Heard of ‘oatzempic’? How the rise of harmful fad diets online is driving eating disorders

The sun had yet to rise and everyone else at home was asleep, but teenager Joy Ng was already up, working out to an exercise video on social media.
This might sound like a healthy start to a day, but she was doing this while suffering from anorexia nervosa, a type of eating disorder and a mental illness.
People who have anorexia have a distorted image of their bodies, thinking they are fat even when they are underweight. They typically exercise excessively, do not eat enough food, take laxatives or make themselves vomit, to the point that they can begin to starve.
Miss Ng, 19, is now on the road to recovery, but the polytechnic student recalled how it had all begun with a well-meaning thought, before it gradually spiralled into a toxic situation.
In 2020, as a healthy and active teenager, she wanted to shed some weight after being cooped up at home during the COVID-19 pandemic, so she began working out and eating less.
Then, as she began to cut her weight, she became increasingly obsessed with the numbers on the weighing scale.
She would spend all her free time exercising and looking for exercise tips and diets on social media platforms such as Twitter, now known as X.
The efforts took a dark turn as she got sucked into groups where members encourage each other to starve for an unrealistically slender body. Food, to her, slowly became akin to poison.
Social media channels have long been known to perpetuate unhealthy or misguided standards of beauty, leading some to develop a warped sense of an ideal body or to become obsessive about keeping up with what others have seemingly done.
However, it is not just comparison and unrealistic expectations that can lead to unhealthy eating habits or eating disorders.
Poor diet advice given by influencers and online content creators are another reason, and this is why nutritionists and dietitians are sounding the alarm bell on diet fads touted on social media.
They are warning that following some of these diet fads could result in individuals missing out on necessary nutrition, especially if they follow trends encouraging them to cut out entire food groups from their daily meals.
When 56-year-old part-time logistics worker Francis Cheah wanted to lose weight last year, he turned to social media for advice. He soon latched onto an unconventional diet of eating just protein such as meat, eggs and fish.
For the past year, he has adopted the “carnivore diet”, which is an extreme version of the Keto diet, where people cut out vegetables and carbohydrates from their meals.
He eats only two meals between 11am and 7pm every day and drinks at least 3L of water, in what is called intermittent fasting, where people eat and fast in regular blocks of time.
He lost 25kg in a year and now weighs about 75kg. While his diet may seem overly restrictive, he told CNA TODAY that he feels healthier and more energetic, which is why he is going to stick to it.
Several influencers he follows include Anthony Chaffee MD, a registered health practitioner in Australia, and KenDBerryMD, who claims to be a family physician from Tennessee, United States.
Still, experts warned that such rigorous diets are unhealthy and could result in eating disorders over time.
Ms Charlotte Chew Soo Cheng, an accredited nutritionist from the Singapore Nutrition and Dietetics Association, said: “Many people, especially the younger audience, trust diet trends and advice that they can find on social media blindly. They often do so without really questioning their validity. They don’t really do the research.” 
Social media experts added that even though there is health and fitness content promoting proper diets and exercise tips, the way that content creators talk about them can sometimes be damaging.
Associate Professor Brian Lee, head of the communications programme at the Singapore University of Social Sciences (SUSS), said that phrases such as “if you can’t keep up with this clean diet for 100 days, you are a big failure” – an utterance that many such content creators say in their videos – can negatively affect a viewer’s well-being instead of motivating them.
Eating disorder diagnoses are on the rise in Singapore. KK Women’s and Children’s Hospital (KKH), for example, has seen its yearly new cases rise from around 50 to 70 in 2017 to about 140 in 2023.
The hospital, which sees eating disorder patients up to 18 years old, said that close to 20 per cent of new cases involve patients under the age of 13.
In response to queries, the Ministry of Health directed CNA TODAY to a statement that was given in response to a parliamentary question in May 2021: It said that an average of 300 patients a year received treatment for eating disorders from 2016 to 2020.
These numbers are in line with global trends: Between 2000 and 2018, a study in The American Journal of Clinical Nutrition found that the prevalence of eating disorders jumped from 3.4 per cent to 7.8 per cent globally.
There are several reasons for this increase.
Dr Chua Sook Ning, a clinical psychologist, said that one is an increased awareness about eating disorders, thereby leading to more diagnoses.
