagram she was connected with people who were going through the same thing.

But this is also where the danger lies – it’s a double-edged sword, says Amalie.

“People with eating disorders can be competitive,” she explains. “They feel like they aren’t sick enough to earn their recovery, if others are sicker than they are.”

And there are some accounts which start off being about recovery – but end up promoting an unrealistic body image after all.

Today Lee says she now doesn’t count calories, weigh herself or go on any diets.

Because defining yourself in numbers is a waste of time.

Friederike Kolb is 100 years old and never thought she’d be able to dance again.

“When I was a young girl I used to love dancing and I still really love it,” she says.

Every Wednesday morning social worker Gerburg Cartus gives quite a special dance lesson at the Frankenhoehe senior citizens home in Mainz, western Germany.

The youngest participant is 80 and all have the same dance partner – their rollators.

The German Dance Teachers Association (ADTV) is taking elderly dancers seriously and recently launched its Elderly and Agile: the Rollator Dance Handbook in the city of Mainz.

In the book, employees at care homes are advised on how to give dance lessons.

It’s an idea that Cornelia Willius-Senzer, president of the ADTV and director of a dance school in Mainz, has copied from the Netherlands.

“It was so beautiful, the dancers had tears in their eyes,” she says.

The ADTV has been giving rollator dance classes in senior citizens homes and dance schools for two years, with health insurance firm AOK providing 20,000 euros (Bt800,000) in funding.

“It’s been very well received,” says Willius-Senzer. “Lots of people were a bit sceptical at first but as soon as the music started playing their eyes lit up.”

The residents of the Frankenhoehe home have a lot of fun in their class; three steps into the centre, rock step, and back again.

Other dances include clapping and arm movements.

Willius-Senzer was already campaigning for the rollator dance classes in care homes back in 2011 and inspired Cartus, who believes they have lots of benefits for older people.

“It does them so much good to show themselves off,” she says. “It’s great for their confidence and their enjoyment of life.”

Her group does performances at Carnival time, at summer, Christmas and other celebrations. The dancers dress up and decorate their rollators, even using fairy lights at Christmas.

“It takes me out of myself and gives me a bit of a boost,” says 80-year-old Marie-Luise Dreyer, who swears by her rollator.

“I use it to move my washing basket and it also doubles up as a tea trolley, a shopping aid and a dance partner!” she says.

Cartus begins her classes with slow dances, and then moves on to the faster ones.

“Dancing’s also very good training for the memory,” says Cartus. And it encourages socialising. After every dance there’s a short pause for conversation.

“The residents are really happy because they connect the songs with happy memories,” says Cartus.

Else Bouche, 89, says her youth was overshadowed by World War II, and she was often afraid.

“Everything was destroyed – but we still danced and had fun,” she says.

That’s why music and dancing still have a special meaning to her.

The federal Health Ministry spent 35,000 euros funding the new ADTV rollator dance handbook, which sets out beginner exercises on rhythm and keeping time and gives practical tips on lessons.

There are instructions on dance standards such as the foxtrot and the waltz with a rollator, as well Latin American classics such as the rumba and the samba, and there are three different levels of difficulty.

The dance steps are set out, often with arm and hip movements and one chapter even gives instructions on how to dance while sitting.

It is also crucial to ensure you stay hydrated. The organisation recommends water, unsweetened fruit or herbal teas and diluted juices. Dry mouth often leads to difficulties chewing, talking, swallowing and can sometimes even cause dental problems.

There are many causes of dry mouth, one of the most common being medications. Many drugs, including antidepressants, sleep aids, painkillers and antibiotics, list dry mouth as a common side-effect.

Under no circumstances should you stop taking medications without first consulting your doctor, says the German Green Cross organisation.

Go big on breakfast, roll with later hunger pangs

An ideal eating schedule does not exist, but for those who want to optimise their metabolism and cardiovascular system, there are guidelines.

People are tied to their internal clocks more so than previously thought. Sunlight and darkness not only impact a person’s sleep cycle, but they also regulate metabolic hormones. This changes the way a person’s body responds to food.

“A meal eaten in the morning will be metabolised faster than in the evening, regardless of the meal,” says Andreas Pfeiffer, a top German endocrinologist.

