Towards a Healthier Self
Eating disorders are serious and complicated illnesses. Estimates show that between 9% and 12% of people will be affected by an eating disorder at some point in their lifetime. For Jewish women, studies find us to be up to double that risk, corresponding to between 18% and 24% of us being directly affected by an eating disorder. This does not include those of us affected by body-image issues and disordered eating practices. Those numbers are closer to 80%. Scary!
Eating disorders are among the deadliest mental illnesses, second only to drug overdoses. Those with an eating disorder are 11 times more likely to attempt suicide. 95% of eating disorders are diagnosed in those between 12 and 25 years of age, but there have been those diagnosed as young as five and up to and including 80-year-olds. I have personally heard stories of women in hospices, that is end-of-life care, who refuse to eat anything that they deem fattening or decadent, as they don’t want to gain weight! I heard about a widow at her husband’s funeral speaking with friends and family, telling them how proud she is that she still wears the same size clothing she wore when she was just 18. The depth of the hold that body image and appearance ideals have over women is unnerving, even for those with a more positive and healthy sense of self.
There is not a clear understanding of why some people with similar risk factors and propensities develop eating disorders while others do not, but we do know that there are numerous factors that contribute to eating disorder onset. Genetic risk contributes to between 40% and 60% of the risk for developing an eating disorder, while other general risk factors include societal and social expectations, personality, physical and psychological factors and family dynamics among others. We, as frum Jews, must contend with all of these, as well as some unique to our community.
Food and its role in our lives does come with an increased propensity for risk. Food is a wonderful brachah from Hashem that is both a promotion of health and a protection of life. Food plays a critical role in our oneg Shabbos and Yom Tov, and in all our simchos. However, the sheer abundance and time spent in the planning and preparation, as well as the weekly occurrence of large and extensive meals, creates a paradox and a challenge for even the least body obsessed. On the one hand, cooking and baking large meals is emphasised and expected, yet often the message given to women and girls is to be careful not to enjoy it too much. We should be able to cook and bake well, but not indulge ourselves. For those struggling with their body image, Shabbos, Yom Tov, simchos and parties in school all create great stress, confusion and risk. Food is further complicated by the fact that it is something we need daily. When someone has an addiction to alcohol, drugs or gambling, the solution is to remove it from their lives completely, but this is not possible with food. Rather, we need to find a way to make peace with it within the context of our lives.
The pressures felt by women in our community increase risk as well.
- Perfectionistic: The need to be perfect and exemplify perfection in all we do is particularly damaging. Our expectations of perfection, to be and to accomplish what everyone else is, and more, and to exemplify that “superwoman ideal”, leads to excessive pressure and can become crippling to those who feel they are falling short. Our overall mindset—that we should be able to do it all, to push through any setback or struggle and get the job done no matter what—places huge pressure on women and girls of all ages, wreaking havoc on our self-esteem, self-compassion, and self-image. This creates and increases our risk for eating disorders. In fact, many girls express sadness and frustration at their inability to be authentic because they must act as if they have it all together and that all is going well.
- Academic: Girls are expected to be model students and get good grades. I’ve heard many stories of girls deeply distraught over any “B” on their report card, believing that anything less than an “A” is a complete failure. This is particularly difficult for those who struggle scholastically. There is also substantial academic pressure to get into the “right” seminary in order to ensure the proper shidduch. There is an overarching subtle message that you must do well in school in order to marry well.
- Shidduchim: This is a multifaceted category of pressure. The pressure to be a desirable partner is created from a very young age. Girls as young as eight or nine are discussing the expectation to be thin and beautiful, and have been overheard discussing jokingly that without that they may not get a “good” shidduch. And sadly, they are correct. I was told the story of a girl whose principal called her mother in when she was in 6th grade. The principal said that the mother should start paying attention to the girl’s weight right away so that she won’t have shidduch issues later on. The girl was only 11 years old and was in the process of going through puberty. Today the girl is emaciated. The person who told me the story wondered, “What did we do to this girl and at what cost?”
