EATING DISORDERS AND THE JEWISH COMMUNITY: WE NEED TO DO BETTER

A topic I am particularly passionate about is health but not health in the way most people think about it. Health, contrary to popular belief, is not simply physical and while exercise and nutrition are important, they actually play the smallest role in what influences our health. Whenever I say this, I always gets lots of pushback but the reality is that health is extremely complex and highly individualized and we do a huge disservice to it when we reduce it to Pilates and salads (both of which I really enjoy, by the way). 

What you may not know is that a lot of the research on “health” tells us that it is actually our mental and emotional well-being that have the greatest impact on our physical health and longevity. The longest Harvard study, (The Harvard Study of Adult Development) found that the key to good health and a long life was close, meaningful relationships. Not the frequency of gym workouts, not BMI (body mass index), not even whether or not someone went keto; but how much love and connection people have in their lives.

It is well documented that stress and poor mental health directly impact the body, so if we want to support individual and communal efforts to achieve true health, we need to stop focusing solely on the size and gravitational pull of our bodies and instead pay attention to our minds, our physical environments, our behaviors and our relationships. When we make bodies and weight the focus, we cause harm to people's health and well-being. When we focus on only eating "healthy" foods we moralize food and create feelings of guilt and shame. The reality is that all food can be healthy. Yes, all food, unless you are allergic to it, it's raw and supposed to be cooked or it's spoiled. When we remove foods from the home because of temptation or fear we create guilt, confusion and mistrust. When we make comments on kids' weight, shape or the way they eat we tell kids that their bodies are wrong which can cause them to feel rejected, unloved and unsafe in their skin. You know what is healthier than any food ingredient or form of exercise? A healthy relationship with food and body.

So, what can we do?

Adults, medical providers, therapists, teachers, community leaders and family members (basically, everyone) learning about what health really means is one important step in the direction of helping protect our kids from diet culture and eating disorders.

Dieting is one of the most important predictors of an eating disorder and before I delve more in to that I want you to understand what exactly diet culture is. Diet culture, according to Christy Harrison, registered dietitian (RD) and author of Anti Diet, is a system of beliefs that:

*Worships thinness and equates it to health and moral virtue, which means you can spend your whole life thinking you’re irreparably broken just because you don’t look like the impossibly thin “ideal.”

*Promotes weight loss as a means of attaining higher status, which means you feel compelled to spend a massive amount of time, energy, and money trying to shrink your body, even though the research is very clear that intentional weight loss fails more than 95% of the time.

*Demonizes certain ways of eating while elevating others, which means you’re forced to be hyper-vigilant about your eating, ashamed of making certain food choices, and distracted from your pleasure, your purpose, and your power.

*Oppresses people who don't match up with its supposed picture of “health,” which disproportionately harms women, people in larger bodies, people of color, and people with disabilities, damaging both their mental and physical health.

Diet culture does not just mean being on a diet because you do not have to be on any official diet to be caught up in the culture of dieting. Also, there are many people who have to eat in a way that they refer to as a “diet” because of medical (like celiac or diabetes), ethical (vegetarian) or religious reasons (kosher) and they may not actually be engaging in diet culture. That being said, diet culture has sunk its claws into the medical field as well so it can be hard to manage medical conditions without diet culture creeping in. How many diabetics have been told they can’t have carbs? How many women with PCOS have been told they have to cut out dairy or gluten? 

The scary reality is that eating disorders are the deadliest form of mental illness and they are on the rise. Contrary to popular belief, you cannot tell just from looking at someone if they have an eating disorder. Binge eating disorder, orthorexia, anorexia, bulimia, ARFID (avoidant restrictive food intake disorder) can occur in people of all body sizes. In fact, only about 1% of individuals with anorexia are underweight. Binge eating disorder (BED) is the most commonly diagnosed eating disorder and it is a very misguided misconception that people in bigger bodies have a higher prevalence of BED. 

Eating disorders don't happen overnight. For many people, it was a comment from a caregiver, family member, (matchmaker.... cough) or medical provider that started the ball rolling. Below are just a few examples of ED triggers. There are many other more complex factors and triggers that can cause an ED/disordered eating that I am not covering here.

Some of the things that have triggered eating disorders for those who are struggling are: 

*A medical provider making a comment about weight or encouraging weight loss or restriction.

* Having a medical condition where unnecessary or ill-informed restrictive nutrition practices were recommended (like PCOS, diabetes etc.)

*A well-meaning parent removing certain foods from the house to be “healthier”.

*Witnessing family members dieting or struggling with their weight and body.

*Being body shamed at a young age.

What starts out as seemingly innocent "healthy" changes can quickly spiral into full on eating disorders or disordered eating. From there begins a lifelong struggle with food and body. In many cases it can become life threatening. 

If you have pre-teens or teens, look out for statements such as:

I'm just going to be more careful.

I just want to lose a little bit of weight.

I'll walk more.