“A healthy breakfast is basically good,” agrees Hans Hauner, a top nutritional doctor. “However, it is debatable whether breakfast must be the largest meal of the day. A person should take into account preference and individual eating patterns.”

A main meal in the evening?

Following a pure metabolically based approach, the largest meals should be enjoyed in the morning and at noon. Dinner ought to be the smallest meal of the day. This way of eating would take advantage of the metabolism’s efficiency.

However, many workers have developed a different rhythm because they cannot prepare large meals for themselves during work.

“For many people it is normal to have the big meal after work in the evenings,” Hauner says. “It would not make any sense to ban dinner. An eating pattern like that would not last.”

Nutritionist Silke Lichtenstein also discourages radical approaches to food: “Someone who imposes a strict food ban after 6pm will start eating in advance at 5pm to make sure they are not hungry later.”

“That would make no sense,” Lichtenstein says.

Most experts agree that snacking can be a problem. “We’re getting to the point where people are eating eight to 10 times a day,” says Pfeiffer. “By constantly supplying our body with food, the energy resources stored in our cells are not being consumed.”

Studies have also shown that eating frequently, even if the amounts are smaller, results in an intake of more calories than the daily recommended amount.

Incorrigible nibblers should at least take care to avoid eating anything after dinner, the nutritionists advise.

The human body never evolved to cope with frequent servings or regular meals. Strict daily mealtimes are more of a cultural development.

“Hunger phases are quite healthy as long as they do not cause malnutrition,” Pfeiffer says. “Alternating between hunger and eating phases will support metabolic flexibility, which has a long-term positive impact on health.”

“We should reject the idea that hunger needs to be satisfied immediately,” Lichtenstein adds. Instead of snacking on something unhealthy, people should think about enduring the hunger until they can treat themselves to something healthy and nutritious.

One recent survey revealed that people over the age of 75 are 85-per-cent more likely to develop osteoarthritis than the elderly in general, and among women, the rate of osteoarthritis is two times higher than among men.

Yet, despite the pain, most elderly people who develop osteoarthritis think they can cope with it or resist it. In reality, this is rarely the case.

Our bones start to weaken when we reach the age of 40. In women, however, the bones and articular cartilage will begin to weaken earlier than in men, due to differences in anatomy and hormones. Men tend to have thicker and stronger bones and cartilage than women, and for this reason, the muscles around a man’s knees will usually be naturally stronger. Another factor that plays a significant part is body weight. Women gain weight more easily than men and are, therefore, more susceptible to developing joint problems.

The following are symptoms of osteoarthritis of which everyone should be aware:

l Feeling pain in the knees

l Starting to feel fatigue, tight calves or foldable knee joints

l The skin around your knee joints feels warmer or hotter than usual

l Symptoms of abrasion and friction around the knees

l Inability to stretch or bend your knees fully

l Swollen knees, legs bowed inwards or legs bowed outwards

l Bones that seem to grow outwards along the edges of the knees

All of these symptoms are signs that you may have osteoarthritis. If you experience these symptoms, it is recommended that you see a doctor immediately so that an x-ray can be taken and the symptoms treated. If osteoarthritis is allowed to develop, the condition will become chronic, and will significantly impact the quality of your daily life. Surgery is not always necessary for treatment: treatment will depend on the severity of the symptoms and on the doctor’s diagnosis. If your symptoms are not as severe, then the doctor may recommend that you change certain behaviours and pay more attention to your diet in order to control your body weight and help ease the stress on your knees. Another lifestyle recommendation might be to exercise regularly in order to build muscle around the legs and knees, which in turn will strengthen and reduce the shock on the knees.

Additionally, the doctor may also recommend that you avoid sitting with folded legs or bent knees for long periods of time. Lastly, if you are experiencing severe symptoms, the doctor may prescribe a course of medication to reduce pain, swelling and inflammation, as well as another course of medication to maintain joint cartilage. Changes in patient behaviour and routines may be necessary.

Thereafter, if your symptoms are still severe, the doctor may recommend a surgical treatment called Total Knee Replacement (TKR) surgery, which can be a partial replacement or the entire knee. The type of surgery required will be at the discretion of the attending physician.