Shadchanim regularly advise girls to lose weight and just get a first date. I have heard many stories from mothers who have said that shadchanim told them that they could get a date for any issues, just not for someone who is overweight; that is the hardest. Mothers too, while screening prospects for their sons, will eliminate girls based on their size or, even more surprising, a girl’s mother’s dress size. This focus on appearance increases risk. These young impressionable girls watch the struggles of their siblings, cousins and older friends and know what is in store for them. There is a constant pressure to be ready and attractive for the shidduch, to ensure you have what you need on your resume and that you conform to the requisite physical expectations.
- Familial: This is a complicated and influential risk factor category, meriting an entire article of its own. In short, there are dynamics between mothers and daughters, issues with how a mother models her own food and body image behaviours, how fathers speak to their daughters about their outward appearance, how fathers speak to mothers about what they are eating and how they look and how siblings model things and speak to one another. There are stories of grandparents paying their grandchildren for each pound of weight they lose, mothers who won’t let their daughters go to camp if they do not lose a predetermined amount of weight, mothers who don’t let their daughters eat what the rest of the family is having and mothers who advocate for diets with severe restrictions. These all add to risk, as does heaping an abundance of praise and reinforcement for losing weight. There are just so many places where things can go awry. While intentions are no doubt sincere and come from a place of not wanting our children to be bullied or ridiculed, the outcome is actually worse. Further, as our girls tend to grow up faster than their secular counterparts, with added pressure to take on more responsibility in the home and with younger siblings, as well as needing to mature early to be ready to marry young, the risk is increased.
Sadly, we tend to stigmatise people for asking for help, for talking about certain topics that we believe should be kept private, for questioning anything religious and for mental health struggles in general. In our community, eating disorders are more stigmatised than other mental illnesses. Sadly, regarding mental illness, there are parents who want to know why their child has so many appointments. They tell them it’s so expensive. They’ll ask them if they realise how much they are investing in them. This prevents the girls from asking for help. There is also a lot of shame and secrets around physical body development, what girls are told, what they can ask about and what they are meant to know.
The homogeneity of our expectations for our girls to accomplish and be what everyone else is increases risk. This leads to struggles with asserting independence and developing unique talents and abilities. The Baal Shem Tov stated, “Everybody is unique. Compare not yourself with anybody else lest you spoil G-d’s curriculum.”
So, What to Do?
The question then becomes: where then do we go from here? How do we counteract these seemingly insurmountable challenges? Can we help our daughters grow up without eating and body issues? The first step is having these important conversations. Educating ourselves about our unique risk factors and struggles creates awareness, and all knowledge is power. As Rabbi Lord Jonathan Sacks, a”h, said, “Moshe knew that you cannot change the world by externalities alone, by monumental architecture, or armies and empires, or the use of force and power. There is only one way to change the world, and that is by education.”
What my organisation, Atzmi, is working on is to create programmes specifically tailored to the needs of our girls, in their schools, to help promote self-esteem, and self-compassion, reduce the focus on outward appearances and foster body acceptance. It is a tall order, yes, but there are empirically proven methods for success. Our programmes will also encompass educational seminars for parents and, very importantly, for the teachers and educators who interact with the girls daily.
That said, there are things we can do in our own homes to promote change and create healthier mindsets, both for ourselves and for our children. After all, Hashem doesn’t make mistakes. He is perfect and His creations are perfect. Rebbe Nachman of Breslov stated, “The day you were born is the day Hashem decided that the world cannot exist without you.” Hashem created you exactly how you need to be.
- Shifting the focus: Very often we are paralysed by numbers on the scale or by the numbers or sizes inside our clothing. We must shift our focus and rethink our relationship with food. Food is nourishment. Food sustains us. We need food several times a day, each and every day. Paying children or bribing them to lose a certain amount of weight is counterproductive and dangerous.
- Food should not be used as a reward: Not in school, not for losing weight, not for going to camp, not for anything. When food is used as a reward or reinforcement of a behaviour, healthy eating habits are undermined, and this can potentially disrupt a child’s ability to accurately recognise and respect hunger and fullness signals and can make food about feelings of achievement or an alleviation of a negative emotion. It is so important to avoid using food as a reward, because the short-term incentive can have long-term effects on the child’s relationship with food. Children can become reliant on food to soothe themselves and regulate their emotions, and the use of especially sugary treats can result in kids craving these types of sweeter foods more often.
Likewise, food should not be used as a punishment—you cannot eat this food or do this thing until you lose a certain amount of weight. Food needs to be used as a tool for our health and it should be recognised as such. We must be so careful how we speak to our daughters about food, what they eat, how much they eat and what they weigh.
