Eating Disorders in Jewish Communities
(Jewish Survivors of incest and childhood sexual abuse)
We have known for some time that sexual abuse can lead to eating disorders -- British Eating Disorders Association
Dear Friends,
The Awareness Center is doing our best to keep our organization up and running, unfortunately at this time we not functioning at full capacity due to lack of funds. If you feel that the information our web page is worthwhile please consider making a donation to our organization. Suggested donation is $1.00 per page that you visit.
Another way you can help is by becoming a paid member of our organization. Membership includes receiving our daily e-mail newsletter, and the ability to join one of our Special Interest Groups (SIGS). The cost of membership is $36.00 for one year.
To become a member fill out our membership form and return it with your payment (US Funds Only) to the address below. You can pay your membership dues online by clicking on the donation button above.
The Awareness Center is a non-profit, certified 501 (c) (3) organization. Our goals include reaching out to Jewish survivors of sexual violence, parents of sexually abused children, family members of alleged and convicted sex offenders, rabbis, cantors and other community leaders. We also serve as a clearinghouse of information, and offer advocacy for those in need and educational seminars.
Disclaimer: Inclusion in this website does not constitute a recommendation
or endorsement. Individuals must decide for themselves if the resources meet
their own personal needs.
Jewish Resources on Eating Disorders
Articles
Books
Sexual Abuse and Eating Disorders - Edited by Mark F. Schwartz and Leigh Cohn
Being Jewish in a Barbie world
Body-image negativism poses physical, mental threats to many women
LENI REISS, Senior Contributing Editor and NADINE BONNER
Wisconsin Jewish Chronicle
http://www.jewishaz.com/jewishnews/981106/barbie.shtml
In a Barbie world.... Stand in line at the supermarket, and you're bombarded by tabloids and women's magazines. "Lose 20 pounds in two weeks," screams one cover headline. Meanwhile, the cover photo is a four-layer chocolate cake offering "desserts to die for."
The tension between these two priorities - being thin and enjoying good food - has created an epidemic of eating disorders. Psychologist Stacey Nye, who specializes in treating those disorders, explains that "even though we're more educated about eating disorders now, it hasn't helped us protect ourselves from developing them, because we're seeing them in younger and younger children."
An additional conflict between Jewish culture, in which food plays a central role, and the general culture, which advocates the ideal of thinness, creates a compounded vulnerability for Jewish women, according to Nye. To explore these issues, Nye attended "Food, Body Image and Judaism - A Conference on Disorders and Resources for Change." The conference, held earlier this year in Philadelphia, was sponsored by the KOLOT Center for Jewish Women and Gender Studies at the Reconstructionist Rabbinical College and the Renfew Center, a women's psychiatric hospital in Philadelphia. It was sponsored in part by the Jewish Federation of Greater Philadelphia with support from the Germantown Jewish Center.
"I specialize in eating disorders and body image," explains Nye. "Being a Jewish woman myself, I wanted to learn more about what particular struggles (exist) for Jewish women. Jewish women have particular cultural vulnerabilities that make them more at risk."
Conference workshops included "Zaftig Women in a Barbie Doll Culture," "Chopped Liver and Chicken Soup: Soothing Food for the Traumatized Soul" and "Bagel Politics: Jewish Women, American Culture and Jewish Culture."
"If we want to follow our tradition, we have to revolve our lives around food," says Nye. "But if we want to assimilate, we have to look different."
Catherine Steiner-Adair, director of education, prevention and treatment at the Harvard Eating Disorders Center, points out that basic hereditary and physiological factors make it almost impossible for most women, including Jewish women, to conform to the Barbie-doll ideal.
"One percent of our population is genetically predisposed to be really tall, really thin and busty. And it's not us - it's the Scandinavians," says Steiner-Adair.
But experts note that societal and psychological influences make women strive to emulate unrealistic prototypes in terms of appearance.
"It's really hard not to buy into the general culture," admits Nye. "Girls are bombarded by messages that tell them appearance defines their identity. We have 8-year-old girls on diets. Body image dissatisfaction and distortion are rampant in our culture."
Steiner-Adair estimates that "every morning 80 percent of women wake up with body loathing. Eighty percent of the women in America don't relate to their bodies in a healthy, respectful, loving way."
"Stop worrying, and meet me at the water cooler"
She says that combining this general obsession with "weightism" and anti-Semitic stereotypes results in a greater vulnerability to eating disorders among Jewish women.
"If you have a Jewish girl who's feeling wobbly about herself and who feels a lot of pressure on her to assimilate, to achieve, it's very easy for a girl to say, 'I can't be all those things. I know what I'll be good at: I'll be thin,' " Steiner-Adair says.
Nye specializes in helping people accept their bodies and stop dieting.
"I help people to normalize their eating, not by dieting." She encourages her clients to eat normal, healthy food and to stop eating when they're full.
"I practice gentle nutrition, staying away from a dieting mentality." Nye also encourages increased activity rather than exercise, which she says has "a bad reputation with some people" - almost like medicine.
"I help people expand their identities. To explore what there is to feel good about," Nye adds.
Nye frequently speaks in schools to educate young people about accepting their own body image and that of others. "They're getting bombarded about looking a certain way. The reality is that not everyone is meant to be thin. Weight falls in a normal curve like anything else. Some people are intelligent, others are less intelligent. You can't make yourself taller."
She says one aspect in Jewish culture that is helpful is the emphasis on knowledge and excelling in scholastic settings, rather than on the athletic field.
Family plays a role
A Los Angeles-based psychotherapist who specializes in addictive behaviors, Judith Hodor finds, "more likely than not," that her patients with eating disorders come from Jewish homes. There often is an "enmeshment" in the Jewish family, she says, where one member, usually a child, feels pressured to be a reflection of the others.
"There is a tendency," she says, for parents to try to create a perfect existence as a positive reflection of themselves. This "demand for perfection" creates huge pressure on a child, who might try to starve herself as a "means of escape." This is one area, she explains, where the child can actually be in control.
Hodor cites an instance during a session in her office when the patient, a teenager, "actually was fading in and out due to lack of food" and the mother ran out to purchase milk, bananas and other edibles. "When she returned," Hodor recalls, "she looked at her daughter with tears in her eyes and said, 'You have to stop this. You are my reason for living.' "
"If I was anyone's reason for living, I might well want to disappear too," Hodor notes ruefully.
Within the context of the Jewish home, Hodor finds, there is an emphasis on intellectualism - and food. In other groups she tends to find "more aloofness, which, in a sense, protects family members from each other." But then again, she notes, they often have their own "isms, such as alcoholism" with which to deal.
Common to many cultures
Taking issue with the premise that eating disorders are more prevalent within Judaism, Phoenix psychiatrist Jill Zweig reports that a significant percentage of her patients who suffer from anorexia or bulimia are not Jewish.
"These ailments are pervasive in all cultures and all socio-economic levels," she finds. "Food plays an important role in the traditions of many cultures," she points out.
"Adolescence is a time of turmoil," Zweig says, "a time of seeking individuality and separation. This typically creates some conflict within the family and this is normal, expected - and to some extent, healthy."
But, she warns, those with eating disorders tend to internalize and distort suggestions that might be as innocuous as "cut down on junk food." Determining "what actually goes into the mouth" is one way that someone can be in total control. This can lead to such inappropriate thought and pattern behaviors as, for example, cutting out all junk food, all meat, all fats - "and then they are down to three rice cakes a day," Zweig says.
Individuals suffering from anorexia and bulimia constantly are thinking about food, Zweig says, and with both there is focus on body image as a source of self-esteem.
"The difference is how the individual goes about obtaining control. The anorexic constantly restricts food intake; the bulimic may binge, regularly or periodically, and then purge."
Parents who fear that their children may be prone to, or suffering from, an eating disorder should be alert to significant changes in their children's eating patterns, such as eliminating certain foods from their diet, skipping meals, finding excuses not to eat with the family; also, hair and/or weight loss, and cessation of menstruation are signals. Warning signs of purging include locking themselves in the bathroom after meals, along with the odor of vomit.
Patients prone to eating disorders are influenced by media-created images portraying the ideal woman along the lines of Ally McBeal, Zweig says, adding: "Dissatisfaction with their bodies comes down to a comparison with image. They look in the mirror and see their own body distorted. That is the illness part of it. They don't see what others see."
The challenge for parents, Zweig suggests, is to work on effective communication, "to go for realistic goal-setting."
To that end, she emphasizes the importance of tension-free family meals and the need to teach youngsters to make appropriate food choices.
"Fat-free items don't necessarily fall into that category," she says. "Rethink what has been drummed into us regarding the craze for fat-free foods," she proposes.
"The truth is that fat is necessary in moderation. The healthiest diets include some fat."
Both Hodor and Zweig advocate a team approach in their work with patients who have eating disorders. When appropriate, they confer and collaborate with dietitians, family physicians, gynecologists, family members and friends.