Another is that of people trying to live up to societal or peer pressure, where thin body types are seen as being the ideal. This pushes people to unnecessary and unhealthy weight loss, she added.
Dr Chua, who is also the founder of not-for-profit mental health organisation Relate Malaysia, is a visiting scholar at the Strategic Training Initiative for the Prevention of Eating Disorders at the Harvard TH Chan School of Public Health in the US.
And social media has a large role to play, too.
Dr Juliet Tan, a consultant at KKH’s Adolescent Medicine Service, said: “Social media content, especially related to dieting and exercise regimes that promote weight loss, can be detrimental to young people and propagate unrealistic appearance-ideals.”
She also said some people mistakenly believe that eating disorders are “just a diet”. This is an exceptionally dangerous assumption for the young and completely inaccurate.
“The weight loss and malnutrition associated with restrictive eating disorders cause changes to the structure and function of the brain, especially with regard to food and eating,” she added.
“In a child who is still developing, eating disorders can have an impact on their height growth and bone mineral density, and affect their puberty or cause loss of menstruation in females.”
Eating disorders can also cause complications to the cardiac, gastrointestinal and immune systems, as well as other mental health concerns such as depression and anxiety, she said.
Nutritionists pointed to certain diet fads popularised on social media, such as “oatzempic” and “ricezempic”, which they said can cause harm.
These refer to the trend of drinking starchy rice water, or oats blended with water, with lime juice. It is named after Ozempic, a medication for Type 2 diabetes that is used for weight management.
Content creators who tout these so-called weight loss tricks say that if dieters drink one of these concoctions in the morning, it will keep them feeling full so they can skip lunch or eat less. 
These fads might sound like they are proposing a healthy mix of fibre and fluids, but a dietitian warned that these drinks are no substitute for medication or a healthy and balanced diet. 
Associate Professor Claire Pettitt from the Singapore Institute of Technology’s Health and Social Sciences Cluster said: “Although fibre is somewhat satiating, it will not suppress appetite in the same way that weight loss medications like Ozempic does. That misleading oversimplification can lead to unrealistic expectations and poor health decisions.
“(The oatzempic diet) is also not balanced and is inadequate for most people as a breakfast meal, at only around 160 calories a serving. Although the ingredients are healthy enough, the concept of this ‘quick fix’ is not realistic or sustainable.”
What does not help is that influencers who tout oatzempic as a diet encourage people to fast or restrict their diet after drinking the concoction, she added.
Assoc Prof Pettitt also said that there are other “absurd” trends such as adding chlorophyll to drinking water and dangerous ones such as swallowing a scoop of dry powdered pre-workout supplement mix. Both have no known benefits.
In a study by fitness application MyFitnessPal and the Dublin City University last year, it was reported that just 2.1 per cent of TikTok nutrition trend videos were found to be accurate.
The same study also surveyed 2,000 millennials and Gen Zers from Australia, Canada, the United Kingdom and the US. About 57 per cent of them said that they were influenced by nutrition trends they found on TikTok.
Thirty-nine-year-old Sandra (not her real name), who works in human resources and has a healthy BMI, followed a diet fad and claimed that it worked for her and her friend.
Despite this “success”, the Singaporean declined to be identified because she did not want others to know she has been following the diet.
Sandra follows the “Liu Yifei diet”, named after a Chinese actress and that was popularised on social media channels Xiaohongshu and TikTok.
As part of the diet, she restricts what she eats on five days each month. The first day is spent eating only eggs, before going on a full-liquid diet on the second day. For the other three days, she eats only meat for one day, only vegetables another, and then only fruits.
“I lost 3.5kg in a week. It was easy and I felt good as my weight did not rebound after that,” she said, adding that her friend lost 27kg in six months.
“I tried intermittent fasting, but it did not work as it was too restrictive for me. With the Liu Yifei diet, at least I can eat whatever I want for the rest of the month. And I just want to look good.”
Nutritionists told CNA TODAY that rapid weight loss can be dangerous, especially when prolonged over weeks. There can be side effects such as headaches, hair loss, muscle loss and, for women, menstrual irregularities.
“Rapid weight loss in a short time period is rarely due to fat loss alone. In fact, it is more likely due to fluid loss and glycogen depletion,” Assoc Prof Pettitt said.
