What to look for, where to find help

As a loving and concerned parent, you may notice that when your daughter enters puberty she will gain weight. Most of this gain is due to her body developing and preparing her to grow taller; the weight usually precedes the growth spurt. A healthy adolescent may gain anywhere from 20 to 50 pounds. Because there is so much focus on weight and body size in our culture, however, adolescents are not given the opportunity to go through these changes with the weight fluctuations that are necessary for normal development. This is the time that most eating disorders start. Over the years, I have heard my clients say that they started their eating disorder between the ages of 11 and 15 years old. Most started with a diet or over-exercising.

It is very hard to tell if your daughter is going through normal changes or has the beginning stages of an eating disorder. Research reports that 50 percent of girls between the ages of 12 and 14 say they are unhappy because they “feel fat,” 45 percent of elementary-school-age children report wanting to be thinner, and 40 to 60 percent of high-school girls in the United States are on a diet.

Here are some eating disorder signs to look for:

• Uses food when upset or stressed.

• Has lost a significant amount of weight in a short period of time.

• Uses laxatives, diuretics and/or appetite suppressants .

• Must exercise or goes to the bathroom during or following meals.

• Has a preoccupation with body, weight, diets and/or food.

You cannot tell if someone has an eating disorder just by looking at them. The eating disorder is used as a way of coping with the stresses of life. It is a way to avoid feelings or some traumatic event that a person does not want to face. Left untreated, the eating disorder can cause disruptions in emotional and physical development, including osteoporosis and infertility later in life.

Many people ask me, “What are the best ways to avoid an eating disorder?” One of the most important factors is role modeling and dieting. We now have generations of women brought up with dieting and not liking their body. A child sees Mom looking in a mirror and being upset about her weight. She sees her going on one diet after another. She thinks Mom is beautiful and wants to be just like her.

Research is showing that 35 percent of “normal dieters” progress to disordered eating that may last a lifetime. Alterations occur in brain chemistry from restricting food then binging. People start using food to feel better. Food uses the same reward system as mind-altering substances. This is one of the reasons for cravings and obsessive thoughts about food. Also, some foods are addictive to some people.

Currently, 11 million people in the United States have eating disorders. Disordered eating is not entirely about what we eat. Most people with disordered eating could write books about nutrition. They know the calories, fat grams and carbohydrate contents of the foods they eat. They know what they should eat and how much; they just cannot put that into practice. The real problem is that food or the compulsive thoughts are being used to avoid some part of our life. Usually they do not know what feelings they are avoiding.

In our treatment center, we see so many people who are not only disconnected from their feelings, but also from their appetite and themselves. When dieting, they may be hungry, but they tell themselves, “I am doing well, because I am sticking to my diet.” They are not listening to their body signals. Over time, they do not even know when they are hungry or full. They search for an external source (the diet) to regulate their food intake. With each failed diet, they lose a little more self-esteem, because they did not stay with their diet. Yo-yo dieting or other forms of external control only work temporarily. The real issues need to be dealt with so that there is no need to use food to shove these issues down. Only an internal shift can produce lifelong changes.

Many people have followed the steps outlined in my book, “Diets Don’t Work” (ReBu, 2009), so that they can once again eat when hungry and stop when full and make healthy choices.

Obviously, there is a continuum of eating disorder behaviors, but if disordered eating is causing a problem in your life, relationships or self-esteem, you should consult a professional who specializes in eating disorders. Eating disorders and disordered eating do not go away on their own; they require professional help. There is no simple cause of eating disorders, nor is there a simple cure.

It is usually a good idea to start treatment with a team of experienced eating disorder professionals. The collaborative approach — including a medical doctor, registered dietitian, exercise physiologist and therapist, along with group therapy — is necessary to facilitate dealing with the core issues and build a solid foundation for long-term recovery. The dialogue among these professionals is indispensable in planning the best treatment for each individual. An eating disorder treatment program will help the person deal with the underlying reasons why he or she has been using the eating disorder, and create the foundation for lasting recovery.

