|Family Matters: Anorexia: It's Not About Food|
While there are no exact statistics, it is clear that Jewish girls are among those suffering
from eating disorders. The question is: How can we identify and help them?
Ann Levine had already lost a child in a horrific car
accident when her 17-year-old daughter, Rebecca, became anorexic. What
began as a diet before a school dance escalated to a full-scale
disorder within months. Levine, a mental health professional, says she
missed the early warning signs—changes in her daughter’s eating habits,
skipping meals, insisting she was full, not eating foods she had
When Levine finally insisted Rebecca have a medical checkup, “there was no hiding anymore. She had lost over 25 pounds.
my own anxiety and wishing I could do something that would make...her
healthy was the most difficult,” says Levine (many names in the
article, including the Levines, have been changed to protect privacy).
“My fear that she was going to die was so strong.”
began seeing a nutritionist and therapist and continued to be medically
supervised in college. “She was angry for a long time and said people
were making a big deal over nothing,” says Levine. “The only thing she
could control, as she struggled with academic pressures, growing up,
transitions and loss was the food she put into her body.” Rebecca is
disorders seem to be about food. In fact, they are a chronic form of
emotional distress and a serious illness, most often seen in girls.
are “a coping mechanism when life feels out of control, overwhelming,
disappointing or painful,” says Catherine Steiner-Adair, director of
Eating Disorders Education and Prevention at McLean Hospital, a
clinical instructor in the department of psychiatry at the Harvard
Medical School in Boston, a clinical and consulting psychologist in
private practice in Chestnut Hill, Massachusett and co-author of “Full
of Ourselves: Advancing Girl Power, Health and Leadership,” a
curriculum for middle-school girls that increases self-esteem and body
acceptance. “What remains sadly consistent,” she says, “is how many
girls refer to their bodies as the ultimate measure of their worth.”
Abigail Horvitz Natenshon distinguishes between disordered
eating—unbalanced or unhealthy eating most of us do occasionally or
even regularly—and clinical eating disorders, which have a genetic
basis and are among the most lethal of mental health illnesses.
Otherwise “benign” disordered eating behaviors such as dieting,
skipping meals or excessive exercise could trigger a clinical disorder
in a susceptible person.
In 2006, the National Institute of
Mental Health confirmed that anorexia and bulimia are biological,
brain-based disorders; in response, group health insurers will be
required to cover treatments for these disorders in the same manner as
medical and surgical procedures are covered; a federal law should take
effect in January 2010.
Since the 1960s, eating disorders in
the form of anorexia, bulimia, binge eating, overexercising and obesity
have doubled, according to the American Academy of Child and Adolescent
Psychiatry. Anorexia is characterized by the refusal to maintain about
85 percent of normal body weight, intense fear of gaining weight and an
undue influence of body shape or weight on self-image; bulimia is a
repetitive cycle of out-of-control binging accompanied by purging,
fasting, food restriction or laxative abuse to compensate for intake of
Precise numbers are hard to come by, partly because
of secrecy, denial and misunderstanding, but experts estimate that
there are 70 million cases of eating disorders worldwide, 11 million in
the United States; 10 to 15 percent of these are males. Eighty-six
percent of victims are young people under the age of 20, and 11 percent
of high school students are afflicted. Eating disorders are also common
in adults, taking the forms of dieting and compulsive overexercising
that masquerade as healthy activities. The majority of people with
severe eating disorders do not receive adequate care.
comprehensive statistics pinpoint the extent of eating disorders among
Jews, but it crosses denominational lines. The Renfrew Center in
a facility that specializes in treating eating disorders, has a Jewish
inpatient population of about 11 percent. Renfrew, which has locations
throughout the country, has opened a track geared to observant Jewish
women at its New York site.
point out that Jews tend to be a high-achieving group with
perfectionist tendencies, traits that make people vulnerable to eating
disorders. “Be an A student, be an incredible society. We also want to
be the best weight losers,” says Faye Wilbur, director of the Boro Park
Counseling Center of the Jewish Board of Family and Children’s Services
in New York, which treats eating disorders—mostly among adolescents and
young adults, but also children as young as 9 and boys and women with
overeating issues. But, she says, “it’s not a Jewish problem. It’s a
cultural problem. America thrives on and admires thinness.”
in middle- to upper-class Jewish communities have lots of pressure to
perform and do well,” Levine says. Holiday meals magnified the problem
in her Conservative home. “Instead of food and drink being joyous, they
became the source of conflict.”
