Eating Disorder Support in Japan

My History of Treating Eating Disorders as a Dietitian

When I first became a dietitian, I remember thinking that the last thing I wanted to specialize in was eating disorders (EDs). Developing the skills needed to address disordered eating, weight restoration, and the numerous conditions associated with eating disorders felt overwhelming, and at the time, I felt more inspired to work on other issues within the nutrition space.

In truth, I think I was afraid of working with EDs because a part of me related all too well to the struggle of maintaining a healthy relationship with food and one’s body. Like many women in today’s society, I had experimented with disordered eating behaviors over the years in an attempt to be “healthy”, and it wasn’t until I was further along in my nutrition coursework that I began to understand how to truly nourish and care for my body and healed my relationship with food and eating.

It wasn’t long before I discovered that although I wanted to escape the treatment of eating disorders, eating disorders couldn’t escape my patients (and therefore me by extension). A seemingly straightforward weight loss consultation would include a confession of disordered eating habits, or an athlete coming for performance nutrition would discuss how pressured they felt to maintain a severely restrictive diet. When these issues came up, I felt woefully underprepared and worried I wasn’t giving my patients the care that they really needed.

With this in mind, I began to seek out additional eating disorder training to better understand and treat those who came to me for dietary counseling. As it turns out, it was one of the best decisions I ever made. Opening up the door to further training made me understand how pervasive disordered eating is, and how I could best support those on the road to recovery. I’m grateful for all of the dietitians I sought advice, training, and support from and the many patients I’ve been able to support since. Witnessing that while recovery is difficult, it is possible has been life-changing, and I feel honored to be a part of their journey to a healthier, happier life.

Barriers to Eating Disorder Treatment in Japan

For those in Japan, seeking out eating disorder treatment can be especially difficult. While diet culture has a strong influence in many parts of the world, it feels even more prevalent and socially acceptable here. Due to a low obesity rate, weight-related stigma is high, even in professional settings, like medical care. Talk to any pregnant women in Japan and you’ll likely hear stories about doctors or midwives lecturing them about weight gain, while working women have told me how they were called “fat” during their annual work-sponsored health check even when their BMI was within the normal range. It is because of these beliefs that severe dietary restriction is seen as normal in many instances, and some of my patients spent months in the Japanese medical system without getting a diagnosis as their low body weight or poor food intake was not seen as a problem.

Even if one does manage to get a diagnosis, care – either in Japanese or English – can be hard to come by. Due to low awareness and a lack of eating disorder related training within the medical system, there are very few facilities that treat EDs in any comprehensive way, such as inpatient treatment centers. While awareness of eating disorders is increasing, progress is slow and resources are few.

Eating Disorder Treatment Options in Tokyo/Japan

So what does this mean for those who move to Japan with an eating disorder or develop disordered eating while in Japan (and need English language care in particular)? While I wish that there was a more robust support network for eating disorder care here, I’ve been fortunate enough to work with several practitioners and organizations that can support those on the road to ED recovery. Below are my recommendations and resources for support, broken down into each category based on the idea that the best ED treatment will encompass medical monitoring, mental health support, and medical nutrition therapy:

For medical support:

Tokyo Medical and Surgical Clinic: all the general practitioners at this clinic speak English (some speak additional languages such as German and French) and have experience in supporting those with eating disorders. If needed, they can also refer patients to English language specialists both in-house or at other medical facilities.

For mental health support:

*note that while many of my patients choose to see mental health practitioners who do not specialize in eating disorders due to a variety of reasons (price, insurance, availability, etc.), some may prefer a therapist with advanced eating disorder training, which I have listed below

Tokyo International Psychotherapy (Futako Tamagawa office): this is one of the only clinics I am aware of in Tokyo that has therapists who specialize in eating disorder treatment and have completed advanced training in the treatment of EDs.

CBT Tokyo - Colin Coxall, MSc MCouns PG Dip CBT: the owner of this practice, Colin Coxall, is an accomplished psychotherapist who has undergone additional training in the treatment of eating disorders. Virtual and in-person appointments are available.

For medical nutrition therapy:

Victoria Lindsay, MS, RD – I currently see patients in person at Tokyo Medical & Surgical Clinic, and virtually through my private practice for a wide range of eating disorders and other disordered eating behaviors. If you think you may have an eating disorder and need more support, please get in touch.

For crisis support:

TELL Japan Lifeline - while this is not intended to be a substitute for regular psychotherapy/eating disorder support, this lifeline provides chat and phone crisis and mental health support services with trained support workers free of charge. While there are numerous crisis hotlines - some of which specialize in eating disorders - many do not provide service during normal waking hours in Japan, which can be an issue for those in need. While support workers do not possess advanced training in EDs, they do undergo some ED training and are extremely kind and empathetic people who do their best to care for those in crisis. I cannot recommend TELL enough, so should you or anyone you know need to talk to someone, please don’t hesitate to reach out.

In closing, know that if you're struggling with an eating disorder in Japan, you are not alone, and help is available. If you have additional eating disorder resources in Tokyo or Japan that you’d like to add to this list, please contact me at victorialindsayrd@gmail.com.