Nadine Bonner is a staff writer for the Wisconsin Jewish Chronicle in Milwaukee. Marilyn Silverstein of the Philadelphia Jewish Exponent also contributed to this story.
Talk links Jews, eating
disorders
By: Tori Katz
The Daily Pennsylvanian - March 26, 1999
http://media.www.dailypennsylvanian.com/media/storage/paper882/news/1999/03/26/Resources/Talk-Links.Jews.Eating.Disorders-2164920.shtml
Every culture has its stereotypes, but according to several experts, there may actually be a correlation between Judaism and eating disorders.
To kick off Body Image Awareness Week, the campus group Guidance and Understanding for Image, Dieting and Eating -- in conjunction with Connaissance, Hadassah, Penn Hillel, Commission on Campus Projects of Hillel of Greater Philadelphia and the Jewish Renaissance Project -- presented "Body Image and Judaism," an all-day conference dealing with food, family and ritual in the Jewish culture.
The conference, which was attended by approximately 100 primarily female Penn students, was held last Saturday in Logan Hall's Terrace Room.
As part of the program, observers attended one of five workshops -- led by professionals in the field, University faculty and students -- that dealt with a particular aspect of food in the Jewish culture.
David Steinman, a psychoanalyst and psychiatrist who was one of the leaders of the workshop "Eating Disorders in the Jewish Community," highlighted affluence and education -- two factors which are commonly associated with the Jewish community -- as common risk factors for eating disorders.
The extent to which religion leads to eating disorders depends not upon religious law but upon the individual. According to the presenter, nothing in the Jewish religion calls for "giving up" one's body. Eating is something that is expected. However, the idea of fasting and self-denial delivers a complicated message.
During the discussion, Steinman added that many Orthodox women turn to eating disorders as a cry for personal control.
College freshman Noga Newberg, the workshop's co-chairperson, commented on the common paradox between food and Judaism.
"Often, the same mother who spends all week preparing food for an enormous seder will be the same mother who criticizes their child for eating too much," Newberg said.
The morning session of the conference consisted of an introduction by the conference's program chairperson, College sophomore Miriam Kiss. Additionally, the audience heard addresses by keynote speakers Lori Lefkovitz of Kolot -- the Center for Jewish Women's and Gender Studies -- and Karen Smith of The Renfrew Foundation, which is dedicated to supporting research, education and advocacy in the field of women's mental health.
"There is a big emphasis on food in Jewish culture," Kiss said. "I wanted to give my peers an opportunity to explore Judaism as both a source of conflict with food, body and hunger and as a resource for health."
By Jodi Bodner DuBow
Jewish Week - May 18, 2001
http://www.thejewishweek.com/news/newscontent.php3?sec=Health
he People of the Book may need to stop turning pages and turn on to a new diet and exercise regimen instead. Mirroring the rising trend in overweight children and adolescents that is, some in the medical world say, reaching epidemic proportions, more and more Orthodox kids are being diagnosed with obesity and its subsequent diseases such as diabetes, high blood pressure, high cholesterol and even osteoporosis.
The epidemic of polio will be dwarfed by the epidemic of obesity, predicts Dr. Henry Anhalt, director of the Division of Pediatric Endocrinology and medical director of the Kids Weight Down Program at Maimonides Hospital in Brooklyn. It is estimated that 90 percent of the population will be overweight by the year 2030.
The problems cited by the rest of the world inactivity due to hours spent sitting watching TV, playing Nintendo or on the computer are compounded in the Orthodox world by lengthier school days and an emphasis placed on educational advancement, leaving little or no time for active play during the school day or after hours.
Its not so much that this group of children is overweight, said Dr. Ilene Coopersmith, a pediatrician in Brooklyn whos been in practice for 30 years, its that theyre not fit. Theyre soft and pasty. Even their posture is inadequate. Being fit depends on the amount of tissue thats muscle, which they dont have much of.
The declining activity level is definitely the biggest part of the problem here, said Bonnie Taub-Dix, a registered dietician and certified dietician nutritionist, with offices on Long Island and in Manhattan and a long list of young clients. In the Orthodox world, physical education is put on a back burner kids come home late, eat dinner and do their homework and theres no time for anything else. Some go to school on Sunday too so unless its a nice walk to temple, they get no activity all week long.
To be sure, said Dr. Michael Frogel, chief of general pediatrics at Schneiders Childrens Hospital, anorexia and bulimia which get so much attention are terrible, but the havoc they wreak are nothing compared to the losses each year due to weight.
According to the Centers for Disease Control, physical inactivity and poor diet together account for an estimated 300,000 deaths each year in children. The National Health Examination Surveys show that the prevalence of childhood obesity nationally is estimated to be 25 to 30 percent. Further, over the past three decades that number has increased by 54 percent in children ages 6-11and by 39 percent in adolescents 12-17.
Standards of obesity are measured by body weight index as compared to age and sex match norms.
It was this grim news that woke up the activist in Evelyn Weinberger. Always interested in health and nutrition, this Brooklyn resident, whose children attend yeshiva, was having dinner with Coopersmith one Friday night, and she made a statement that blew me away, said Weinberger. She said that she believes we will see an increased incidence of mortality in the Orthodox population because of their inactive lifestyle. Now I know that healthy children produce better, so we need to see to their health.
So Weinberger, together with Frogel, founded the Yeshiva Health Task Force (YHTF), a multidisciplinary group of physicians, rabbis, educators, therapists and parents, formed to help schools promote good health through curriculum development, Health Fairs and resource materials.
Its the halachic thing to do, said Frogel. The Torah clearly states that we must diligently protect our physical and mental health. People must recognize their obligation to care for their health.
We need to start educating our kids at a young age and get them to think from early on about the good way to live. And its not just about weight its about being healthy and safe.
Coopersmith agrees. They key is in the percent of muscle tissue. Ashkenazic Jews are predisposed to being fatter. You cant defy your own body, but you can work at making it work more efficiently and at being physically fit.
She also stressed that the emphasis should not be on obesity but on fitness. We dont want kids to become anorexic but to concentrate on looking good and fit. And its been proven that exercise is an anti-depressant and gives adolescents good strong ego formation.
Said Anhalt: Its all about the energy expenditure and the energy intake and the balance between what we take in and what we put out. We need to get back down to basics and take care of our physical bodies.
To that end, there needs to be cooperation between the home and the school. Parents set an example, said Taub-Dix. If theyre not physically active, their kids will see that. And they do the shopping. They need to watch what kind of foods theyre bringing into the home.
And schools need to start working fitness and health education into their daily schedules. Some area yeshivot have already worked with the YHTF and hosted weeklong health fairs. Time must also be made for physical activity, even 15 minutes of Jumping Jacks every morning will make a difference, said Anhalt. Curriculum also needs adjustment and, says Frogel, can be worked into any subject without missing a beat. On Rosh HaShanah when we teach about new fruits, a discussion on fruits and vegetables and a well-rounded diet can be launched. Matzah on Passover can veer into carbohydrates and grains. It can be woven into the fabric of the curriculum without any loss of time.
Life begins with health, he says, and parents and schools need to work in conjunction.
Talking to Jewish women about their struggles with
eating disorders
By Susan Tomchin
Jewish Women International - November 6, 2002
http://www.jewishwomen.org/Eating.htm
Eating disorders begin in adolescence and often affect girls well into adulthood. Recognizing the problem early and helping girls to feel good about themselves is important so they can go on to lead emotionally healthy adult lives.
Toby Goldstein of Savannah, Ga., kept the secret for a long time. In high school, she worked at a job during dinnertime so her family wouldn't see her skipping a meal. At night, while everyone slept, Goldstein would run in place for hours. In college, she pushed food around her plate to make it look like she was eating. Even when she was pregnant, she ate little and exercised a lot.
"My obstetrician was concerned about the baby's growth," says Goldstein, now a recovering anorexic and mother of Sara, 3-1/2, and Josh, 15 months." The baby was small. I told him I was doing everything fine. He didn't know the extent of my history. I'd go to bed at night and cry. I'd think: `why am I so selfish? Why can't I do this for this child and then do what I want?'"
Luckily, Sara—induced at 36 weeks—was fine. But even afterwards, Goldstein could barely take a bite. Nursing was tough: "My milk wasn't coming in...She wasn't getting a whole lot from me."
One day, Goldstein saw an ABC-TV Prime Time Live segment on singer Paula Abdul and her struggle with eating disorders. Goldstein immediately identified with the singer's troubles—and realized that she, too, needed help.
On July 9, 1995, Goldstein checked into the Renfrew Treatment Center, an eating disorder clinic in Coconut Grove, Fla., leaving her husband and her 16-month-old daughter behind for three weeks. Less than a year later, Goldstein was herself featured on Prime Time Live in a segment about pregnant women with eating disorders.