In cases in which knee replacement surgery is required, many patients worry about the pain associated with the operation, including the recovery period. However, medical technology has come a long way, and this type of surgery is now simple, convenient, relatively pain free, and also very safe.

These days many hospitals use a method known as Minimally Invasive Surgery (MIS) with Total Knee Arthroplasty (TKA), which is a type of knee replacement surgery that uses only small incisions that cut through as little muscle tissue as possible. Afterwards, the doctor will introduce a High Flexion TKA as the replacement knee. Patients will lose very little blood and feel very little pain during the operation. They also spend less time in recovery, and need just a short stay in the hospital to physically rejuvenate and return to normal life.

Previously, knee replacement surgery was a heavy burden, but with recent advances in medical technology, it has become much simpler.

That said, if we look after our health earlier on in life, and also watch our diet, eat food that nourish our bodies, and avoid overeating, we will naturally nourish and extend the lifespan of our bones and joints so that we can use them well into our older years. Exercise and being physically proactive, as well as maintaining good posture, are some of the ways in which we can prevent our bones from weakening. We cannot simply wait for further advances in medical technology.

DR WERAYUT CHAYAPINUN is an orthopaedic surgeon attached to the Sports and Orthopaedic Centre of Samitivej Sukhumvit Hospital.|Call (02) 222 2494-6.

The reason for the delayed reaction is that iron the body doesn’t need immediately is prudently kept in reserve, points out Antje Gahl of the German Nutrition Society.

A vital mineral that the body can’t produce itself, iron must be taken in with food. Only small amounts are required.

“Iron, found in the blood pigment protein haemoglobin, enables the smooth transport of oxygen in the body,” explains Wolfgang Wesiack, a German internist.

“Women need more iron than men do,” because of blood loss during menstruation, Gahl notes

Their daily requirement of iron is 15 milligrams, compared with 12 milligrams for men. Pregnant women need 30 milligrams a day.

Left untreated, an iron deficiency can lead to what is known as iron deficiency anaemia, a condition in which blood lacks adequate healthy red blood cells. Without enough iron, the body can’t produce sufficient haemoglobin, the substance in red blood cells that enables them to carry oxygen to the body’s tissues.

If you suspect that you have an iron deficit, you should by no means “go to the supermarket and buy an iron supplement to take,” warns Lutz Engelen, a pharmacist. This carries the risk of consuming too much iron, which can also be harmful, he adds.

Instead, you should consult your family doctor, who can detect an iron deficiency with a blood test. The method of treatment depends on the cause.

“An iron deficiency can be caused, for instance, by gum bleeding, blood loss during surgery or unnoticed gastrointestinal bleeding,” Wesiak says. Other possible causes are frequent blood donations or impaired iron absorption by the body.

“An unbalanced or meatless diet can also lead to an iron deficiency,” Gahl adds.

Treatment may involve stopping internal bleeding. Sometimes a doctor will prescribe tablets to replenish depleted iron stores in the body. Iron supplements should be taken in the morning on an empty stomach with plenty liquid since they often have a high fat content, Engelen advises.

They can cause black stools for a while, “but that’s completely normal,” Wesiak says

The best way to prevent an iron deficiency is to eat balanced meals.

“Iron-rich foods include liver, beef and pork as well as eggs, poultry and fish,” Gahl said, but cautioned against putting too much emphasis on animal products, which are often high in fat.

Vegetarians can meet their iron requirement by eating whole grain products, legumes, beetroot and green vegetables such as kale and spinach.

You should also avoid drinking coffee or black tea with your meals because they contain tannins that could inhibit the body’s absorption of iron. The calcium in dairy products is also considered to be an iron blocker, so you should avoid high-calcium foods for a half-hour before or after eating iron-rich foods.

Being overweight during |pregnancy has negative effects

DEUTSCHE PRESSE-AGENTUR

Women’s eating habits during pregnancy and while breastfeeding can significantly affect their children’s health, even beyond their growth stage.

Negative after-effects can stretch into late adulthood, says Jan Daebritz, a nutrition specialist.

