Avoid excessive focus on healthful eating, do not compliment on weight loss and do not refer a teenager who exhibits excessive preoccupation with food to a dietician who does not specialize in the field
These are some of the strategies suggested by Esti Herman, clinical social worker and an expert on eating disorders who serves as Manager of the Eating Disorders department at Maaynei Hayeshua, as she speaks about the various forms of eating disorders. Parental role in prevention, identification and treatment of the disorder.
At first, it seemed to be one of those passing social trends. Sara and four of her friends decided to embark on a weight-loss programme that included a diet and daily physical exercise. Sara was not especially overweight, but she decided to join her friends and began adhering to a healthy diet. She restricted her food intake, kept away from sweets and white flour and joined an exercise class twice a week.
As Sara began to lose weight, she received encouraging feedback from people who saw her. “You look great!” People asked her “how she did it.” When she told them about her diet and exercise, they complimented her on her self-discipline and perseverance.
All this could have been fine, even healthy, had the weight-loss efforts stopped once Sara reached her ideal weight, or at least if things remained within reasonable boundaries, leaving Sara with other areas of interest.
But that did not happen.
Sara’s initial interest spiraled into an unhealthy preoccupation with food. She continued restricting her already-limited diet more and more, and continued to shed pounds well past her healthy weight. It was only after she began losing a significant amount of hair that her mother grew concerned. When additional symptoms started cropping up, Sara’s mother realized that her daughter had a serious problem.
At this point, about a year after Sara first began her weight-loss regimen, Sara was diagnosed with Anorexia.
Eating disorders in children and adolescents are a complex problem that concerns the best doctors, psychologists and psychiatrists in the Western world; a world that admires thinness to the point of madness. Unfortunately, this phenomenon has penetrated into the Torah-observant communities as well. Despite the tremendous emphasis placed on one’s internal world and self-fulfillment, many religious children and adolescents nevertheless suffer from serious eating disorders.
“It is important for parents to recognize the first signs of an eating disorder,” says Esti Herman, a clinical social worker who specializes in eating disorders and serves as Manager of the Eating Disorders department in Maaynei Hayeshuah. “Awareness is important so that parents can stop the process from developing, or at least take the child for treatment before things deteriorate. When it comes to eating disorders, it is wrong to assume that ‘If we don’t talk about it, it will go away on its own,’ or that ‘If we talk about it, it will only get worse.’ Parental authority can have a tremendous impact on preventing the development of these disorders, and it is important to reach out for professional guidance when necessary.”
In order to understand what differentiates between a balanced diet and an eating disorder, it is important to recognize the signs and symptoms that characterize these disorders.
The most common forms of eating disorders affecting children and adolescents are: anorexia, bulimia, and binge eating.
Anorexia: The patient severely limits his food intake, experiences a powerful desire to weigh less than normal, and a tremendous fear of gaining weight. People suffering from anorexia usually deny the severity of the problem: “I’m fine. I have self-control.”
Many anorexia patients are perfectionists and suffer from low self-esteem.
Anorexia may lead to severe complications, damages to main body systems, and even death.
Bulimia: The patient eats large amounts of food within a short period of time. Diagnosis is reached after three months in which there were at least two episodes per week.
Bulimia patients suffer from feelings of guilt after binging and “compensate” by purging, fasting, etc.
Of the three disorders, Bulimia is the most difficult to diagnose since it is concealed by the patient. In addition, due to the compensative measures taken, the patient’s weight is generally within normal range, unlike those who suffer from binge eating.
Binge Eating: The patient feels a loss of control and consumes large amounts of food, to the point of discomfort. Since there are no compensative measures taken, the patient will gain weight.
Eating disorders involve an excessive preoccupation with food. For example, limiting one’s food intake, fasting, suddenly avoiding eating or certain foods or components (such as sugars, carbohydrates, fats, etc.), vomiting, an obsession with food, skipping meals, vegetarianism, veganism.
At a later stage, these are joined by physical and emotional symptoms, as well: moodiness, hair loss, tooth decay, fuzzy hair growth in areas where there is generally no hair growth, weakness, dizziness.
As the condition progresses, all systems of the body are affected. Patients experience loss of calcium, loss of menstrual cycles, heart muscle damage, and more. Besides the physical damage, emotional (such as moodiness), cognitive (such as impaired concentration and slow thinking), and social (withdrawal) ramifications are experienced as well.