This woman who subsisted on beer, popcorn and lettuce in college, who had been in and out of hospitals since adolescence, and who developed ulcerative colitis as a result of her diet, opened up her wounded heart to millions of Americans alerting them to the dangers of eating disorders—and the importance of self-acceptance.
Thousands of people like Goldstein, many of them Jewish, are battling with eating disorders. According to the Eating Disorders Awareness and Prevention, Inc., (EDAP), nearly 5-10 percent of all women starve themselves (some even to death), binge on food and then purge or compulsively overeat.
Eating disorders can cause harmful medical effects. Anorexics who lose more than 25 percent of their body weight suffer from low blood pressure, a slow heart rate and other problems. Bulimics can damage their esophagus, gums, teeth and kidneys from vomiting so frequently. And compulsive overeaters are higher at risk for coronary heart disease.
Women develop eating disorders for different reasons. Some feel they'll never meet their parent's expectations. Others, swayed by popular culture, believe that only a thin body can win them love, respect and success. Many have been abused by spouses or fathers. All of them use food—be it overeating or not eating—to cover up their real yearnings to be loved, understood and accepted.
Increasingly, more and more Jewish women are confessing to having eating disorders. "Eating disorders are a form of domestic violence, but it's a self-inflicted form and it's going on in Jewish homes all over America," said Goldstein. So Goldstein, along with Dorothy L. Wexler Chapter of Jewish Women International, organized an eating disorder community education day in Savannah last year that drew 650 teens and preteens from 10 area schools.
Jewish organizations in Baltimore, San Francisco and other cities are also running workshops to reach out to Jewish women whose bodies and souls are undermined by this disease. In fact, the Union of American Hebrew Congregations (UAHC) will be launching a program to educate rabbis, teachers, camp staff and others about eating disorders and how to reach out to those afflicted with them.
According to Rabbi Richard Address, director of the UAHC Department of Jewish Family Concerns, "we are looking at issues of self-destructive behavior and abuse. Eating disorders fit right in." He emphasizes that any type of violence against women—be it self-imposed or imposed on them—is a Jewish issue. "If we are a spiritual religious community which has as a base embracing the world through Jewish values, how people see themselves and act in relation to themselves and others is a prime religious value.
"Within the concept of Jewish tradition," he adds, "someone abusing drugs, for instance, is less able to function at the highest level of his ability to remake the world, do mitzvot. It's a fundamental religious issue...If people exhibit behavior that takes them away from the image of God then they can't heartily follow the Torah.
It's not surprising that Jewish women—as some experts suggest—may be at higher risk than the general population to develop food disorders. Food, after all, plays a central role in the Jewish community. Jewish holidays are marked with large traditional meals and everyone is encouraged to eat all the time. The woman in an Orthodox household, says Adrienne Ressler, director of Clinical Outreach for the Renfrew Center, is responsible for preparing the food so her husband can prepare for Shabbat.
"The kitchen is the place where we connect with other women as Jewish women," says Sue, a policy analyst in Washington D.C., who is recovering from a compulsive eating disorder. "I can remember as a kid talking about food all the time, about recipes. If we weren't eating it, we were talking about it. If we got too heavy, we talked about diets, we did Slim Fast, we cheated together. It was a never ending cycle of food."
But that attitude about food is changing in some Jewish homes as assimilated American women seek the "ideal look" that many others in society strive toward. "A legacy of reverence for the zaftig body has not protected Jewish women from developing eating disorders or from the need to conform to the media's 'ideal' body types," says Ressler.
"There has been a shift," she continues, "from the caricature of the Jewish mother, who says, 'eat, darling eat' to someone who is much more concerned about the types of foods they are eating and not getting fat." And girls with mothers who are constantly dieting get the message that "part of being a woman always means being dissatisfied with your body."
"Fat," she says, "is seen as a moral lapse...You are a good girl if you are thin, a bad girl if you are fat."
Eating disorders usually start in early adolescence, when young girls are pressured at home to be the best at school, at sports, at everything. This tension takes a toll as girls also feel they should look like supermodels, figuring that being thin will bring them success and solve their problems.
Julie DeLettre, an eating disorders specialist, came from a strict family. "Not making A's or B's was not acceptable," she says. "I was an honor graduate, on the student council, the Homecoming Queen." But she was also anorexic, and had to be hospitalized for dehydration.
"I see lots of Jewish girls," says Goldstein, who remembers her own mother battling weight all her life, "the doctors' daughters, suffering from eating disorders. These are smart girls who felt that nothing was ever enough, that they could never do enough to get their parents' approval."
The first time Goldstein started obsessing about food was in the summer before her senior year in high school. "My sister went away to college," she says. "When we visited her, she had lost weight. Mom and dad were so impressed...My senior year is when I started eating less and working out all day."
A Washington D.C., professional who works in the Jewish community also felt that she "wasn't good enough," and figured that if she lost weight, she'd at least get a shot at happiness. But instead of starving, she stuffed herself with food to drown out her loneliness, depression. "When I was in 9th grade," she said, "the guy in front of me turned around and called me piglet...I'll never forget that. Boys didn't like me because I was a fat kid...So when I got home, I'd eat a bag of cookies zoning out in front of the TV."
Once an eating disorder starts it's hard to stop it.
"It's a progressive disease," says Sue. "When I was a kid, I used food for release, escape. But as I grew older it wasn't a choice anymore. I got into it because I was upset over a relationship issue or uptight about school. Then it got to a point where that's just what I did. I came home after work and where some people may talk about their day, my release or reward was to start eating."
Sometimes, her binges were so voracious that she couldn't taste anything. "I'd eat food that was too hot and burn my mouth or not defrost it because I couldn't wait."
Another woman from Potomac, Md., says that her sister-in-law used to be discreet about her bulimia. But now, she vomits in an empty bottle of Coke that she carries around in a big purse. "Whenever she comes here, she eats huge meals and then excuses herself. There is residue on the toilet when she visits."
"She blames her bulimia on my mother-in-law, who used to tell her, 'If you don't stop eating you'll never get a guy.' It's been torment for my husband to see his sister this way. He tried to talk to her...but she refuses to go to a treatment center."
Many women with eating disorders deny they have a problem until they hit rock bottom. That happens at different times for different people. Goldstein realized her life was at stake after her daughter was born. Sue has had many days where she didn't care if she lived or not. Her moment of enlightenment came during the High Holidays at synagogue. "I remember crying, and knowing in my heart that I had no place else to go," she says. "I finally hit the bottom, no matter what I tried to do. Therapy. Dieting. I wasn't going to get better. I needed divine intervention."
And she found it through Overeaters Anonymous.
"I've been working on the 12-step program for almost four years, and the obsession over food has been lifted. I don't wake up in the morning and think, what will I eat today? As a result, I've connected with Judaism. It's interesting, several women who go are Orthodox, Hasidic, Lubavitch. It's a spiritual program of recovery."
But many women with eating disorders need more than divine intervention or support groups to recover. They need medical treatment—IVs and supplements, nutritionists and psychologists. With the help of a team of experts, anorexics learn to overcome the fear that every bite they take will make them fat. Bulimics learn to eat smaller meals, and ward off purging a little longer each day.
All of them learn to eat and exercise in moderation and to develop a more wholesome approach to life where food is only one part of it. At treatment centers, women meet to talk about how their obsession with food began and why they were so unhappy. What most of them realize is that what they've been yearning for all along is love and acceptance, not food.
They also learn to be more realistic about their bodies and to accept that no matter how much weight they lose, they may never be able to look like models. "Women are often unhappy with their appearance," says David Schlundt, associate professor of psychology at Vanderbilt University. "Because the genetic shape of their body doesn't fit the cultural ideal they mistakenly think that losing weight will make them look like models."
If a patient says to him, "I don't like my hips," Schlundt will talk to her about what is bone structure and what is body fat. "If they say, `I want long skinny legs,' well, there is nothing they can do about that. If your tummy is sticking out, a diet may flatten it somewhat. But that's all it will do. It won't change your self-esteem. Women need to establish realistic expectations."
Women also need to develop a systematic way to examine their feelings about their bodies. Therapists often challenge notions that aren't based in fact, he adds. If, for instance, a patient says, "If I gain weight nobody will love me," the therapist may ask, "what evidence is there for that?" If she can't come up with any, the woman may perceive something that isn't true.
"But if the patient says, 'Well, my boyfriend said he'd leave me if I gain more weight,'" continues Schlundt, "then I'd discuss the extent to which that's a healthy relationship, [that] he is putting unrealistic demands on her. Maybe they should renegotiate the terms of the relationship."
Treatment worked for Goldstein. "It changed my life," she says. "I was given a gift to go there. I cleaned my slate. I'll never go back to where I was." The real test for Goldstein came only eight weeks after she left the center, when she discovered she was pregnant again." It was hard putting on weight," she said, "but at least I could say, 'this is the baby, not me.' My pregnancy with Josh was much healthier."
