Weighty Matters

Lenny Kramer had never seen his eldest daughter in such a state. Rebecca’s face was pale, her features drawn, her palms discolored in an orangey hue. Rebecca had left her Long Island home three months before for a year of study in Israel, and during the interim she’d shed so many pounds that friends alerted her father: Rebecca may be bulimic.

It turned out that anorexia was to blame for Rebecca’s rapid weight loss, and after Kramer arrived in Israel, he refused to leave Jerusalem until he’d arranged a treatment plan, securing the standard trio of experts — a doctor, psychologist and nutritionist. But in retrospect, he wishes he’d picked up on earlier cues: The time, for example, when Rebecca, at age 16, called home from summer camp to announce that even after the long fast of Tisha b’ Av, she opted not to eat the cereal she desired because the camp offered only whole milk, not skim. Also how she never sampled a bite of the many elaborate desserts she prepared during her senior year of high school.

While the media has trained its attention recently on the rise and severity of eating disorders both inside and outside of the Jewish community, most parents aren’t familiar with how to prevent or mitigate or even recognize the stirrings of a crisis in their homes. And most aren’t aware of how their behavior could unintentionally provoke a problem. An eating disorder is an illness, and like alcoholism or diabetes, some individuals are predisposed to develop it. But just as “genetics loads the gun, environment pulls the trigger,” said Judith Ruskay Rabinor, a psychologist who is founder and director of the American Eating Disorders Center of Long Island.

“I was clueless,” said Kramer, referring to indications of a developing problem during of Rebecca’s high school years, and also unaware of how parental behavior could exacerbate a problem. “Parents can be a major part of the solution, but they can also be a major part of the problem,” said Kramer. He now realizes, for example, that he “had an eating problem the other way my whole life. I’m not obese,” he said, “but we made food too much of a topic. I’m sure it contributed to the illness. If a parent has an issue, deal with it, but don’t make it everyone else’s issue.”

Kramer believes he’s become a better father, recognizing the need for more positive reinforcement, for example. He said, “It’s not always smooth sailing, but at the end of the day, you just have to love them.”

In conversations with psychologists who specialize on eating disorders, one phrase surfaces repeatedly: role modeling. Parents, particularly mothers, are exhorted not to comment excessively on their own appearance, not to wonder aloud about slimming down, not to severely restrict their own eating in front of their children, not to cook one meal for the family and another for themselves, not to exercise incessantly.

“Mothers need to practice self-acceptance,” said Catherine Steiner Adair, a prominent psychologist in the field, speaking in the documentary, “Hungry to be Heard,” about Orthodox Jews who struggle with eating disorders. Aliza, a former patient who shares her experience in the film, says: “Don’t obsess about yourself in the mirror because the 7-year-old behind you will come up and do the same thing.”

Parents can also boost their children’s confidence by teaching media literacy, pointing out that even the gorgeous models displayed in magazines and pop-up ads have been air-brushed beyond recognition. One place to start the conversation might be the Dove Evolution clip, posted on YouTube, suggests Beth Cooper Benjamin, director of research at Ma’yan, a program of the JCC in Manhattan.

This time-lapse ad, which won a top award in 2007 at the Cannes Lions International Advertising Festival, shows the transformation of a woman to a super-model, but not without the significant aid of make-up artists, hairdressers and digital manipulation. “No wonder our images of beauty are unattainable — they don’t exist,” says Benjamin, who often works with and writes about adolescent girls.

Women who do closely resemble our society’s ideal of beauty probably don’t trace their heritage to the shtetls of Eastern Europe. As Rabinor says, “Only one percent of the world’s population is really tall, really trim and busty. And these people are not Jews. They are Scandinavians.”

Esther Altmann, a Manhattan psychologist who specializes in eating disorders, says that for the other 99 percent of us, this cultural standard of beauty can be a set-up for problems. Altmann, who has written extensively on the topic, highly recommends setting aside time for a daily family meal, and reminds parents to expect their daughters to gain some weight during the prepubescent years. She warns that a parent’s comments during this vulnerable period can potentially trigger the illness.

Also, for troubled teens, Judaism can offer structure and solace. “A lot of people are starving — not just for food, but they’re starving for nurturance, both body and soul,” says Altmann.

Altmann has developed a hand-out for parents with a long list of early warning signs and risky activities, including habits that in another context would be innocuous — such as participation in ballet or gymnastics, wearing baggy clothing or becoming a vegetarian.

Sarah, a resident of South Florida who requested that her last name not be used, recalls that when one of her daughters opted to become a vegetarian, she wasn’t worried. But a few months later, that daughter began restricting more and more foods. Sarah, who is a chasidic Jew, says, “We’re very careful about what we put into our mouths. To add 10 or 12 more requirements to the food rules makes it very difficult.”

The daughter also began exercising intensely and took to wearing a sweatshirt, always, “even when it was 90 degrees outside and broiling. She didn’t want anyone to see how thin she was getting.”

“Parents have an instinct,” says Sarah who brought her daughter in for an evaluation at The Renfrew Center, a residential eating disorder treatment facility. “If a child is not going through the teenage changes with ease, if they are obsessing over cleanliness, if they stop socializing with friends,” it is time to seek help.

Hilary Yohlin Waller, a former patient at Renfrew’s Philadelphia facility, says to bear in mind that this is a physical issue wrapped and rooted in emotional pain. When Waller looks back on her journal entries from the time of her sickness, she finds “pages and pages of writing about my body and how terrible I felt.”

Waller, who is a graduate of the Jewish Theological Seminary joint program with Columbia University, credits a college friend for calling her parents, suggesting that Waller needed a new medical team. Though her illness had been diagnosed in high school, Waller had become adept at fooling her doctors, drinking water before being weighed, for example, or loading her pockets with coins.

Now the mother of 2-month-old girl, she advises parents: “If it happens, it’s not your fault. It’s not your kid’s fault. Just get them well. Just love your kids to death.” Tell them that you love them unconditionally, she suggests. “It made a difference for me.”