Eating plays such a central role in spiritual practice, notes Steiner-Adair, “it makes issues around food loaded.”
contends that food in the context of Jewish observance can be a source
of emotional strength and identity, ultimately offering protection
against the onset of an eating disorder. “Through Shabbat dinners,
parents model a healthy foundation for living and eating and human
connection. This is the stuff of cherished memories, continuity,
tradition and mental health. It is only when behaviors become excessive
or compulsive that they become pathological.”
who struggled with anorexia between 1991 and 1999, attributes her
recovery in part to finding herself and connecting to others at the
Hillel at her university. Israel, who was raised Reform, says she would
have laughed if, in her last year of high school, someone had said she
was on her way to an eating disorder. She began by exercising and
eating low-fat foods. Soon, she felt good being smaller than everyone
else. Her weight dropped to 93 pounds in her first three months at the
University of Michigan.
She had lived in a small town, and
suddenly, at college, she felt anonymous. “I was losing an identity I’d
built up in high school,” says Israel. “Anything I did, I did to
perfection.... The only time I didn’t feel fine was when I was forced
to eat or stop exercising.” The hardest part of the illness, she
recalls, is that she did not have any perspective on reality. Israel
had to leave school, was hospitalized and battled the disease in
inpatient and outpatient settings. “My college experience was hospitals
and therapists three times a week.”
Now a social worker in San
Diego, Israel, 36, is a mother of two, which is almost miraculous
because her period stopped the summer before college and did not resume
for nine years. She is still reluctant to call herself recovered: “If
my jeans don’t fit one day, I still think about it. If there’s any
change or trauma, I have to be careful I don’t start skipping meals,
restricting foods and overexercising. But I look at women in the throes
of the disorder and I don’t find anything remotely attractive about it.”
childhood and adolescence, between high school and college—are a
particularly delicate time. Orthodox girls often spend the year after
high school in Israel. Many gain 20 to 25 pounds; to lose the weight,
they simply stop eating before they go home and continue in that
David Klein says his daughter’s symptoms “spun out of
control” in Israel, and she had to come home. The yeshivas in Israel
“have no clue how to deal with eating disorders.” Klein notes his
daughter’s illness forced him and his wife to recognize family issues:
“We were part of the solution but also part of the problem.”
daughter, now 29, is married with three children. In the Orthodox
community, when girls are “on the [matrimonial] market,” he says,
thinness can be a Catch-22, a fine line between beauty and pathology.
“Matchmakers say girls must be thin, though if a girl has an eating
disorder, it’s a negative factor in a shiddukh [match].”
homes where grandparents or great-grandparents went through the
Holocaust, an illness in which a child looks like a survivor creates an
added source of agony, says Steiner-Adair. Often, parents blame
themselves for not catching the symptoms early enough; they may believe
they have no right to participate in treatment, particularly after a
child turns 18.
Parents need to learn the warning signs. Says
Natenshon: “Because disordered eating is so common, people tend not to
recognize when benign problems morph into pathology. Healthy eating is
not fat-free eating. Children need fat in their daily diets to grow
their neurological and reproductive systems.”
Natenshon is the author of Doing What Works: An Integrative System for the Treatment of Eating Disorders from Diagnosis to Recovery (NASW Press) and When Your Child Has an Eating Disorder: A Workbook for Parents and Other Caregivers (www.empoweredparents.com).
She urges parents to play a role within the treatment process,
alongside a professional team that usually consists of a physician,
psychotherapist, nutritionist and pharmacologist. That support network
is essential as patients recover, says Israel, eventually reaching
their own moment of readiness to change their destructive behavior.
myth that people with eating disorders don’t get better—that it’s like
alcoholism—is disempowering,” says Natenshon. “There are plenty of
success stories with early and effective treatment.” Statistics
indicate that 80 percent recover: 50 percent recover so fully as to
never have to deal with eating issues again; the other 30 percent may
need to be treated on an as-needed basis to prevent recurrence.
Golden represents one such success story. Fifteen years ago, she
struggled with anorexia athletica, a disorder involving restricted food
intake and excessive exercise.
Golden began running
competitively at age 14. Worrying that too much food in her stomach
would make her sick during runs, she ate a small breakfast and lunch.