Goldstein is now on a mission: To reach out to Jewish women and others suffering from eating disorders and let them know that they need help—that they owe it to themselves to get better.
By Abraham J. Twerski
Jewish Week - August 16, 2002
http://www.thejewishweek.com/top/editletcontent.php3?artid=2180
`Ess, ess, mein kind" (eat, eat, my dear child). Who would ever have envisioned that these endearing words from a loving parent might one day contribute to major health problems?
Recent studies show that the incidence of obesity is rapidly increasing in the United States, now affecting 23 percent of the population. Even more people, although not obese, are heavier than their healthy weight. Fifty-five percent of people older than age 20 are either overweight or obese.
Being overweight increases the risk of coronary heart disease, high blood pressure and stroke. The additional stress on the joints aggravates arthritis. Obesity can elevate the likelihood of breast cancer, as well as colon, uterine and prostate cancer. Obesity is the leading cause of Type 2 diabetes, which generally develops after age 40.
It is legendary that Jewish mothers promote eating. The erroneous idea that the more one eats the healthier one will be may have had its origin when tuberculosis was rampant, and victims of this disease often appeared emaciated. The logic then went, "If thin equals disease, then fat equals health.
There may also have been a psychological factor. In many Jewish homes in Europe, food was not in abundance. When it was available, it was the greatest gift a mother could give her child. Whatever the reasons, the fact is that eating disorders are common among Jews.
It is only natural to look for easy solutions to problems. People are attracted to any diet that promises to take off weight. Anyone who has tried these miracle diets will testify that they work for a short period of time, only to be followed by return of the weight plus a few additional pounds.
Reliance on medications for the long term has also been futile. These approaches result in the yo-yo phenomenon, which is anything but healthy.
In cases of very severe obesity, surgery has been effective in producing significant weight loss. Nevertheless, obesity surgeons state that maintenance of health requires a change in lifestyle, particularly addressing management of emotions.
The latter insight is crucial. Neither diets nor medications alone will work. The most effective method of long-term weight control is ongoing participation in a support group, such as Overeaters Anonymous. In many cases, psychotherapy and counseling, whether individual or group, is a valuable adjunct.
Changes in lifestyle and habits do not come about easily. Initiating the change in a residential treatment center can give one a foothold on recovery. The intensive treatment can help overcome the resistance to change and give a person basic tools that one can then use over the long term.
The body has specific nutritive needs. When one consumes food beyond these needs, it is no longer nutrition. Because food can quell emotional discomfort, it can be used as a tranquilizer. It is this use of food than can result in eating disorders.
The tendency to overeat, coupled with the cosmetic desire to appear thin, has resulted in a high incidence of anorexia-bulimia. This is a condition in which one binges on food and then tries to prevent weight gain by forced vomiting, fasting, exercising or using laxatives and diuretics. Anorexia-bulimia is more common among females and often has its onset in adolescence. It is a well-guarded secret, so parents and husband may be unsuspecting. It is believed that 25 percent of high-school and college-age women may have anorexia-bulimia.
The emotional effects of anorexia-bulimia are deleterious. These young women often become depressed. Their preoccupation with food and weight may absorb all their thinking, so their performance in school or at work suffers. They may realize they have a problem and would like to help themselves, but they are trapped in this condition. They are afraid to tell their parents or spouse about their problem.
Awareness of the prevalence of eating disorders can help identify them. There are treatment resources available. On the Internet one can find information about anorexia-bulimia and obesity. There is now a facility that provides kosher food.
As food can be a tranquilizer, no one wishes to lose the comforting effects. However, we must become aware of the serious dangers to life and health resulting from eating disorders. We must overcome the denial of the problem in ourselves and in our children, and implement the methods that can bring about sustained, healthy weight. n
Dr. Abraham J. Twerski, a rabbi and psychologist, heads the Gateway Rehabilitation Center near Pittsburgh.
By Lisa S. Lenkiewicz, Managing Editor
Connecticut Jewish Ledger in West Hartford.
http://www.healthyplace.com/Communities/Eating_Disorders/minorities_jewish.asp
Stop worrying, and meet me at the water cooler
In many offices, the hot topic of conversation is L'affaire Lewinsky. Not at the Connecticut Jewish Ledger.
All day long we bump into each other at the water cooler, but it's not to chat. We are too busy forcing down our eight glasses.
On any given day, someone in our office is on a diet. (Most everyone that is, except for the men, who seem able to eat what they want.) The method varies - some are doing Weight Watchers, others, the no-carbohydrates plan, or the cabbage soup diet. I'm on a plan also, although the nutritionist I see would correct me and say, "You're not on a diet, you're just eating healthily." (He can say what he wants, but not having many fats and swearing off my beloved chocolate sounds like a diet to me.)
At this place where I am learning how to "eat healthily," I often run into Jewish women I know from all walks of life. "What's going on here?" I wondered. "Why are so many of us having to fight to shed pounds? Do Jewish women struggle with weight issues more than other women?"
In the spring edition of Lilith Magazine, there was an interesting article titled, "Why Jewish Girls Starve Themselves." The thrust of the piece was about the high rate of eating disorders among Jewish women, discussing how issues of food, body, sexuality and appetites are "used and confused in attempts to deal with interpersonal relationships, or to deal with pain" - including second- or third-generation Holocaust trauma. I don't know much about this psycho-speak, but I was intrigued by the title of the article.
The flip side of overeating is the obsession with being thin. Too often lately you hear of young girls who decline dessert or birthday cake, saying they are watching their weight. One 8-year-old girl was heard complaining her thighs were too fat. When I was her age, I'm not sure I knew where my thighs were.
We all have our excuses about how we ended up this way: When we were young, our grandparents constantly urged food on us; we had to clean our plates out of guilt for the "starving children in Africa;" it's in our genes - Jews don't drink, we like to eat.
My excuse has always been having two pregnancies close together and three operations in two years. I did try to fight the battle of the bulge. I bought the "Stop Kvetching and Start Stretching" exercise video. I bought the video starring Gilad, that handsome Israeli who leads aerobics classes at exotic locales in Hawaii. I have a Richard Simmons tape. But when my doctor said my stomach muscles were shot, that was just the excuse I needed. No pain, no gain they say? For me it was, yes pain, and yes complain. I simply stopped doing the situps, and voila! The pain went away.
I looked to our Jewish texts for some guidance on shmirat haguf (guarding the body). Solomon wisely counseled, "He who guards his mouth and tongue guards himself from trouble" (Proverbs 21:23). In other words, one who refrains from gluttony and guards his tongue from speaking except for what is necessary, stays out of trouble. Good advice.
"It is advisable for one to accustom himself to have breakfast in the morning." This suggestion is from the Shulchan Aruch (Code of Jewish Law) under "rules concerning physical well-being." Our sages must have been right - every diet plan I've seen stresses the importance of eating a good breakfast. The Shulchan Aruch also says that it is best to omit one meal during the week, in order that the stomach may have a rest and its digestive power be strengthened. Not the advice my nutritionist would give - something to do with metabolism and storing energy - but it might be worth trying, nonetheless.
Although statistics indicate eating disorders are prevalent among Jewish women, there still is reason for optimism. The therapist who was interviewed in that Lilith article said Judaism is a potential cure for dysfunctional eating, what with our religion's "enormous potential for renewal." I do believe in teshuva - that we can turn, change and do better. If I fall down in my weight management from time to time, well, tomorrow is another day.
So, no guilt over that Hershey bar my son magnanimously offered up from the goodie bag he got today. Tomorrow, I'll be first in line at the water cooler, I swear.
Lisa S. Lenkiewicz is managing editor of the Connecticut Jewish Ledger in West Hartford.
It's hard to be a body - Eating disorders in the Jewish
community
By Lois Goldrich
(NJ) Jewish Standard - January 26, 2006
http://www.jstandard.com/articles/484/1/It%92s-hard-to-be-a-body
Anne — today a successful New York lawyer in her 50s and a former Fair Lawn resident — says she was anorexic "before there was a name for it." She remembers two years in particular, beginning when she was 17, when she "chose not to eat."
"I got really bony," she says. "I was 5'3" and about 90 pounds." Still, with eating disorders not yet a hot topic in the public arena, the problem was not picked up by family and friends.
"People thought it was great that I was so thin," she says. "We didn't think of it as an illness or a problem."
The disorder put a halt to Anne's menstrual cycle. "Now that I think about it," she reflects, "I may have been afraid of growing up. I was afraid to leave for college, but I didn't want to admit it." After years of therapy, she now thinks she may, unconsciously, have been trying to keep herself small and undeveloped.
"I had been overweight for a short time and I couldn't deal with it," Anne remembers. Afterwards, even when the extra weight was gone and she kept losing, she "always felt fat."