Rebecca Cooper is a licensed therapist, certified eating disorder specialist, the author of “Diets Don’t Work” and the founder of Rebecca’s House Eating Disorders Treatment Program in Laguna Hills.

For more information about Cooper’s work, visit www.DietsDontWork.org and www.Rebeccashouse.org, or call (800) 711-2062.

My anorexia: How I became a survivor

About seven of us have gathered for group therapy in a large room scattered with chairs. A woman with frizzy red hair and a head that looks several sizes too big for her emaciated body sits across from me. Next to her, a statuesque blonde has a polished demeanor that belies the fact that, after lunch, staff members will try to keep her from going to the bathroom to vomit.

It’s just weeks before my 16th birthday, and I’ve been deposited here in the eating disorders unit of the Waltham-Weston Hospital in Massachusetts because, after a year and a half of starvation, my vital signs have dropped dangerously low. With my knees tucked under me to guard against the chill, though, I feel fine, and the fact that I’m the youngest person in the room gives me a smug sense of accomplishment.

This moment stands out to me now, 15 years later, because I credit what happened next with saving my life: Looking around at the ghosts of my future that bright September morning, a voice shot into my head, replacing my self-satisfaction and shocking me with the following epiphany: “I don’t want to die.”

And with that, I became one of the lucky ones.

My battle with anorexia began when I was 14. I was wrapping up my first year at a private school and at the same time coming out of an adolescent rebellion that involved a lot of dark eye makeup and short skirts. If I was going to fit in with my new Polo-wearing classmates, I figured that I would have to change my look, starting with dropping the extra 20 or so pounds of baby fat that stuck stubbornly around my middle.

One afternoon in the spring, I mentioned my diet to a delicate, ethereal-looking girl who was one year younger than me.

“All you have to do,” she said breathlessly, “is just not eat.”

It was both brilliant and incredibly obvious. Almost immediately, the gears in my mind that carry whatever glitch causes eating disorders were sent into overdrive. All of my mental energy stopped, pivoted and turned toward her suggestion, becoming completely focused on ridding my body of unwanted, excess pounds.

I weighed and balanced calories with the precision of a molecular chemist. I went from eating three meals and two snacks a day to eating one meal a day and nothing else.

As soon as summer rolled around, I convinced a friend to spend every afternoon doing hours of workout videos with me in the basement of her house. Once the sun went down, I would jog the two miles back home through the sweltering New England humidity.

When I went back to school in the fall, though, the ride came screeching to a halt. My now-bony body caught the eye of the class ballerina, who was experienced enough in such matters to notice when the flesh covering a girl’s rib or hipbone was stretched just a bit too much. She tipped off a teacher, who in turn notified my parents. 

The news was met on their end with palpable fear, and within weeks I was set up with a psychiatrist. He was the best of the best, the head of the eating disorders program at Massachusetts General Hospital, and for one hour every Tuesday night, in the basement office of his imposing gray mansion in Newton, I would sit silently as he worked his magic, peppering me with questions for which

I didn’t have any answers.

Two afternoons a week, my mother would drive me to my pediatrician’s office in Weston, where I would strip down and don a plastic gown, remove all my jewelry and empty my bladder, and then watch with delight as the numbers on the scale continued to drop.

On the way home, I never knew whether my mother’s silence meant she wanted to scream or cry.

As the year wore on, despite my continually plummeting weight, the eating disorder lost its thrill. I began to get exhausted, and my rituals became obligations that I could no longer comprehend. Food had turned into an obsession that drove me to think up ways to eat without eating. When I knew I was alone, I would take out snacks or leftovers, smell them and put them away. Other times I would chew them up and then spit them out.

But I couldn’t stop; the sicker I became, the more successful I felt.

My psychiatrist was the one who broke the news that my bags were being packed for Waltham-Weston. After getting an EKG and blood work done, I landed in his office, where he informed me from underneath his bushy gray mustache that I was going to be taken directly to the hospital.