Despite rapid weight loss, she continued winning, becoming one of the
best runners in Illinois. Though she is 5 feet 6 inches tall, her
weight had dropped to 88 pounds.
Golden’s father, Jim,
remembers “walking on eggshells. I wanted to let her know I was there
and not make more of it than it was, but also not pretend it wasn’t
there. I wanted her to win but I also harbored fears that she would
snap and break.”
The summer before college, Golden developed
pneumonia and her doctor issued an ultimatum: Stop running until she
reached 100 pounds. “For me that was like an undoing,” she says. “I
lost control and overate,” reaching 165 pounds. With therapy and time,
she put her illness behind her.
Today, Golden rarely thinks of
that chapter of her life. Currently a nurse, she is married, has had
her first child and is still running. “It feels like just a blip on my
radar,” says Golden. “With therapy, hard work and time, you can leave
an eating disorder behind and take with you only the life lessons. You
can grow stronger and live your life.” H
One Girl’s Story
8:15 A.M., 16-year-old Zara is standing during Shaharit, numbers
running through her head. She adds 250 plus 120, 16 for the gum, 300
for lunch and 100 from breakfast.
As the total presents itself,
she sighs in relief: 786 calories, a successful day. Around her, peers
at the Ramaz school in New York are lost in prayer. If Zara had not
been consumed with calculating calories, she would have noticed the
praise being offered to God for creating a body wondrous in design.
yesterday’s tally is done, she maps out the day’s eating. She schedules
time for exercise and had had no breakfast—perhaps she can keep her
intake to around 500.
But by 11, Zara is feeling light-headed
and cannot concentrate in class. She excuses herself and races to a
candy machine to buy a Kit Kat bar. Breaking it into four sticks, she
gobbles two and saves the others to nibble on during the day.
Kit Kat has 54 calories per stick. Leaning on the candy machine, she
feels defeated, a loser. She decides to skip lunch. Morale renewed, she
returns to class.
Since the age of 11, Zara’s life has revolved
around food. There were the memorization of a calorie-counter book and
tears if more than 400 calories were consumed; binging, followed by
Ex-Lax and dashes to the bathroom. There were rage at her body, leggy
but with wide hips, and the triumph of achieving her lowest weight—92
pounds—at age 12. While others prepared for bat mitzvas, she marked the
passage to womanhood by starving herself.
As I write, I weep
for the girls and boys engaged in a battle with their bodies. Yet in
reviewing Zara’s story, I also cry for the girl I was: Zara is my
younger self, and her story is my own. —Shira Dicker
Shira Dicker is a New York-based writer and publicist.
Hungry for a Response
Jewish community is beginning to wake up to the prevalence of eating
disorders and disordered eating and is developing ways to combat it,
says psychologist Catherine Steiner-Adair. With funding from the
Hadassah Foundation, she has created a Jewish component to her
prevention curriculum, “Full of Ourselves.” Called “Bishvili: For Me” (www.bishviliforme.com),
it draws on Jewish ethics and spirituality and targets day schools,
afternoon school, youth groups and camps. A version for the Orthodox
community is currently being developed.
The title “Full of
Ourselves” reflects the difficulty girls have in claiming their
strengths, explains Steiner-Adair. “Being full of yourself doesn’t mean
being stuck up. It means you believe you matter.” To sustain
“psychologically healthy and pleasurable relationships with food,” she
adds, girls must learn how to identify feelings that upset them, deal
with conflict, bullying and disconnections in relationships and how to
nourish other appetites—including spiritual ones.
It’s a Girl Thing!,” another program for middle and high school girls
funded by the Hadassah Foundation, teaches girls to recognize cultural
biases that affect their self-worth. “Coming into adolescence has
become treacherous.... At the time your body is filling out, you’re
being told, ‘skinny, skinny,’” says Deborah Meyer, executive director
of Moving Traditions (www.movingtraditions.org),
which sponsors the program in 190 Jewish institutions. The five-year
curriculum doesn’t mention eating disorders directly; participants with
the illness are referred to professional help.