"When I was growing up, I didn't recognize my own capabilities," she says. "I didn't value my own ability to write or express myself. The only thing that seemed to matter was how you looked."
"I thought I was the only one in the world who had this problem," she says. "There's no scarier place than inside the head of an anorexic. I don't want other girls to have to go through this."
Unfortunately, many do.
Twenty-six-year-old Sara, living in Mahwah but raised in Glen Rock, relates that she was bulimic/anorexic from the time she was a freshman in high school until her sophomore year in college. She only stopped because, after a bout with pancreatitis, "I finally realized I could die."
Sara now visits area schools to talk about her experience. Last year, she was spoke to the students at Ma'ayanot Yeshiva High School in Teaneck as part of the school's effort to teach its girls about healthy eating. Also on the program was Nancy Graham of the Renfrew Center in the Ridgewood, a group that educates about and treats eating disorders.
Sara says she had been sick with asthma much of her childhood. Today, she understands that a large part of eating disorders is tied into the issue of control. "I couldn't control my health," she says, "but I could control my weight."
Sara's weight dropped to 92 pounds — on a 5'6" frame. Her parents and friends were extremely concerned.
"I was taken to psychiatrists, hospitalized, treated in outpatient programs, and underwent group, family, and art therapy," she says. "I was also admitted to a residential treatment center six times."
Sara, now a nurse, doesn't believe anyone else can have a major effect on someone determined to lose weight. "There's only so much someone can do," she says. "I didn't want to get better. I saw myself as heavy and wanted to see my bones, to disappear."
On the other hand, she doesn't recall any one reason she felt this way. "It wasn't about appearance," she says, adding, "the last thing you want is attention. You become isolated. If it was only about looks, you would stop when you were the right size.
"Doctors don't get it," she says. "They blame families."
As for the pervasive influence of cultural factors — more specifically, in a society that teaches "you can't be too thin" — she fears that "anorexia is accepted in today's world," and this worries her a great deal.
Jodi Rubin, a therapist at the Renfrew Center, which Sara attended, reports that "the number of people seeking treatment [for eating disorders] has increased — especially among those in midlife, people in their 30s, 40s, and 50s."
Rubin thinks "the older groups have been struggling with this for many years or have had mild disorders throughout their lives but have now been sensitized by media coverage, and by [programs such as] `Desperate Housewives,' to seek help."
She is adamant that "the common misperception that anorexia relates to vanity is just wrong." Rather, she believes that the disease is just a symptom of an underlying issue involving depression, anxiety, or lack of self-esteem and that eating disorders in general are simply ways to cope with problems in self-image, relationships, and the like.
Echoing Sara's conclusion that "anorexia is almost accepted because of the value our society places on looks," she emphasizes that the condition itself is "not about looks or appearance."
In addition, "the problem crosses religious lines," says Rubin, who notes that more African American women — who used to value voluptuous bodies — are now being treated for these disorders.
Rubin says that there are four main influences on body image: social/cultural, family, psychological, and biological. When all four converge, she says, there can be a "perfect storm, resulting in an eating disorder."
"We are all struggling in some way," she says, "depending on how broadly we define the issue."
Janet Bauer, director of professional services for the Wayne-based Jewish Family and Children's Services of North Jersey, says that to understand eating disorders — which include anorexia nervosa, bulimia nervosa (binging and purging), and compulsive overeating — "you need to start by defining the issue."
According to Bauer, "An eating disorder is a survival mechanism using food or lack of food to cope with emotional issues," such as low self-esteem, depression, feelings of worthlessness, identity issues, family communication problems, and feelings of loss of control."
Bauer points out that there are "basically two ways to cope with emotional stress: We can self-soothe through food, or we can stop eating. We all have this pattern to some degree."
She says she hasn't seen more eating problems in the community served by her organization, "mostly middle- and upper-middle-class families," than exist in the population at large. She also says that the people she sees with food disorders rarely come in saying they have any eating issues.
"It almost never presents on its own," she says. "People come in with other presenting problems, or parents come in because they're worried about their children."
While anorexia is found mainly among girls between the ages of 15 and 24, men are certainly not immune — especially those competing in sports that tend to place an emphasis on the athlete's diet, appearance, size, and weight requirements. According to the Website of the National Eating Disorders Association (www.nationaleatingdisorders.org), in the United States, "as many as 10 million females and 1 million males are fighting a life and death battle with an eating disorder such as anorexia or bulimia. Approximately 25 million more are struggling with binge eating disorder."
Bauer says that anorexia results from "a major body image distortion — anorexic young women don't have a realistic view of what their bodies look like, regardless of their weight."
She adds that these women are "good at hiding." Bulimia is somewhat harder to hide. Bulimics may chew their food and then spit it out; they make take laxatives; or they may engage in compulsive exercise.
Bauer is equally troubled, however, by the rise of morbid obesity — a concern echoed by social workers and psychologists who work with the Jewish community.
Rabbi Abraham Twerski, founder/medical director emeritus of the Gateway Rehabilitation Center, a nonprofit drug and alcohol treatment system in western Pennsylvania, believes that "within every problem there is a component of self-esteem that needs to be corrected."
"Animals in the wild eat for nutrition and stop when they're done," he says. "They don't have eating disorders."
Twerkski, who served for 20 years as clinical director of the department of psychiatry at St. Francis Hospital in Pittsburgh, has written more than 40 books, including "The Thin Within You." Now "90 percent retired," he lives in Monsey, N.Y., and visits the Gateway Center once a month.
"For some people, food can be a tranquilizer, used essentially as a drug," he says, pointing out "while some people at a shul kiddush make a l'chaim and they're done, others need to keep drinking." Similarly, "anorexics may get a rush from losing weight, similar to narcotic addiction."
Twerski estimates that some 20 percent of young Jewish girls have, or will develop, an eating disorder. And while he suggests that there is probably a genetic component to all addictions, he talks about the importance of "ingredients."
"Just as you need ingredients to bake a cake and without one of the ingredients you cannot do it," he says, "addictions need critical amounts of each ingredient as well. If you've got a strong genetic makeup, you may be less affected by psychological and social factors. Or, if you are strong psychologically — have high self-esteem, handle pressure well — you will be unlikely to develop a problem."
Twerski also points out a problem that appears to be unique to segments of the Orthodox Jewish community — in particular, those who rely on a shadchan, or third party, to arrange marriages for their children. He says that some young men specify the dress size of a prospective spouse, and this is more likely to be a size 2 than a size 12. In addition, some want to know the dress size of the girls' mothers, to get an idea of how the girls will look when they're older.
"This is causing an increasing number of cases [of anorexia] among middle-aged women as well," he says, adding that both the affected girls, and their parents, may be "in denial."
The rabbi tells two stories. First, he discusses the case of an observant girl who was sent to board with a local family in a major northeastern city in order to attend a particular yeshiva. The family she was staying with realized that she was bulimic and told her school. The principal, in turn, called the girl's parents, who told him, "Forget it. Don't worry about it." Later, when the situation worsened and the principal called the parents again, they withdrew their daughter from the school.
The second story concerns a rabbi's wife who reported to Twerski that her husband did not appear to notice that she disappeared several times during each meal. Suffering from bulimia, she was afraid to tell her husband, lest he think she was mentally ill. Twerski suggested that she be honest with her spouse, telling him that she would seek help for the problem. This story has a happy ending. The issue was talked through, treated, and resolved.
Despite the media attention paid to anorexia, Twerski suggests that "obesity is the number one health problem in the country."
"We come from an `ess, ess, mein kind' culture. Parents express their love by feeding their children," he notes. "They push food at you thinking to make you healthy."
He says his own father showed his love by personally cooking him a lot of eggs. Also, noting that historical memory lives on beyond its relevance, he suggests that the fear of tuberculosis in Europe led Jews to proudly display their extra weight. "If you were thin, you were suspected of being ill," he says.
Interestingly, Twerski suggests that Cathy Guisewite, author of the comic Strip "Cathy," is the country's best authority on eating disorders and says he would be delighted to coauthor a book with her. (He coauthored four books with "Peanuts" creator Charles Schultz.)
Zeva Citronenbaum, a social worker in Rockland County, N.Y., who serves mainly Orthodox and chasidic clients through a privately funded non-profit mental health center, recently co-sponsored a presentation with the Renfrew Center called "Balancing Your Relationship with Food: A Discussion about Emotional Eating." The center approached her, she said, because they wanted to work through someone known to the community, so that "people would feel safe."
According to Citronenbaum, while the portion of the program presented by Nancy Graham of the Renfrew Center dealt mainly with anorexia and bulimia, her segment was devoted to overeating, which she said was a more common problem in her area. To prepare for the presentation, the Monsey social worker set out to collect material from Torah and rabbinic sources on the importance of eating properly.
"It's amazing," she said. "All of it is in the Torah — desire, emotion, depression, exercise. It's all there. You just have to know how to interpret it and use it."