“In most cases, parents approach us for help only about a year after the development of the eating disorder,” says Esti Herman, “because patients who suffer from an eating disorder usually try to conceal it, or are in denial.”
Herman describes the warning signs that must propel parents to reach out for professional help:
“An early sign is a diet that keeps going and does not stop once the teenager has reached his target weight. Such a diet can continue and reach a loss of control, requiring immediate attention. Additional signs that can alert you are, for example, during family mealtimes, when you see your child limiting her food intake, avoiding certain foods, or showing an excessive preoccupation with food. Many times, a patient suffering from an eating disorder will spend a long time preparing and serving the food. Sometimes they might hide their eating.”
Others signs are those that have previously been mentioned in this article: moodiness, excessive hair loss, poor concentration, withdrawal, etc.
“Generally, eating disorders are a manifestation of other difficulties which show up in this manner, as a disorder. That is why it is not always possible to isolate the causes of the disorder. For example, a short while ago I treated a girl who suffered from anorexia. It turned out that her condition was triggered by an innocent remark said to her by the school nurse during a standard weigh-in that was done to all the girls. The nurse told this girl that her weight was above average and that she must lose weight. The girl took the comment to the extreme and developed anorexia. In her class of forty girls, there were certainly many other girls who received the same kind of comment from the nurse, and yet none of them developed anorexia. There were certain reasons why this specific girl developed it.”
Nevertheless, there are certain behaviors at home that may serve as triggers for the development of an eating disorder, and avoiding such behaviors may prevent this from happening. For example, many of the children who were diagnosed with an eating disorder grew up in homes that were extremely focused on healthy eating. The healthy-eating trend, although largely a positive one, may be damaging when taken to the extreme. When children hear that certain foods are “forbidden” or see an excessive preoccupation with food and food labels, they may acquire fear of certain food components, to the extent that an eating disorder may develop.
Overall, it is best to avoid speaking about dieting and weight at home. Most importantly – parents should refrain from criticizing or commenting on the shape of the body.
It is also important to refrain from encouraging weight-loss. Many times, a girl may be complimented on losing weight, and this reinforces her desire to continue, sometimes to the point of a loss of control.
Just like in every other area, there is a middle path to healthy living too. It is important to raise children’s awareness of healthy choices, yet avoid instilling fear. It is also important to pay attention to children whose personality is naturally more sensitive and ensure that they do not take the message of health, which the parents are trying to instill, to the extreme.
Another mistake that can be avoided is referring a child to the wrong practitioner. Sometimes, when a girl exhibits excessive preoccupation with food and calorie-counting, the parents take her to a dietician. Yet if the dietician is not professionally trained in treating eating disorders, she may actually only worsen the problem by proposing a strict diet. Therefore, even if you decide to approach a dietician, make sure that she specializes in eating disorders.
“Parents’ alertness to the first signs of an eating disorder and reaching out for professional help may actually prevent the development of the disorder. Therefore,” Herman urges parents, “please do not ignore such signs! Use your parental authority to limit dieting. You can explain to your children that because their bodies are growing now, they need important components in their diets, and it is not the right choice for them to go on an extreme diet. Observe your children, make sure they are eating their lunches in school and that they receive their daily requirements of protein and carbohydrates.”
Since eating disorders are multi-causative (caused by a combination of genetics, biology, environment, social and family factors), treatment is multi-dimensional and includes a psychiatrist who may sometimes decide to medicate, a psychotherapist, a dietician who will provide guidance and monitoring until the target weight is reached, and a family physician who will examine the patient for physical damage such as loss of minerals, damage to heart muscle, and more.
Treatment also includes guidance for the parents, and must entail full cooperation among all caregivers.
Maaynei Hayeshua’s Mental Health Clinic offers this multi-dimensional service to the public and provides dedicated, professional treatment for all eating disorders.
A Few Facts about Eating Disorders
• Eating disorders may develop as early as ages 8-9.
• Eating disorders may develop in males and females equally.
• The sensation of hunger may develop into an addiction. When this happens, it is extremely difficult to overcome this addiction.
• Treating eating disorders is especially challenging since often the patients refuse to cooperate with the caregivers and prefer to continue their behaviors.
• Unlike other disorders, eating disorders may appear in a number of children in the same family.
In the last week of November 2019, Professor Rael Strous, the South African-born medical director of Mayanei Hayeshua’s Mental Health Centre, and professor of psychiatry at Tel Aviv University’s Faculty of Medicine, was in London for a busy round of meetings and events organised by the British Friends of Mayanei Hayeshua.