“Like, to stay?”


It was another year or two before my weight became stable, but after that, I shut the door on what I viewed as a one-time episode. I didn’t want to think or talk about my anorexia; I didn’t understand it, and it seemed no one else did either. The details also seemed unsavory at best — I was certain that they would repulse normal people.

When I was assigned to write an article for The Jewish Journal about eating disorders several months ago by my unsuspecting editor, I took it on thinking that I was far enough removed from the topic that I would be unfazed.

I was wrong. It took shockingly little to jog the memory of the flesh on my body feeling almost parasitic, and how satisfying it once was to starve it off. But as I’ve been telling people that I’m writing this, a surprising number of women have confided that they have battled eating disorders, too. Many of them are Jewish. Many still struggle, every second of every day.

And I suppose that’s the point: to expose my thoughts and feelings and secrets to the light of day, for myself and for anyone else who might be affected. I am one of the lucky ones. But I don’t want to sit by silently anymore.

Eating disorders: Still on the path to understanding

For nearly 40 years, Sharon Pikus hid what she calls her “dirty little secret”: After an adolescent case of whooping cough caused her to vomit everything she ate, she turned the experience into a trick to lose weight. 

“I was always a chubbette as a kid, so I said to myself, ‘This is terrific — I can eat whatever I want and throw it up,’ ” recalled Pikus, now 60.

She kept up the habit for decades, eventually having to hide it from her husband and children. Even as other parts of her life were in place — her family was happy, her business was successful — her bulimia lurked under the surface, an overwhelming compulsion.

“It is an obsession, like an addiction to food,” she said. “You can just go eat [and] eat, but you have to throw up, and then you have to mask it.”

For Nancy Malvin, problems with eating began when she was 13. She came home from school one day devastated by unexpected teasing from her classmates. The incident sent her on a downward emotional spiral, which she later recognized as the onset of her lifelong battle with anorexia.

“She began losing massive quantities of weight and lying about how much food she was eating,” her sister Jennifer Malvin, now 53, remembered.

For the next four decades, Nancy tried every treatment she could find, battling her disorder ferociously.

Eventually, her weight plummeted to a terrifying 60 pounds, and her body began to fail. In the last few years of her life, Jennifer says, Nancy needed a pacemaker. With no fat cushioning the soles of her feet, even climbing stairs became painful. Her teeth fell out, Jennifer said, and “she lost her beautiful hair.”

Nancy was not at a loss for information about her eating disorder. She understood what had triggered it, had been through massive amounts of therapy in an attempt to get well, and was brilliantly analytical and insightful. “She worked on herself all the time,” her sister said. “But she used to say, ‘At the plate, I can’t follow what my brain is telling me.’ ”

By the time Nancy died as a result of complications from her disease at 51, her liver had failed. Her husband came home to find her unresponsive on the floor, and paramedics were unable to revive her.

Doctors remain baffled by the psychological causes that make people like Sharon and Nancy turn outside events into rituals of starvation or binging and purging, but it’s a question that is in dire need of an answer — anorexia has the highest mortality rate of any psychological disorder, with anywhere from 4 to 8 percent of people who struggle with the disease dying as a result of it. Bulimia is not far behind; just fewer than 4 percent of those with the disease eventually die from complications.

There is, however, some good news: Researchers are making headway in understanding the roots of the disease. Eating disorders, they’ve discovered, likely begin with a certain gene or combination of genes. From there, external factors like family dynamics and cultural pressure trigger those genes into action.

In other words, said Lynn Grefe, president and chief executive officer of the National Eating Disorders Association, “You are born with the gun, and life pulls the trigger.”

It’s taken researchers many iterations of theory to get to this point. Years ago, for instance, it was widely believed that parents were the cause of eating disorders. Given that symptoms are most likely to appear during the throes of adolescence, experts believed that budding teenagers in families with exceedingly high expectations were cracking under the pressure of overbearing parents or societal pressures.

