Orthodox Eating Disorders - Unorthodox Treatment

For a while now there has been a slowly forming consciousness in society, both on and off the web, that Orthodox Jewish religious communities may have a higher than average incidence of eating disorders among the young women.  There have been many posts and articles discussing an Orthodox Jewish eating disorder connection.  Here are some of the best (in WNL's opinion):

Kelli Kennedy, writing for the AP at MSNBC's Women's Health Section, has an interesting overview of  conservative Jewish society as a possible breeding ground for the stresses that are believed to possibly initiate disordered eating behaviors.  She includes the following observation:

When Dr. Catherine Steiner-Adair arrived in Israel more than a decade ago amid pleas from Jewish activists alarmed by a spike in eating disorders, she recalls patients were so afraid to get help that they sent a proxy.

"A nurse would come up to me on the street and say, 'Please help me. I'm here on behalf of a 19-year-old girl who's lost 30 pounds but she can't ask for help because she comes from a very religious family and they think it's good (for her to be underweight) because it's better for marriage making,'" said Steiner-Adair, a clinical instructor in Harvard Medical School's psychiatry department. "I was overwhelmed by the needs and the requests."

In an article in the NYT headlined "Rabbis Sound Alarm..." Roni Rabin explains some of the pressures of Jewish life, with the addition of some statistics.  As you can imagine these are hard to come by:

There is little research to indicate how many women are in a similar position. Israeli studies consistently find high rates of disordered eating among Jewish adolescents but not Arab ones, and Israel’s rate of dieting is among the highest in the world — more than one woman in four — though obesity rates are relatively low.

Data about American Jews is limited, but two small studies have reported high rates of disordered eating in certain communities. One of those, a 1996 study of an Orthodox high school in Brooklyn, found 1 in 19 girls had an eating disorder — about 50 percent higher than in the general population at the time. The 1996 study was done with the agreement that it would not be published. The other study, done in 2008, looked at 868 Jewish and non-Jewish high school students in Toronto and found that 25 percent of the Jewish girls suffered from eating disorders that merited treatment, compared with 18 percent of the non-Jewish girls.

Jewish communities are struggling, just like the non-Jewish ones, to figure out how to repair affected women (and some men), re-establish normal body image and relationship to food, eating, and exercise. Esther Altmann, Ph.D. a clinical psychologist with a specialty in the treatment of eating disorders and adolescence in Manhattan, has written an eloquent, multifaceted article on Jewish life and eating disorders which covers everything from marriage pressures to a possible Holocaust connection.   She emphasizes the difficulties of treating these disabling conditions, but also describes the variety of responses Jewish organizations have mobilized to help their daughters.

For insight from the heart of Orthodox Jewry, there's this sensitive article describing the difficulties of treating observant teens in regular facilities from CrownHeights.info.

Up until recently all treatment of eating disorders has focused on eliminating and controlling psychological abnormalities while supporting eating with in-patient supervision and feeding tubes.  Much of the clinical time is spent exploring family dynamics, coping skills, and personality disorders which presumably result in, among other things, eating abnormalities.

But what if this approach is backwards.  What if the disorder really is about eating/not eating enough food, and the anxiety, obsessive behavior, etc. are the result of malnutrition?  Read on -

A NEW APPROACH TO EATING DISORDERS

"The U.S. Food and Drug Administration announced on March 31 that it had cleared Mandometer® for the treatment of patients with eating disorders.

Mandometer® is an innovative device that provides biofeedback allowing individuals to monitor their rate of eating and their development of satiety during meals and in comparison to those eating normally. Once patients learn to adapt to a normal eating pattern, they are able to normalize their body weight.

The device has been shown to be effective through randomized clinical trials for the treatment of eating disorders. Those trials have demonstrated that 75 percent of the patients treated with the Mandometer® method recover and 90 percent remain healthy over five years.

This breakthrough program was developed by Cecilia Bergh, Ph.D., and Per Sodersten, Ph.D., two researchers at the world-renowned Swedish academic health center, the Karolinska Institute in Stockholm, Sweden." (Press release from MedicalNewsToday.com)

This article at HealthHabits.ca explains how the combination scale and computer program works to retrain those recovering from an eating disorder to eat like a normal person, at a normal speed, and to begin to recognize satiety signals that have been suppressed or damaged.  It is not magic - just biofeedback - and the developers at the prestigious Karolinska Institute are claiming success rates and, more importantly,  maintenance rates to the 5-year-mark.

Using a series of informative videos from several sources, including interviews with Dr. Bergh and Dr. Sodersten, the article explains that the Mandometer was developed in 2003 by researchers at the Karolinska Institute to test their theory that restrictive eating behaviors causes psychological disorders (anorexia, bulimia, binge eating, etc) rather than the other way around - the way eating disorders have been understood.  If their theory was correct, they guessed that retraining eating behaviors would cause the obsessive behaviors to disappear, without treating them at all.  In fact, in one video, Dr. Bergh says raising family or self image issues makes things worse!

The best thing about the videos, though there are several of them, some accessed once you have finished the one currently on the monitor, is that the researchers and patients are speaking for themselves.  I hope you will take a moment to look into this - it has the earmarks of being quite a revolution in the way food, stress, obsessions, and behaviors are linked.  By the time I saw the videos, I wished I had a Mandometer of my own to keep me company while I eat.

WNL:  There is no doubt whatsoever that the pressure to be thin, perfect, and beautiful weighs on girls and women in every culture and at every age.  Fighting back against that pressure is an obligation not only for ourselves but for our daughters, granddaughters, nieces, and neighbors.

It is also apparent to the reasonable observer that those social entities like religious observance, family values, the right schools, "find a nice man" are no protection against sexual and emotional abuse, physical abuse, perfectionistic competitiveness, and a million other perversions of human interaction.  

But it is possible that not everything that happens within communities and families is about psychological disorders.  What the Mandometer experiment (now put into clinical practice) demonstrates is that sometimes we just lose track of ourselves and our signals and some biofeedback, a sweater or heating pad after eating, and plain old kindly resocialization can put us back in the game.  Hooray!


["Tefillin Barbie" Image via Jen Taylor Friedman's Official Website.]