When Hiroyuki Suematsu left medical school in the early 1960s eating disorders were still rare in Japan. During his own childhood after the Pacific war binge eating would have been almost unthinkable.

"When I was at elementary school we didn't have enough food to eat. No-one knew what bulimia was."

Even just ten or twenty years ago eating disorders were thought to be much less common in Japan than in other developed countries. But recently Japan appears to have caught up, and the number of sufferers may still be increasing.