“In the olden days, we used to say that perfectionistic families, those that dealt poorly with conflict and those that weren’t willing to address disputes, were the families that anorexia would show up in,” said Dr. David Rosen, the chief of the teenage and young adult health section at the University of Michigan Health System. “There is less sense now that those family dynamics are as important — they play a role, but more in how [the disease] gets perpetuated over time than how it develops.”

Anorexia and bulimia were also once believed to be the sole province of successful, high-achieving affluent white girls — a prototype that easily applies to many Jewish girls. And while young women with those characteristics are not unusual patients to see, Rosen said, now “we see boys and people of color and of every socioeconomic background; eating disorders have become equal-opportunity illnesses.”

Another myth is that eating disorders are a byproduct of unrelenting advertisements and entertainment featuring impossibly thin women. While those images certainly aren’t a positive influence on girls, they also don’t single-handedly cause disease, said Cynthia Bulik, director of the eating disorders program at the University of North Carolina at Chapel Hill.

“It’s so convenient to have these face-value explanations; it makes sense [to people] that the media shows skinny people, and that must cause eating disorders,” she said. “It’s a simple explanation, but it’s an inaccurate explanation.”

The fact that eating disorders have genetic underpinnings has been accepted in the medical community for more than 10 years, after a number of studies were published that demonstrated a familial tendency toward the disease. One such study was published in the American Journal of Psychiatry in 2000. Researchers looked at 2,163 female twins, and by examining the women who were found to have anorexia, concluded that when it comes to the likelihood that someone will develop the eating disorder, genes play about a 58 percent role.

In the same year, researchers at UCLA and the University of Pittsburgh compared the likelihood that a relative of someone with anorexia or bulimia would also develop the disorder, compared to relatives of people without either disease. They found that among family members of participants with anorexia, the rate of the disease was 11.3 times as high as it was among relatives of healthy participants. For relatives of bulimic participants, the rate of bulimia was 4.3 times as high.

Researchers are using this information to guide them in their studies; many are now trying to pinpoint a specific gene or group of genes that these families have in common.

In the meantime, experts have been able to identify certain personality traits that might make people more susceptible to anorexia or bulimia. Individuals with both disorders tend to be obsessive or perfectionists, and many steer unusually clear of risk. Bulimics often have an added tendency toward impulsivity.

Anorexia and the new values of courtship

The New York Times article last week about the explosion of anorexia and eating disorders in the orthodox community highlights a tragedy that has long been buried. About four years ago I published a column about an eighteen-year-old girl my daughter knew at seminary in Jerusalem who died of anorexia. The seminary denied it was the cause and cited some other illness, even though the girls at the seminary watched her wasting away with the administration seemingly oblivious.

The tragedy is not only the danger posed to religious girls with eating disorders but rather the growth of corrupt values in the orthodox community. The New York Times highlighted how matchmakers are calling about girls and asking what dress size they and their mothers are. What does this have to do with Jewish values? Sure, a man has to be attracted to a woman. But the narrow definition of the body as the only ingredient of attraction is a betrayal of the traditional Jewish definition of feminine beauty.

Time was when a Jewish woman’s comeliness was determined holistically and was based on five key components: her body, her mind, her heart, her piety, and her personality. Now, it’s been reduced to her dress size. Stick-thin scarecrow-like features are the foremost determinant of attractiveness.

To be sure, being overweight is not healthy. But women who focus only on their bodies to the exclusion of their souls are equally unhealthy. And religious men who have practiced Judaism their whole lives but are blind to a woman’s righteousness and virtue, focusing exclusively on her form to the exclusion of her substance, are even more unhealthy.