“Pregnant women have obligations: studies have established that there is definitely something in the view that overweight mothers also have overweight children,” the expert says.

The consequences later on, in adulthood, can include vascular diseases like high blood pressure or cardiac infarction, as well as diabetes.

The reason for this lies in what is known as metabolic programming. According to this, the ingredients in foodstuffs can lead to genetic changes. These are not actually passed on, but they can affect the way in which genetic information is interpreted, which impacts the production of protein and enzymes.

No single foodstuff can be described as “bad” in this respect, Daebritz notes. The issue has a lot more to do with overall unhealthy eating habits and with the far-too-high supply of energy that comes with an excessive food intake.

This is the view of the German Nutrition Society (DGE). Being severely overweight during pregnancy also increases the risk of complications for both the mother and the baby during childbirth.

Pregnant women should not eat for two. They do not need that much extra energy during pregnancy.

Obesity prevention begins as early as the womb, Gahl stresses.

According to Daebritz, who is deputy head of the university clinic for children and adolescents in Rostock, Germany, gynaecologists have a duty to inform pregnant women about the importance of their diet.

Expectant mothers should for example eat fish, which is high in important fatty acids, in order to boost brain development in the unborn child.

The “One Gift for One Life” campaign was launched recently at a press conference during which medical experts provided information on the disease, which is the second most common cancer in Thai women. Also joining the event were Pimmada “Pim” Boriraksuppakorn, who has been diagnosed with early-stage ovarian cancer, and actress Kemmanit “Pancake” Jamikorn who shared her tips for staying healthy.

The fund-raising campaign is receiving the support of leading fashion designers Teerut “Vick” Wongwatanasin of Vickteerut, and Bhubawit “Roj” Kritpholnara, who have come up with a special bag and cap priced at Bt200 and Bt299 respectively that are guaranteed to appeal to fashionistas.

“Cervical cancer is one of the few types of cancer that can be prevented through regular screening, which is even more effective when it goes hand-in-hand with HPV vaccination. Despite the fact that the vaccine has a 70-per-cent success prevention rate among high-risk strains, a staggering 8,184 Thai women are still diagnosed with cervical cancer each year,” said Dr Wichai Termrungruanglert, head of Gynaecologic Oncology Division at Chulalongkorn University’s Medical Faculty.

“It is therefore critical that we continue to drive awareness and foster an accurate understanding among the public about this disease before it is too late. Moreover, given that the majority of women still lack access to essential information about the HPV virus as well as the financial means to obtain effective protection methods, the Thai Gynaecologic Cancer Society sees the urgent need to equip those in need with knowledge and reinforce its efforts by collaborating with various parties to launch such initiatives as the “One Gift for One Life” campaign. The campaign includes a fundraising activity, with all proceeds intended for acquiring HPV vaccines for children and young girls in the Juvenile Observation Homes throughout Bangkok.

We have plans to extend vaccination support to other regions in Thailand and expect more than 200 children and young girls to have access to a free HPV vaccination service.”

For his part, Group Captain, Panon Kasemsarn MD, an expert in gynaecologic cancer, explained the symptoms of gynaecologic cancer.

“All women are at risk of contracting cancer of the reproductive tract, and therefore, must regularly perform self-examination and immediately consult a gynaecologist for further diagnosis should they notice any abnormalities.

Another preventive measure women should take is to protect themselves against any viruses that are responsible for various types of cancer, particularly cervical cancer, takes the lives of many Thai women each year.

“A large number of women still have neither an adequate understanding nor the proper know-how about protecting themselves from the dangers of the |HPV virus, and providing them with the right knowledge will significantly lower the risk developing cervical cancer from the infection.”

For the past 10 years, many countries such as Australia, United States, Canada, and the countries in Scandinavia have been giving HPV vaccines to 11-12 year old girls. Recent research that studied the long-term efficacy of HPV vaccines also revealed that vaccination can significantly lower the risk of HPV infection, the main cause of common diseases such as genital warts and cervical cancer, by as much as 90 per cent. The vaccine has also been proven effective in inhibiting malignant lesion formation that often leads to cancer by 85 per cent.

– To place an order for the bag or cap, go to Line ID: onegiftbags2016 or call (087) 365 5973.