“When we drastically reduce calories, our body uses glycogen stores as its energy supply instead of using calories from the diet.”
Glycogen is a form of glucose that the human body stores in the liver and muscles, and it holds three times as much water.
Assoc Prof Lee of SUSS said that people fall for such diets because those who promote it are fitness influencers or online personalities.
“In the name of promoting a healthy lifestyle, some (influencers) are really just focusing more on extremely restrictive diets or detox fads that can lead people to develop unhealthy perceptions of healthy lifestyles,” he added.
In checking six social media platforms, CNA TODAY found that safeguards on content related to diets and eating disorders were uneven across these channels.
Among the four with safeguards, it was not difficult to circumvent filters recommended by the platforms, by using alternative phrases and spellings.
Ms Long Li Yann from Temasek Polytechnic said that once users are engaging with the fitness and diet content, these social media platforms will resurface more similar content.
The lecturer of the communications and media management diploma course also said that social media platforms are “designed to be addictive, with algorithms prioritising visually engaging and emotionally charged content”.
And so, social media content that promises quick weight loss and showcases drastic before-and-after photos is likely to surface as a user increasingly engages with this topic.
Senior clinical psychologist Henny Tan from Promises Healthcare clinic said: “Viewing more and more body image-related content such as dieting and losing weight can lead to unhealthy obsession or excessive preoccupation with our body weight, shape and size, as well as eating and exercise, which may contribute to further issues like anxiety and eating disorders.”
There are instances, though, where social media has been a source of support for people who want to be healthier, provided they understand that being healthy does not mean simply losing weight.
For Miss Ng, the 19-year-old with anorexia, even though social media led her down a path of self-destruction, it also helped her find a way out, as she found and followed mental health advocates online.
One of these is 22-year-old Ro Mitchell, a UK-based influencer who promotes having a healthy relationship with food, among other things. She has more than 203,000 followers on her Instagram page.
Social media experts acknowledged that there are influencers who advocate healthy diets as well as body-positive and well-meaning fitness content. Body-positive content encourages users to appreciate their bodies regardless of size or shape, rather than fixating on unrealistic beauty standards.
Yet, even on such positive and uplifting accounts, there can be toxicity – in the comments.
For example, CNA TODAY found several body-positive social media influencers on Instagram who received comments from people shaming them for being fat. These comments then received hundreds of “likes” or approval from other users.
And even if the content creator might be steeled against such hurtful remarks, other users scrolling through the post might not.
Dr Chua the clinical psychologist said: “The salience of these comments lead people to believe that these comments reflect what the public believes.”
Studies have shown that people with body image concerns are also more likely to recognise, remember and apply these negative comments to themselves, she added.
In other cases, content creators or internet users with good intentions might want to help others maintain certain diets, but inadvertently pressure them.
One example would be Facebook groups for people who subscribe to the Keto diet – a high-fat and low-carbohydrate diet. Such a diet can have health benefits when done in moderation, but it is not recommended for everyone because it is not balanced.
Ms Chew the nutritionist said: “In these Facebook groups, people who follow Keto diets might share their meals and give comments on how a meal could be better. This is often framed in a professional manner, with claims of science and specifics on calories and ideal eating hours.
“But sometimes, it creates this pressure that if you do not follow their advice, you will fail to lose weight. That makes people feel guilty, and these strict diet restrictions can lead people who cannot keep up to begin binge-eating.”
Binge-eating is a type of eating disorder, where people overeat despite feeling full.
With the internet and social media being a source of information for most people, how does one discern what to follow and what to ignore?
Experts said that there are some telltale signs of poor advice. They include:
Instead of relying on social media, online users can head to HealthHub, run by national health technology agency Synapxe, and hospital websites, which serve as reliable sources of information.
Ms Chew said that people interested in having a deeper understanding of diets should turn to scientific journals.
The Cochrane Library, for instance, has plain language summaries that make scientific jargon easier to understand.
Know this: Losing weight rapidly can be dangerous. The experts said that most adults should lose not more than 0.5kg to 1kg a week – this is the rate at which fat loss is most likely and muscle mass is retained.
The safest way to lose weight safely? Get advice from a professional face-to-face.
Ms Charlotte Lin, head of dietetics at the National University Hospital, said that it is important to do this, especially because some people may have medical conditions or should not even lose weight in the first place.