Citronenbaum says that people who eat too much or too little are misreading Jewish sources, which stress balanced, healthy eating.
She points out that the topic of mental health is still both "taboo and underfunded" in the community at large, and even more so in the Orthodox community. While she has not seen a large incidence of anorexia among the young girls seeking shidduchim in her own area, she suggests that "this may be a bigger thing in Brooklyn, where people are more fashion conscious."
The problem that concerns her most is that "overeating is accepted in the frum community. It's no big deal. It goes along with the old Jewish philosophy that fat equals healthy, and an overweight child is a happy and healthy child."
Dr. Michael Salamon, senior psychologist/director of the Adult Developmental Center in Hewlett, N.Y., points out that there is big difference between clinical eating disorders and problems that are pervasive in society. While only a small percentage of people have diagnosable eating disorders, some 30 percent are obese.
Why Jews? "First," he says, "we believe that food makes you feel better. Also, in the absence of the Temple, we now have the Shabbat and holiday table, where there is a requirement to eat certain amounts of different kinds of foods and invite others to eat as much as they want — food as a means of celebration."
On the other end of the spectrum, however, "our culture is trying to sell women an image rather than the reality of health."
"My father was in the `shmatta' industry," he says. "Today's size 4 was last generation's 8 or 10. People are trying to match the Nordic ideal of beauty, but even most Nordic women have pear shapes."
Salamon has been told by 16- to 19-year-olds in the observant community, where there is pressure to marry young, that "thinner girls get the better husbands." He decries what he calls the "superficiality of the shadchan approach, where matchmakers don't know clients and what they do know has nothing to do with bringing or keeping a couple together."
In once case, he says, he was told that a prospective groom requested a picture of a girl's grandmother, assuming that the girl's mother was probably dieting to help get her daughter a match and therefore her picture would not be reliable.
He says he's seeing increasing numbers of young girls — and now middle-age women — who have created unhealthy modes of eating: "fasting in the morning, taking a bite of a power bar in mid-afternoon, and eating one piece of fish for dinner." While they will ultimately become physically ill, he says, the presenting symptom is generally something like anxiety or compulsive behavior.
"This is not a geographic phenomenon," he says, pointing out that he has seen girls with the problem who have come over from Israel. Like the other experts, Salamon believes that the incidence of eating disorders among Jews tends to match that of the general population; however, he notes that the particular pressures and causes may differ.
Salamon says that while he sees anorexic girls (he estimates that 5 to 8 percent of girls are dangerously thin), he sees many more who have "given up" and have begun to overeat to soothe their anxiety.
Dr. Naomi Mark, a mental health professional on the Upper West Side of Manhattan, agrees that the Jewish community is highly influenced by secular culture, which today stresses the primacy of materialism and thin bodies.
"Add to this the fact that Orthodox Jews generally put great value on high achievement and the quest for excellence ... and [we get] children who are highly driven to succeed, please their parents, make an early marriage, and have a lot of children."
She says that "while all adolescents face challenges, secular girls have a broader period of time in which to achieve success. The expectation is that the Orthodox girl will do it at an earlier age. In school, she will have both academic and matrimonial pressures."
In that regard, she says, the shidduch system is a kind of "social control. Girls must be cognizant of their reputation, appearance, etc., or a favorable match won't be made. Some girls are more vulnerable than others and have a higher propensity for anxiety. They want to appear perfect."
Mark says "this is both a `doing' and an `undoing.'"
"The `doing' part is that they're able to master their weight. The `undoing' is that, unconsciously, this is also a way to resist growing up, to stop their growth."
Mark adds, "There may be more of a need for these Orthodox adolescent girls to try to reassert control (albeit in a self-destructive way) in a world where, for them, so many issues are decided outside of the realm of their control."
She points out as well that girls tend to internalize their stress (and often hurt themselves), while boys generally "act out." In addition, Mark cites the difficulty some Orthodox girls may have in developing a healthy body image and coming to grips with their sexuality when interpreting the attribute of "tzniut" (modesty).
Says Mark: "It is not necessarily the emphasis on tzniut alone that creates difficulty but rather, at times, when the [worthy] value of tzniut gets distorted and misunderstood as a rejection of the body and sexuality."
Author Jonathan Rosen — whose many writings include the book "Eve's Apple," the story of a young woman struggling with anorexia — says that while he was certainly interested in the reality of eating disorders, "I was surprised that anorexia became my subject." Rosen is also the former cultural editor of The Forward and current series editor of the "Jewish Encounters Book Series," a collaboration between Schocken Books and Nextbook.
In an interview with The Jewish Standard, Rosen said he knew many smart young women at college [Yale] who were "at war with their own bodies." Based on that experience "and my own perplexity," he said, he decided to engage in "novelistic sociology" and pursue this mysterious subject.
While Rosen offers the disclaimer that he is far from an expert on the subject, his research has yielded several interesting perspectives on the illness.
He notes that while there have been many advances in understanding the illness, it remains "at root, mysterious."
"It is a real illness but fascinating because of its metaphorical nature," he says. "It's hard to be a body."
Rosen points out that while anorexia is a universal disorder, it is apparently related to socioeconomic factors. "We don't see "nearly as much among poor women," he points out. "Since Jewish women tend to be more educated and upwardly mobile," he suggests, they may be more susceptible to this condition.
Rosen is particularly intrigued by the fact that after the '60s, after sexual liberation, the incidence of eating disorders increased. "You would expect the opposite," he said. "But comfort with the body is not easily achieved in modern culture."
"When I was an undergraduate at Yale," he recalls, "women were under the dual pressure to be great students and conform to ideals of beauty. This had not yet been addressed by the feminist movement, which was then tackling the idea of equality."
Furthermore, he adds, "what we want intellectually, and what our bodies want, aren't always the same. Many professional women I know are overwhelmed and surprised by the biological urge to have kids. We persuaded ourselves that we are in an age beyond biology, when of course we never are."
Rosen suggests that Jews have absorbed the Christian dichotomy between soul and body as an aspect of Jewish consciousness. Traditionally, in Judaism, the two were intertwined; while in Christianity, "the soul and the body were not even on speaking terms," he says.
But, in a metaphorical fashion, aspects of anorexic thought seem bound up with certain aspects of Jewish life, he feels.
"A homeland is like a body. We got used to being in exile and made it a virtue, and for a long time we were uncomfortable about things — like weaponry, etc. — that went with having our own county, which takes up space, exhibits appetite, aggression. To shrink from this can seem a kind of `political anorexia.'"
Rosen's anorexic heroine is, figuratively, stripped of flesh, reminiscent of the degraded bodies of Holocaust victims. According to the author, in the aftermath of the Holocaust, Jews have experienced a shared trauma and fascination with bodies stripped of dignity, even of flesh.
While anorexia represents an inversion of the natural order — the heroine is described as viewing "illness as the road to health, control as the path to freedom, denial as the way to fulfillment" — Rosen says this is "an exaggeration of what we do all the time."
"We dam rivers and build cities where we shouldn't, which leads to flooding. We do the same thing to our own bodies."
Since writing the book, Rosen has received "many heart-breaking letters from women, from their teens to their 30s," who felt it was an accurate portrayal. "There is a lot of suffering out there," he says, "[and] much of it invisible."
Dr. Shulamis Pollak, director of guidance at Ma'ayanot Yeshiva High School in Teaneck, believes strongly in being proactive about teaching the issue of health. The school has a mandatory year-long 10th-grade health class that covers topics such as nutrition; and seniors — who are are offered an elective in health and fitness — attend two programs that deal specifically with body image and proper eating.
Pollak is especially proud of the "Mechanechet" program, through which all students meet once a week throughout their four years at Ma'ayanot to discuss special developmental issues. The 11th-grade curriculum focuses heavily self-understanding, with emphasis on how the girls feel about their bodies. It also explores the pressures and influences that play a role in shaping body image.
According to Pollak, there is an ongoing debate about whether schools should invite recovering food addicts to address the students. While Ma'ayanot has had such presentations in the past, "we are opting to do something different this year," she says.
Those who oppose such presentations say that, unlike other mental disorders, such as depression, the behavior of food addicts is something students may choose to emulate.
Pollak points out that girls who get information from people recovering from anorexia/bulimia occasionally try to copy the maladaptive behaviors or may say, "She's OK now; I can do this, too, just until I get thin enough."
Pollak says that rather than focusing on the conditions themselves, she prefers to educate students about healthy ways of eating and of dieting, and then to provide some information about the warning signs of eating disorders.
"I would tell parents to be wary of weight loss that doesn't make their child feel better or that the child does not see. Parents should look further into what might be the source of pain for their child, if the child still doesn't feel good about herself after significant weight has been shed. Also, they should be aware of how their child is losing weight, especially with fad diets."
