Wednesday, November 06, 2002
Talking to Jewish women about their struggles with eating disorders
By Susan Tomchin
Jewish Women International - November 6, 2002
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.