“Some people think they must lose weight, but their weight and BMI is normal. If they lose more weight, it might be detrimental to their health,” she added.
“In addition, for some people who are undergoing medical treatment such as cancer treatment, and are slightly overweight, it may not be the best time for them to lose weight. So it’s best for them to speak to their physician to see if this is safe for them medically.”
For reference, accredited nutritionists and dietitians can be found on the website of the Singapore Nutrition and Dietetics Association, Ms Chew said. 
The experts also highlighted that social media literacy is crucial in educating the masses on how to combat the negative effects of consuming content on online platforms.
“Users need to be armed with the critical thinking skills to recognise manipulated content and understand the commercial motives behind it,” Ms Long from Temasek Polytechnic said.
“By learning to question the authenticity and intention of images and trends, users can build resilience against the pressures of comparison and develop a more informed and mindful approach to consuming content.”
On their part, the administrators or management of social media sites should proactively identify harmful content and reduce the spread of misinformation, Assoc Prof Lee of SUSS said.
“At the same time, the pertinent authorities should enact regulations that hold social media companies accountable.
“However, I reckon that it is challenging to take some of these social media content creators to task because what they post may be problematic, but it is not illegal.”
For Miss Ng, finding support from a mental health professional who told her that eating “did not need to be stressful” helped her to slowly build a relationship with food again.
Trying to recover from her anorexia was not easy. She admitted that it was not pleasant to feel her clothes fitting tighter and watch her body change.
With the support of her friends, family and social media influencers who share their eating disorder recovery journey, she said that she is healthier, even though she still struggles with thoughts of eating less.
These days, she posts on social media about her experience in the hope that others would not become obsessive about weighing themselves and counting calories constantly, and that people who have eating disorders would be able to find support as she did.
“When I did not eat, I found myself consumed with thoughts of hunger and my body image. But I pressed on to recover because I simply wanted my life, hobbies and personality back,” she said.
“I wanted to be me again.”
When CNA TODAY searched for “eating disorder”, “weight loss”, “skinny” and the names of eating disorders on social media sites Facebook and Instagram – both of which are owned by technology company Meta – a warning page appears providing contacts for helplines and a suggestion to “message someone you trust”.
Users must tap “continue to search results” to access content related to the terms.
When searching for “diet”, Facebook and Instagram display a small warning that “your well-being is important” above a selection of content on diets. The warning message directs users to several self-help tips such as “listening to your body” and how to “resist the pressure to judge yourself”.
This alert appeared on two of the three Instagram accounts containing the searched content that CNA TODAY clicked.
Tiktok and Lemon8 – social media platforms owned by China-based company Bytedance – also display a warning page when users search for “eating disorders” and the names of such disorders. Unlike Facebook and Instagram, users have no option to access related posts.
However, both TikTok and Lemon8 recommended slightly altered spellings of search terms. By searching these terms, users can view posts on the topic.
On all four sites, safeguards can be easily bypassed by using similar keywords such as “slim”, “weight loss tips”, “diet trend”, “diet tip” and “calorie deficit”. TikTok and Lemon8 did not have warnings for terms such as “skinny” and “diet” either.
When it comes to the quality of content, TikTok and Lemon8 had positive and negative diet trends available. For example, when searching the term “diet” on TikTok, the first four videos recommended general weight loss tips such as reducing your sugar intake.
However, the fifth video was of the “IU Diet”, named after the South Korean pop singer-actress who claimed that she lost weight by eating one apple for breakfast, a sweet potato for lunch and a protein shake for dinner. The video has more than 64,700 likes.
CNA TODAY also began finding more of such diet and weight-loss content surfacing on their TikTok account’s For You Page. This included the “looksmaxxing” trend – where users post about how they can maximise their physical attractiveness by working out and slimming down.
There are no safeguards on X (formerly Twitter), with several social media users creating “accountability threads”. These users would post daily, detailing their dangerous fasting habits to show they are following their restrictive diets.
The community groups on X have also allowed people with eating disorders to enable each other through advice and “motivation pictures” of people who are skinny. One group has more than 8,400 followers.
Similarly, messaging application Telegram has several channels that post pictures and videos of extremely thin women about every three hours and their unrealistic diet plans.
Some channels have more than 60,000 followers, though it is unclear if any Singaporeans are in it.