- Rethinking priorities: We teach our children from a young age to focus on middos, what is on the inside, as that is what matters and is fundamental to our relationship with Hashem. Sadly, our behaviour often says the opposite. Frequently, we model and reinforce externality and physicality as things we aspire to—be beautiful and thin in order to have real value. We praise those who lose weight or are physically pleasing, highlighting how important these things really are to us and reinforcing the belief that in order to be good you have to look good.
Think about the first thing we say when we see a young girl: “You look so beautiful (or adorable or lovely)” or “I love your dress” or “Your hair bow [headband, braid, style, etc.] is so pretty”. Even when we meet a woman on the street we compliment her on her clothing, or if she lost weight, or how her sheitel looks—all about how she appears physically. But, as Yidden, this is not where our focus is meant to be. We must reduce our emphasis on externals, because when we focus primarily on how people look, we reinforce the subconscious belief that this is the most valuable and important thing to us. This does not mean we cannot acknowledge anything physical; rather we must do that sparingly and redirect what we compliment, ensuring that we highlight middos and inner character traits. Instead of telling someone they look beautiful, perhaps tell them it’s so nice to see them again or ask them how they have been or compliment something about them that you missed or perhaps ask about something you’d like to hear about that you know they experienced. It will take time and deliberate practise, but this shift will ultimately have huge implications for both ourselves and our girls. There is nothing wrong with some focus and compliments on our physical looks, but we have to be so careful not to focus solely on that as a form of praise, as girls feel that without it they have failed in some way.
- Stop modelling perfectionism: It is critical that our children see us acknowledge that we are not perfect, and that that is absolutely normal and okay. We work so hard to be superwomen: having children and taking care of them, cooking elaborate meals, cleaning and taking care of the house, entertaining, learning, davening, and working. If our children cannot see us acknowledge that we are not perfect, that life is not perfect and that we too sometimes get overwhelmed and make mistakes, then they do not have the tools to cope when they feel they have not lived up to our standards and expectations. They feel less than they should be and often don’t even know how to ask for help. This can lead to all kinds of negative coping strategies that are detrimental, both mentally and physically. Further, those mothers who need help with their own food and/or body issues must work on that if they want to be able to successfully make a change in their daughter’s mindset. Modeling is the primary way children learn. It does not matter if we say that we don’t talk about food in front of our kids. If they see us disparage our bodies, make comments when we pass mirrors, talk on the phone to friends or family about our insecurities in ourselves, then they will develop similar issues. Full stop.
- Educate: Don’t shy away from, or refuse to talk to, your child about the real dangers and influences of social media use. Talk to them about the images they see and how they are not realistic or real. Explain how they are filtered and altered, only showing the perfect side of someone’s life. Tell them how social-media use, or overuse, can lead to anxiety, depression and low self-esteem as well as feelings of envy and jealousy. Explain to them how social media can make them feel as if they are less worthy than others.
- Reducing the stigma: Baruch Hashem there have been inroads in our community regarding mental health stigma, but sadly there is still a long way to go. There are parents who refuse to get help for their children with issues such as speech, anxiety or OCD because they are worried about what that will lead to for them and their family further down the road. It is even worse for those struggling with an eating disorder. Many go untreated for fear of the stigma. We need to realise that those in need of help for their mental and emotional health should be treated equally to those in need of medical intervention for a physical disease or ailment.
- Education, prevention and increased awareness: Developing a healthy relationship with food must start at a young age, as attitudes and perceptions that may ultimately contribute to disordered eating are developed in children as young as five. Parents, educators and health professionals need to understand that our community has unique risk factors for disordered eating and eating disorders and know how to recognise the symptoms and signs that accompany them. Programs must also be instituted in schools to bolster self-compassion and body acceptance and reduce the focus on outward appearance. The focus must be on physical health, not on weight or body size.
Being beautiful, both inside and out is part of being holy. Taking care of our physical body is as important as taking care of our soul. We actually bring out the beauty of our soul through proper care of our body. Rav Avraham Isaac Kook said that sometimes “we forgot we have a holy body that is not less than our holy spirit”. We must remember to treat it with respect and dignity and with the utmost care.