I'll stop eating carbs and eat more vegetables.

I'm gonna be healthier.

I'll cut out sugar.

No more white flour for me.

These statements can be a red flag of a more serious issue brewing. If you hear your child say something like this, take a deep breath and get curious. You could say something like “Tell me more about what you are thinking about this?” or “What does being “healthier” mean to you?” Also, be on the look out for a sudden obsession with exercise, especially if they have a hard time taking a day off from exercise, they are exercising multiple times a day or they are exercising in dangerous weather conditions such as excessive heat or at times of day that could be interfering with their sleep or overall safety (ie; very early in the morning, when it is dark outside, inclement weather).

As parents, we want to teach our kids habits that support their health and well-being, but that is actually different from focusing on body size. Encouraging our children to lose weight sends them the message that there is something wrong with their bodies, that they are not good as they are, and that they need to change their body in order to be loved, accepted, have confidence, be successful and healthy. This message is misguided and can set the stage for a lifelong struggle with body image and food.

What we have learned is that kids do not belong on weight loss diets. In fact, the data indicates putting children on diets is actually counter-productive and dangerous. Both because it can damage to their physical health, with long term health issues such as osteoporosis, delayed menstruation, impaired muscle development, stunted growth, learning/attention issues among other, possibly irreversible, problems and because of the detrimental effects it has on their mental health as well.

Restricting a child's calories or food increases the likelihood of sneak eating, bingeing behavior, eating disorders, low self-esteem, trauma, anxiety, depression, self-harm behaviors and suicidality. Research repeatedly shows that diets typically lead to weight cycling (yo-yo dieting) which has been proven to be even more detrimental to health than simply being "overweight" your whole life. Also, dieting has been shown to ultimately put individuals (kids included) at higher weights than those in bigger bodies who don’t diet.

A child who is put on a diet is five times more likely to develop an eating disorder. Remember: Eating disorders have the highest mortality rate of any mental illness. During the pandemic, there was a sharp rise in eating disorders, particularly in teens and the trend is continuing upward. Inpatient treatment centers are at capacity and have tremendous waiting lists. Helplines have seen a 40% jump in volume since March 2020. The strongest predictor of an eating disorder? A history of dieting.

In 2016 the American Academy of Pediatrics (AAP) advised against prescribing dieting and weight loss interventions for kids (which makes their new “guidance” about weight loss surgery for kids even more horrendous. I’ve written about it here previously). It is alarming to me that there are still pediatricians giving this “advice” to parents. Children are supposed to be growing, not shrinking. They are supposed to gain weight. During their puberty years it is normal and healthy for children to gain anywhere from 40- 60 pounds (sometimes more depending on their genetic makeup). When it comes to a child’s growth it is more important to look at trends in growth over time and that doesn’t always look linear either. Your child’s growth is unique to them and it’s important that you internalize this fact and tell them this. Some kids might be bigger and some may be smaller. Body diversity is a reality and there is no one right way for a body to look.

Humans are born knowing what our bodies need. As new parents, we allowed newborn cries to tell us if they were hungry, tired, or needed a new diaper. They let us know when they were full from a feeding by turning away (and good luck trying to get them to take more at that point, right?). They are born intuitive eaters. Somewhere along the way though kids are taught they can’t trust those inner cues anymore. The adults in their lives suddenly take over and know better.

“You had enough now.”

“One more bite, you didn’t eat enough”

“Finish what’s on your plate if you want dessert.”

“You don’t need that, you already had….”

They are taught that eating “too much” (there is no objective right amount. Every human body has different nutritional needs) is bad and that certain foods are “junk”, “toxic”, “garbage” or “unhealthy” and other foods are better and “healthier”. When our kids want those “bad” foods they feel guilt and shame and internalize the message that they are bad too. I often talk about boundaries and consent for our kids. Well, this is one of the earliest boundary violations a child can experience. These mostly well-intentioned actions give a child the message: “I’ll tell you what is good for your body, no matter how you feel. You can’t be trusted to know what you need”.

Instead of trying to shrink a child's body, we can teach them to trust their innate cues, honor their hunger and enjoy the pleasures of eating without guilt or shame. We can teach them the joy of movement and how it is a wonderful tool to enhance our physical and mental health. We can teach them that health is multi-faceted and it is not something you can see. All bodies are good bodies. Healthy people come in all shapes and sizes. Also, we can lead by example. How we talk about food and our own bodies has a profound influence on how kids view food and their own bodies. Do you believe certain foods are good or bad? Do you believe that being in a bigger body is a result of moral choice? Do you believe thin bodies are better? More attractive? What do you say about people in bigger bodies? Did you struggle with weight as a child? How does dieting feel? What is your current relationship with your body, food and exercise? Do you think “fat” is a bad word?