The crisis in orthodoxy today is the practice of Jewish ritual to the exclusion of Jewish values. And in no area is this more evident then in the increasingly shallow dating values that are betraying our community. King Solomon’s ode to the ‘Eishes Chayil -Wife of Excellence’ that we chant every Friday night risks becoming an empty refrain, with men paying lip service to its central proclamation that ‘physical beauty is misleading, but a woman who fears G-d is truly to be praised.’

I would never have thought we orthodox Jews would arrive at a stage where our young men of marriageable have become so one-dimensional that their superficiality and pickiness would begin to literally kill our young women. That their mothers – women themselves – are colluding in this corruption by calling up to ask a girl’s dress size in the same breath as asking what her level of Torah observance is doubly tragic.

The New York Times article also cited the immense pressure that orthodox women feel to marry at a very young age and how they feel themselves to be failures if they are in their mid-twenties and not yet married with a few children.

I have long advocated marrying young – for orthodox and secular alike – because it allows a couple to grow up together and solidify their union with life’s formative experiences. But this has to be balanced against the desire of the orthodox community to see their young women educated and using their minds and not just their wombs. It’s a beautiful thing to see orthodox Jewish seminaries for women bursting at the seams. Jewish women today are being exposed to the great texts of Judaism, from Talmud and Midrash to Halakha and Chassidus. Stern and Touro are graduating orthodox girls with degrees in international relations and public relations, proficient in the sciences and mathematics.

Secular Jews have long dismissed the orthodox attitude toward women as demeaning and misogynistic. They argue that we treat our girls as baby-making machines who belong in the kitchen. But the highly educated orthodox Jewish woman gives the lie to these malicious accusations. Should we be so stupid as to prove them right by making women feel so much pressure to be married by the age of twenty that failure to do itself constitutes failure? Is it not our responsibility to demonstrate that a woman can maximize her fullest intellectual potential alongside having a family and that she need not choose between them.

I am, thank G-d, the proud father of nine children. People often ask me how I have time to do my professional work with a large family. I answer them that only in the modern world have we created this false notion that family is an impediment to achievement. Queen Victoria had nine children but ruled the largest land empire in the history of the world. Rose Kennedy, an accomplished woman in her own right, had nine children and is the matriarch of the greatest political dynasty in American history. The list goes on.

I want my daughters to marry young and to marry virtuous men. I shudder at the idea that after raising them to embody the virtue of the Jewish matriarchs they should meet orthodox Jewish suitors obsessed with their external beauty to the exclusion of their inner G-dly commitment. And if that’s the case, could I not have found that in the secular world?

I have spent my life critiquing the secular culture’s attitudes toward the feminine, especially in my book ‘Hating Women,’ where I decry a culture that has reduced women to the libidinous man’s plaything. But we in the orthodox community dare not make our own mistake of reducing our women to pretty baby-making mannequins. Our women must possess, and be appreciated for, intellectual and spiritual substance.

Sure, family in Jewish life is the most important thing. And dating recreationally for ten years – as is common in secular society – is scant preparation for the life-long commitment of marriage. I am a counselor to secular singles who suffer the effects of the recreational dating culture. They often experience the pain and heartache of going in and out of relationships and the numbing affects of sexuality practiced as a hookup.

Orthodox Jewish life is meant to offer a radical alternative, one where romance is valued and sexuality, reserved for the sanctity of marriage, is practiced as the highest expression of human intimacy. But viewing women as either the orthodox male’s frum Barbie, whose foremost responsibility is not learning Torah and practicing mitzvos but going on the treadmill and pumping iron, or seeing a woman’s education as inconsequential and making her feel old and discarded if she is not married by twenty-three, is hardly an attractive alternative.

Shmuley Boteach, ‘America’s Rabbi,’ is one of the world’s leading relationship experts and the recipient of the American Jewish Press Association’s Highest Award for Excellence in Commentary. Among his 25 books are such classics as ‘Kosher Sex,’ ‘Judaism for Everyone,’ and, most recently, ‘Renewal: A Guide to the Values-Filled Life.’ Follow him on Twitter @RabbiShmuley.