By Lillian Cohen-Moore, other
Editor’s note: This story has been corrected to note that Jewish Family Service refers clients to both medical and mental health professionals, as well as clarifying that their “Choices, Changes and Challenges” program is a holistic program that touches on eating disorders but does not focus on them specifically.
While much of the nation closely follows worries about obesity, conversation has begun within the Jewish community about the opposite problem. Last year Renfrew, a well-respected eating disorder treatment facility on the East Coast, added a therapeutic track geared toward Orthodox Jewish women, the first of its kind. In 2010, 13 percent of Renfrew’s patients in Philadelphia and Florida programs were Jewish women, up from 5 percent three years ago.
With programs like the Orthodox Union’s Hungry to be Heard, or Dr. Catherine Steiner-Adair’s curriculum Bishvilli, a supplement to a prevention program that addresses self-esteem and eating disorders in the Jewish community, the general silence often felt around such disorders is slowly being replaced with recognition and prevention.
Requests from the local community served as a basis for Marjorie Schnyder, director of Family Life Education at Jewish Family Service, to offer “Choices, Changes and Challenges,” an ongoing series of workshops that runs until December. Co-sponsored by Congregation Beth Shalom, the series gives parents tools to support their child’s healthy development in areas of self-esteem, body image, and healthy eating. Topics such as self-esteem and positive body image are interwoven throughout many JFS programs, Schnyder said. However, the agency will refer the not-uncommon requests for direct assistance to medical or mental health professionals.
“Since these disorders can be life threatening, services should only be provided by specialists,” Schnyder said.
Clinicians Dr. Alexia Giblin and Tawney Jones of Seattle both specialize in eating disorder treatment. They agree that eating disorders require expert care; patients can experience health disturbances long before losing enough weight to qualify medically for a disorder. Signs can include electrolyte imbalances, tooth decay and loss of menses, among other issues.
The patient’s weight differentiates diagnosis of the two best-known eating disorders, anorexia nervosa and bulimia, Giblin explained. Anorexia nervosa patients fall below the 85th percentile for body weight for age and height, while bulimia patients will often exhibit normal weights.
Jones detailed the criteria for diagnosing anorexia as “a refusal to maintain a healthy body weight, fear of weight gain, a lack of recognition of low body weight or skewed body image, and often a cessation of menstrual periods,” she said. “Bulimia is diagnosed when there is recurrent binge eating and some type of compensation for the binge.”
That compensation can include laxative abuse, purging, or periods of fasting. In addition, Jones added, “the binging must occur at least twice weekly for three months, and the person’s self-worth must be highly influenced by their perception of their body.”
Oftentimes, patients don’t meet the diagnostic list for other eating disorders, but still exhibit emotional distress or unhealthy relationships with food. They too can often benefit from therapeutic treatment.
These patients, however, are not always the best judges of when they should be treated.
“I have patients who say that that they don’t belong in treatment because they don’t ‘look sick,’” Giblin said. “Most of my patients look just like a normal person who isn’t suffering from an eating disorder, someone you’d walk by on the street. Body size is not always a helpful gauge.”
Jones said higher care options such as inpatient treatment are limited in the Seattle area, marking Seattle as an underserved community. Three inpatient care programs currently exist in Seattle, one of which is exclusively devoted to adolescent treatment, meaning patients must often travel outside their communities to receive the care they need.
Harriet Brown, author of the book Brave Girl Eating, a memoir about her own family’s fight with eating disorders, is familiar with the search for adequate treatment.
When her daughter Kitty was diagnosed with anorexia, Brown, a Jewish writer from New Jersey, tried a method known as Maudsley Family Therapy, or FBT, an outpatient model where treatment is handled primarily in the home with oversight provided by a trained therapeutic professional. Success, Brown said, was fleeting. This is not uncommon, as many eating disorder patients will a relapse before they fully recover.
“The first time we worked with a pediatrician and therapist, and we all educated ourselves together to pull a collaborative effort together,” Brown said. “The second time around we worked with an FBT therapist and it didn’t work well.”
They eventually found an outpatient program that served their needs. Still, Brown saw firsthand how the Jewish community could be silent about confronting eating disorders.
“I had a cousin who ruptured her esophagus from bulimia,” she said. “Her mother to this day denies it was an eating disorder.”
Shani Raviv, a program assistant at the Seattle-based National Eating Disorders Association, recently released a book titled being Ana: a memoir of anorexia nervosa. The book tells Raviv’s story of how, as a Jewish teen in South Africa, she developed anorexia. Like Brown, she sees the potential for the Jewish community to speak more about eating disorders. She also approaches the difficulties anorexics may have with religious practice — such as with holidays like Yom Kippur.
“I used to fast…but I don’t anymore,” she said. “Having this in my history, it’s not something I want to mess with. It’s easy for me not to eat for a day.”
Raviv thinks solutions could come from the Jewish community.
“I think maybe the Jewish community could address eating disorders from a spiritual perspective, because I really do think it’s spiritually related,” she said.
Raviv’s disorder developed before she left home to join the Israeli Defense Forces. When she returned to South Africa, she was able to find treatment on her own, but it was a difficult and long-term regimen.
“I did a lot of work with a dietician,” Raviv said. “She put me on a very strict meal plan, and I followed that for about six months to year, till I felt comfortable eating on my own, deciding what I felt like.”
Dedication to a meal plan is an important aspect of treatment, said Barbara Skibell, a dietician who specializes in eating disorders.
“The preferred method right now is to normalize eating,” Skibell said. “From a diet point of view, you focus on a balanced diet. Balanced food includes everything someone would eat.”
Raviv dedicated herself to her recovery for five years, and documented it during much of the process. That journal became the basis of her book.
“I think you have to make a commitment to wanting to be well,” she said. “I want to be well, because I know what the alternative is and it’s not going to go anywhere. You just keep it simple. Eat your three meals a day. Follow your meal plan every single day. Go to therapy, keep talking about your feelings no matter how big the pain, and like they say in AA, take it a day at a time.”
For more information on Jewish Family Service’s “Choices, Changes and Challenges” program, which covers many aspects of parenting teens, including eating disorders, contact Marjorie Schnyder at mschnyder@jfsseattle.org or visit www.jfsseattle.org.