I encourage parents to consider where you have gotten these ideas from. We live in a culture that is obsessed with thinness, often at any cost. There is a 75-billion-dollar industry (and growing) that profits from making us believe that fat is bad, thin is healthy, and more attractive, smarter, more employable and more worthy. We compliment weight loss, when it could be the result of grief, depression, illness, or an eating disorder. We assume weight gain is bad when it could be the result of a lifesaving medication, healing from illness, surviving a pandemic, recovering from disordered eating or an eating disorder. STOP COMMENTING ON PEOPLE’S BODIES. 

It is important to understand that losing weight and improving health are not the same thing. Very often we give credit to weight loss for health improvements when in reality it is behaviors that you engage in that impact your health, among many other factors that are not within our control like genetics, chronic illness, a history of trauma, race etc.

If you are concerned about your child being treated differently for their size, you cannot solve this problem by treating them differently because of their size. You can teach them that regardless of size they are valuable and loved.

If your pediatrician prescribes weight loss, I strongly suggest telling them that you will not be discussing your child’s weight or weight loss in front of your child (if possible, you can hand them a card with this request written on it) and instead discuss any medical concerns without your child in the room. If there is a medical concern ask what they’d suggest for a child in a small body with the same issues (because there is no one medical issue that occurs exclusively in bigger bodies). If your doctor continues to push weight loss, please consider finding a new practitioner. If you are a medical provider reading this, please read about the dangers of medical weight stigma.

Are there times when weight may be a concern? Yes, but the answer is not to prescribe weight loss. Sudden weight changes in EITHER direction can be very concerning yet somehow, we are “so jealous”, celebrating and praising one direction while panicking about and shaming the other. Instead, focusing on the behaviors that support general good health have far greater benefits in the long run. Increasing fruit and vegetable intake for your family (not just one child), incorporating more movement into your life as a family, getting better sleep, managing stress by teaching a variety of coping skills, stopping smoking and reducing alcohol consumption are all behaviors that improve health without focus on weight. 

Health is so much more than what we eat and how we move. Those are just two behavioral factors. Health is also how we feel about ourselves and our overall mental health, whether or not we live in a safe home and neighborhood, how connected we are to community and spirituality, how stable we are financially, our access to quality medical care, the availability of food, access to education etc. 

Instead of teaching kids that health is about their body size, instead we can:

Help them learn to trust their bodies regardless of size.

Help them find ways to move that they enjoy.

Create structure around meals and snacks when they are young (learn more about Division of responsibility by Ellyn Satter).

Offer a variety of foods in tastes and textures and consider their preferences.

Let them eat until they are truly satisfied without judgement.

Not label foods as good or bad. All foods have a time and a place.

Make “fat” a neutral word in your home and let your kids know you don’t use it as an insult. It just is. Just like there are tall people and short people, there are thin people and fat people and everywhere in between. 

Teach them that commenting on people’s bodies is never okay and that we are all so much more than our bodies.

Teach them about body diversity and the natural changes to expect during adolescence including the necessary weight gain.

What your child needs from you is love, support, and understanding that their worth is not connected to their body size because a lot of messaging out there is going to try to tell them otherwise. We all want to set our kids up for success and that's a beautiful goal. The best way to do that is helping them have a healthy relationship with themselves, regardless of what their bodies looks like.

One additional note I want to make is that over the years I have seen Rabbis get up at the pulpit or take to their social media to promote dieting or shul “weight loss challenges” (wish I was making this up) while somehow tying it to being a better Jew. Knowing what we know about the risks of dieting, there is NEVER a time where this is appropriate. As I’ve discussed in this article and extensively in my other writings and lectures, you can talk about health and honoring your body without demonizing foods or promoting weight loss. Leaders bear extra responsibility in this regard and as a result need to be extra sensitive.

This past week, The Meaningful Minute podcast interviewed Atara (Herrmann) Lasky and her parents Chani and Daniel Herrmann about Atara’s experience battling an eating disorder beginning when she was in 8th grade (currently, kids develop eating disorders as young as 8 years old). Her parents share their experience coming to terms with her illness and helping Atara find recovery. Atara shares very openly and candidly about the start of her ED and what factors fueled and maintained her illness and how she learned what “health” really means. The Herrmanns and Atara offer some really important advice and guidance for parents, families and the community. It is a very important conversation that I hope will create more awareness of eating disorders, its causes and presentation. Many eating disorders are preventable and with the proper education around this topic we can avoid so much unnecessary pain and suffering.

Some recommended reading on this topic is: Intuitive Eating by Evelyn Tribole MS, RDN, CEDRD-S and Elyse Resch MS, RDN, CEDRD-S, FAND, Health At Every Size by Dr. Linda (Lindo) Bacon, Anti Diet by Christy Harrison MPH, RD, CDN, Fat Talk by Virgina Sole Smith, How To Raise an Intuitive Eater by Aimee Severson MPP-D, RDN and Sumner Brooks MPP, RDN and Body Happy Kids by Molly Forbes.

As we go in to the New Year, may we all be able to embrace true health for ourselves and our loved ones!