According to Pollak, who has had many years of experience working with teenage girls, those "who have the disorder often don't realize that they are in trouble. If we can help the child realize that losing weight won't dissolve her underlying pain, and that professional counseling might, it's usually easier getting through to the parents once the kids understand that they need help."
The month of February will be "health month" at Ma'ayanot, during which the girls choose programs that touch on a wide range of health issues, including nutrition, healthful cooking, and aerobic exercise. In addition, Ma'ayanot "offers its seniors a unique program on what to do when you need to make it out there on your own," says Pollak, "for example, if you're spending a year in Israel or going off to college." The workshop teaches girls "how to make the right choices, what to eat in restaurants, etc."
Pollak points out that going away may create two problems. "The girls may begin to overeat, or a fear of overeating may cause them to eat too little." Girls in their senior year also learn how to recognize eating problems among their friends.
Shalva Schwartz, a social worker at the Hebrew Academy of Nassau County, says the school uses a curriculum created by F.E.G.S.-Long Island in programs designed for middle-school students. (F.E.G.S. was established in the 1930s as the Federation Employment and Guidance Service, Inc. It is now a health and human services agency.) The curriculum avoids addressing the signs and symptoms of specific disorder and emphasizes instead positive body image and issues such as the dangers of dieting. A Jewish component of the program incorporates material on noted Jewish women, from biblical times to the present.
At a recent program, a trained instructor did yoga with the students "to encourage them to feel good about their bodies." The school also held a Health Day, which included a component on body image.
"We discussed what it is, what influences it, and what we can do to create a more positive image of ourselves," says Schwartz, adding that "the girls came up with their own solutions ... through exercise, manicures, etc."
Also during Health Day, the school screened a video showing students how images of models are touched up to make them look better.
Schwartz points out that "the purpose ... is to show the girls that even what we see in the media is, most of the time, not real. Yet we feel bad about the fact that we don't look that way, when, many times, even the model doesn't look that way.... The media is trying to sell an image that doesn't really exist."
As at Ma'ayanot, health is a regular part of the 10th-grade curriculum and special programs have been arranged, including visits from survivors of eating disorders. "The students responded very well to that," she said. "They asked for the speaker to come again."
Throughout the year, says Schwartz, "we focus on the topic of self-esteem and how it can influence all our decisions."
Schwartz says that when the school suspects an eating disorder, it calls the parents, who get the child appropriate help.
While "no girls at this age are happy with their bodies," she says, "we have done a lot of education so [that] students and parents are recognizing problems earlier, and getting help earlier, which leads to much more successful outcomes."
The Renfrew Center's Rubin suggests that in detecting eating disorders, weight is not the only thing to watch out for. "The signs include psychological factors," she says, "such as [a tendency toward] perfectionism."
Anne, who weathered anorexia some 30 years ago, says that anorexics "engage in black and white thinking, all or nothing, no gray areas. I thought about food 24/7."
Acccording to Rubin, if parents suspect that their children have eating disorders, they should talk to them about how they're feeling. It's also important that parents project good values, she says, modeling a healthy attitude toward their own body image and relationship to eating.
As Sara, a former anorexic/bulimic points out, "If mothers are overconcerned with their weight and diet all the time, their daughters will [do this] too."
Today, Sara tells high school girls that while it is not their job to be their friends' psychologist, if they recognize that something is wrong, they should tell someone — whether parents, teachers, the school nurse, or another school professional. She also talks to them about staying healthy and maintaining a healthy lifestyle.
"You have to educate kids before they get to the point where they develop disorders," she says. "Don't pressure them too much about eating or exercise. Teach them to love themselves as they are."
Rubin stresses that "parents can take steps to strengthen the `family' area [of the child's life] so it can serve as a buffer against other psychological, social, and cultural factors." Echoing that view, Mark emphasizes that "parents must keep open the lines of communication with their teens and able to talk to them and understand the pressures they're under."
Salamon, likewise, cautions that "parents must know how to recognize signs of anxiety in young children."
"There's great denial in the population as a whole," he says, "but maybe even more in the Jewish community. Parents say of boys' problems, `His rebbe will take care of it in school,' and of girls' problems, `She'll outgrow it.' Parents must deal with the issues that present."
Mark believes that "day schools are becoming more sensitive to this issue. While some have invited speakers on eating disorders, others are stressing the concept of a healthy balance in eating and — in a culture that overstimulates us — discussing how to balance pleasure and health."
She believes the goal is to "create a world where people can be who they are and teach that there are multiple ways to live and to succeed. There is a place in the community for all different kinds of people."
Rosen would urge that we train ourselves to be "more aware." As the father of daughters, he has heard that a good father-daughter relationship may help to prevent eating disorders.
Research in Jewish
Communities
Eating disorders among Jewish female adolescents in Israel: a 5-year study.
Mitrany E, Lubin F, Chetrit A, Modan B.
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=7669795&cmd=showdetailview&indexed=google
Department of Child and Adolescent Psychosomatic Medicine, Chaim Sheba Medical Center, Tel-Aviv University School of Medicine, Tel Hashomer, Israel.
PURPOSE: The current study examines the nationwide incidence of eating disorders (ED) among Jewish adolescents over a 5-year period (1989-93). METHODS: Data were obtained from 80% of all community and hospital adolescent and mental health institutions in Israel. Case identification was based on screening records according to DSM-III-R criteria for ED. RESULTS: Six hundred and thirty two new cases were identified with the following diagnostic distribution: anorexia 60%, bulimia 17%, anorexia and bulimia 4%, and ED not otherwise specified 20%. The present analysis is limited to females only (N = 602 or 95%). Median age for anorexia is 15 years and for bulimia 16 years. CONCLUSION: On the basis of this initial survey, the mean annual incidence of all eating disorders in Jewish Israeli females 12-18 years of age is 48.8 per 100,000. For anorexia the mean incidence is 29.0 and for bulimia 8.6. These figures represent an underestimation of the actual incidence due to incomplete data accrual.
PMID: 7669795 [PubMed - indexed for MEDLINE]
Young girls who are sexually abused are more likely
to develop eating disorders as adolescents
University of North Dakota School of Medicine and Health Sciences
Stephen A. Wonderlich, M.D., et al, University of North Dakota School of Medicine and Health Sciences in Fargo, Journal of the American Academy of Child and Adolescent Psychiatry 2000;391277-1283.
http://www.prevent-abuse-now.com/stats.htm
Young girls who are sexually abused are more likely to develop eating disorders as adolescents. The findings also add to a growing body of research suggesting that trauma in childhood increases the risk of developing an eating disorder. Abused girls were more dissatisfied with their weight and more likely to diet and purge their food by vomiting or using laxatives and diuretics. Abused girls were also more likely to restrict their eating when they were bored or emotionally upset. Wonderlich suggests that abused girls might experience higher levels of emotional distress, possibly linked to their abuse, and have trouble coping. Food restriction and perhaps other eating disorder behaviors may (reflect) efforts to cope with such experiences. The report also indicates that while girls who were abused were less likely to exhibit perfectionist tendencies (such as making extreme efforts to avoid disappointing others and a need to be 'the best'), they tended to want thinner bodies than girls who had not been abused.
By Dr. Dianne Neumark-Sztainer
University of Minneapolis, International Journal of Eating Disorders 2000; 28:249-258.
http://www.prevent-abuse-now.com/stats.htm
Among both adolescent girls and boys, a history of sexual or physical abuse appears to increase the risk of disordered eating behaviors, such as self-induced vomiting or use of laxatives to avoid gaining weight. Among those at increased risk for disordered eating were respondents who had experienced sexual or physical abuse and those who gave low ratings to family communication, parental caring and parental expectations. In light of these findings, the researchers conclude that "strong familial relationships may decrease the risk for disordered eating among youth reporting abuse experiences."
Sexual Abuse and Eating Disorders: A Test of a
Conceptual Model
by Trent A. Petrie, Margie Tripp
Sex Roles: A Journal of Research, Jan, 2001
http://findarticles.com/p/articles/mi_m2294/is_2001_Jan/ai_77384284
To provide a better conceptual understanding and to stimulate further research, A. Kearney-Cooke and R. H. Striegel-Moore (1994) proposed several theoretical models concerning the relationship between sexual abuse and eating disorders. In this study, we tested the model that hypothesized an indirect relationship between sexual abuse and eating disorders, with the effects of sexual abuse being mediated through bodily shame and body disparagement. Three hundred thirty female undergraduates from a large southwestern public university participated. The women represented the social class of the university, which is predominantly middle to upper-middle class. Race/ethnicity of the participants was 69.8% Caucasian, 15.9% African American, 5.8% Latinol Mexican American, 4.9% Asian American, and 0.9% Native American; the remainder did not indicate their race/ethnicity Of the total sample, 60% reported having been sexually abused at some point in their lives; 21% had experienced abuse prior to age 14. Almost 8% were ca tegorized as having a diagnosable eating disorder, whereas another 72.7% were symptomatic. To test the hypothesized model, structural equation modeling with LISREL 8.3 (K. C. Joreskog & G. Sorbom, 1999) was used. Results indicated that the model fit the data well and the hypothesized relationships among the variables were in the expected directions. Sexual abuse predicted higher levels of bodily shame that, in turn, predicted increases in body disparagement. As expected, only body disparagement directly predicted eating disorder symptoms. Directions for future research are discussed.