Union has funded a documentary, Hungry to be Heard, to “galvanize the
community to take action,” says Rabbi Tzvi Hersh Weinreb, OU’s
executive vice president (for more information, contact Frank
Buchweitz, OU’s director of community services at 212-613-8188). Thin,
an HBO documentary by photographer Lauren Greenfield (www.laurengreenfield.com),
is also available in book form (above) from Chronicle and as a
traveling exhibit, January 22 to March 21 at the University of Missouri
in St. Louis, and April to June at the University of Utah in Salt Lake
City. Though it does not have a specifically Jewish orientation, it
follows four young women struggling with anorexia over the course of
six months at the Renfrew Center in Florida.
With the help of the Jewish Women’s Foundation of New York, the Foundation for Jewish Camp (www.jewishcamp.org)
created “Beyond Miriam,” a resource guide and seminar for directors and
staff on girls’ body image, eating disorders and cutting. JWF also
funded a program for grades 3 through 5 called “NoBody’s Perfect,”
administered by FEGS (www.fegs.org).
a comprehensive strategy evolves, however, eating disorders still “take
a back seat to alcoholism, drugs and AIDS,” says Ann Levine, whose
daughter struggled with anorexia. “I don’t know of any structured way
that brings it to kids’ attention the way other problems are addressed.
There’s less shame in drug abuse.” —R.M.
For More Information
■ ATID’s list of Jewish eating disorders resources: www.atid.org/resources/eating.asp
■ “Litapayach Tikvah—To Nourish Hope: Eating Disorders: Perceptions and
Perspectives in Jewish Life Today,” a manual from the Union of Reform
■ We Need to Talk (Devora) by Rachel Sofer.
■ Life on the Fringes: A Feminist Journey toward Traditional Rabbinic
Ordination (JFL Books) by Haviva Ner-David. In her book, Ner-David, the
first woman to receive Orthodox ordination, recounts her bout with
■ Going Hungry: Writers on Desire, Self-Denial, and Overcoming Anorexia
(Anchor) edited by Kate Taylor. Includes a chapter by Jewish writer
■ Body and Soul: A Guide for Addressing Eating Disorders in a Jewish Education Setting (ATID) by Caroline Peyser.
Treating Eating Disorders in Israel
Over 1,000 children ages 18 and under are treated each year in Hadassah
Hospital’s Child and Adolescent Psychiatry Unit for a variety of
emotional and psychiatric disturbances. About half of those in its
outpatient care and half of those hospitalized in its 10 beds are
battling eating disorders. One of only three inpatient centers for
eating disorders in Israel, Hadassah’s young patients come from all
over the country. And they are getting younger.
[the] core of eating disorders has probably always existed as a
biological problem, added psychosocial stresses mean that more and more
people are affected, at younger and younger ages,” says Dr. Esti
Galili-Weisstub, head of the unit. “Our youngest anorexic patient was 8
years old. Her treatment, as for all our eating disorder patients, was
multidisciplinary—behavioral modification, family intervention,
psychotherapy and medication—with the aim of total cure.”
10 years ago at Hadassah–Mount Scopus, the unit today operates from
custom-designed premises in Hadassah’s Children’s Hospital at Ein
Kerem, comprising the inpatient beds, an after-school day treatment
center for adolescents and an outpatient clinic.
and bulimic youngsters are cared for as outpatients, attending the
after-school center, where their eating is supervised and they do their
homework. The more severely ill are hospitalized until they reach a
minimum target weight. Their day in the hospital opens with a group
session, followed by a communal breakfast—the first of six meals eaten
daily under supervision. The remainder of the morning is given to
school subjects taught by teachers from the education ministry. The
afternoons are for art, music, drama and movement therapies. Social
workers and psychologists work with young patients individually, with
their families and in groups.
“Our daughter seemed like a
regular kid to us,” says the mother of a 14-year-old girl hospitalized
in the unit. “We didn’t realize her self-esteem was rock-bottom until
she tried to draw attention by being the thinnest girl in her class. It
was only then that we realized how much help she—and we—needed.”
the unit’s team of child psychiatrists, nurses, social workers,
clinical psychologists and dieticians is satisfied that eating habits
are changing, youngsters are gradually discharged—initially, returning
daily to the unit.
“Our patients are adolescents, and we give
them space, self-respect and independence, under supervision, while
they conquer their eating disorders,” says Dr. Galili-Weisstub. —Wendy Elliman
For additional resources on eating disorders, and a look at how they
are treated at Hadassah Hospital in Jerusalem, look at Hadassah
Magazine’s Web site, www.hadassahmagazine.org.