Abuse 'triggers eating
disorders'
BBC - November 9, 2005
http://news.bbc.co.uk/1/hi/health/4417938.stm
We have known for some time that sexual abuse can lead to eating disorders -- British Eating Disorders Association
Childhood sex abuse increases the risk of women developing eating disorders - and can even impact on their children, a study says.
Researchers found girls abused before the age of 16 were twice as likely to develop eating disorders later in life.
The University of Bristol team also said these women were likely to have weight concerns while pregnant and that had a knock-on effect on the child.
The findings were published in the British Journal of Psychiatry.
The team studied 10,000 women - one in five of whom had being abused.
Researchers involved in the university's Children of the 90s project found 79% of the women recalled happy childhoods.
The report said these women were less likely to worry about their weight or develop conditions such as bulimia and anorexia later in life.
But of those who were sexually abused, 15% showed symptoms of an eating disorder and 30% showed concern about their weight during pregnancy.
The researchers said this was a cause for concern, as maternal eating problems after childbirth interfered with parenting and child growth.
Women with excessive fears about weight and shape are less likely to breast feed.
But the report accepted other distressful experiences during childhood could also trigger problems.
Previous research has shown that eating disorders may be connected to a wide range of unhappy childhood influences including parental alcohol misuse, physical or emotional cruelty and other family problems.
Awareness
Lead author Dr Rob Senior said health professionals needed to be aware of the pattern.
"The majority of women with concerns about weight, shape and eating do not describe a history of abuse, and GPs or midwives may have reservations about raising the topic."
He said the high-prevalence of concern during pregnancy was particularly worrying because of the knock-on effects.
A spokesman for the Eating Disorders Association said the findings were not surprising and should be viewed in context.
"We have known for some time that sexual abuse can lead to eating disorders.
"But it is not the only, nor most common, cause. Being teased and bullied about your weight is more likely to cause a problem.
"What is interesting about people who develop disorders after abuse is that it is a defence mechanism; they do it so they don't draw attention to themselves.
"They do not care about how they look, whereas others generally do it because they are worried about how they look."
Study shows complex link between abuse and eating disorders
University of Illinois - December 19, 2005
by Craig Chamberlain, Education Editor
http://www.news.uiuc.edu/NEWS/05/1219disorders.html
CHAMPAIGN, Ill. — Women who were victims of childhood sexual abuse have long been assumed to be at a higher risk for eating disorders. The results of research, however, have been mixed, with some studies showing a link and others none.
A recently published study of college-age women shows there is a connection between the two, though not a direct one. Childhood sexual abuse is not a significant risk factor on its own, but it is when combined with psychological distress (depression or anxiety) and a condition of emotional disconnection known as alexithymia, say study authors Anita Hund and Dorothy Espelage, both with the University of Illinois at Urbana-Champaign.
"Those factors appear to play an important role not only in how eating disorders get started, but more importantly in how they keep going," according to Hund, a doctoral student in educational psychology at Illinois and the lead author of the study, published in the October issue of the Journal of Counseling Psychology.
"What sends one woman over the line, and not her classmate (with a similar background), probably has a lot to do with how they experience emotions," Hund said. If those factors can be addressed through counseling, it holds promise for reducing a woman's risk for developing a disorder, she said.
The study's results validate a lot of what many counselors and clinicians already believe or suspect, according to Espelage, a professor of educational psychology at Illinois and co-author of the study. The results also have consequences for the treatment of eating disorders and related behaviors on college campuses, she said.
Many women on campuses engage in disordered eating behaviors, from severe restriction or dieting, to binging and purging, Espelage said.
Among those are women who come to campus with no history of such behaviors, "but begin to feel dissatisfied with their bodies in a very competitive environment and engage in disordered eating for the first time," she said.
But many campuses devote few resources to counseling women engaged in those behaviors, she said. And there is a movement toward sending those with fully developed eating disorders to off-campus treatment centers, in part because the treatment is so expensive.
"I think this research lends support to the idea that we can do something in college counseling centers and have a tremendous effect," she said.
Previous research on the association between childhood sexual abuse and eating disorders had produced inconsistent and confusing results because it did not take multiple factors into account, Hund said. "In reality, the association between a history of childhood sexual abuse and disordered eating behaviors is very complex," she said.
The researchers believe their study is the first on this topic to take those multiple factors into account, using a research technique called structural equation modeling.
Using results from previous research, including work by Espelage and Suzanne Mazzeo, now a professor at Virginia Commonwealth University, the researchers developed a hypothetical model or map of associations between various factors. The factors in the model included childhood sexual abuse, general psychological distress, alexithymia, restrictive eating behaviors and attitudes, body dissatisfaction, and bulimic eating behaviors (such as binging and purging).
Alexithymia (uh-lex-uh-THIGH-me-uh) is defined as a condition in which a person is unable to recognize or describe his or her own emotions. Hund described it as "a disconnect between emotions and the rest of you."
Their data was gathered through a written survey administered to 608 undergraduate and graduate women at a large Midwestern university, producing 589 usable responses.
What the researchers found when they sorted out the data was that it fit their hypothetical model of how the various factors were associated and how they affected the level of risk for an eating disorder, Hund said.
"These study results fit into the idea that eating disordered behaviors actually have a purpose," she said. "Somebody who's abused is of course going to have some issues around dealing with emotions, and this is their solution to functioning."
Therefore, it may be important for counselors and clinicians not to move too quickly to take away those behaviors, except when immediately life-threatening, and to deal with the woman's "underlying emotional structure," Hund said.
By Simon Rocker
The JC - September 14, 2007
http://www.thejc.com/home.aspx?ParentId=m11s18&SecId=18&AId=55394&ATypeId=1
A ground-breaking guide has been published in the UK to help combat drug, sex and other addictions among strictly Orthodox Jews.
Believed to be the first of its kind anywhere in the world, the 130-page book, "Understanding Addictions" is trilingual, written in English, Yiddish and Hebrew.
Ranging from eating disorders, gambling and "shopaholism", to internet porn and gambling, it has been produced by Talking Matters (TMA), a National Health-funded counselling agency set up in 2001 to promote stress prevention among the Charedi community.
Its purpose is to equip rabbis, teachers, parents and youth and community workers with the knowledge to identify problems and provide help in a "constructive and non-judgmental way". Its contents include an illustrated guide to illicit drugs as well as an extensive list of Orthodox counsellors.
In the introduction, TMA's founder and national director, José Martin, says that in the past people with such problems would be "shipped out" to other towns. "We pray that no child comes to harm in his life, but if s/he stumbles, it is our duty to help them up, not push them further into the quagmire."
She told the JC that one motivation for compiling the book was learning a few years ago that an official Drug Action Team (DAT) in Manchester had a record of 10 Orthodox Jews. "By the time, they get to the DATs you'd never know they were Orthodox or even Jewish, it's too late. Two or three died," she said.
A report on mental health in the Charedi community that she helped compile earlier this year for the University of Central Lancashire Centre for Ethnicity and Health also found anecdotal evidence of drug-taking among strictly Orthodox youth. It recorded: "What has been quite shocking, even for the researchers, is the frankness with which some respondents said that`There are teenage girls and boys using drugs like marijuana, cocaine and speed.' This is alarming as it was always thought that the girls in particular, of Stamford Hill, were totally immune from such terrible things."
Feedback from therapists also sheds light on what problems need to be addressed. "Life has changed," Ms Martin said. "We didn't have internet pornography 10 years ago."
The publication is endorsed by a highly-respected strictly Orthodox rabbi, Dr Abraham Twersky, a psychiatrist with expertise in substance abuse and author of numerous religious books.
"We must get our heads out of the sand and realise that all social problems that exist in society at large may exist among Orthodox Jews as well," he writes in the foreword, "and even if there may be a lesser incidence, the prevalence is significant. Families are being ruined and children suffer the consequences of parental addiction."
Other rabbinical backing comes from Rabbi Dr Chanan Tomlin in Manchester, the chairman of Talking Matters, and Rabbi Azriel Schechter in Stamford Hill.
Ms Martin said that 300 copies had so far been sent out — mostly attracting positive reaction — "although there were three negative responses, including one who sent it back".
FAIR USE NOTICE
Some of the information on The Awareness Center's web pages may contain copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of environmental, political, human rights, economic, democracy, scientific, and social justice issues, etc.
We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.
For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use copyrighted material from this update for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.
Last Updated: 10/07/2007
"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."
--Margaret Mead