Rabbis Sound an Alarm Over Eating Disorders

By RONI CARYN RABIN

In the large and growing Orthodox Jewish communities around New York and elsewhere, rabbinic leaders are sounding an alarm about an unexpected problem: a wave of anorexia and other eating disorders among teenage girls.

While no one knows whether such disorders are more prevalent among Orthodox Jews than in society at large, they may be more baffling to outsiders. Orthodox women are famously expected to dress modestly, yet matchmakers feel no qualms in asking about a prospective bride’s dress size — and her mother’s — and the preferred answer is 0 to 4, extra small.

Rabbis say the problem is especially hard to treat because of the shame that has long surrounded mental illness among Orthodox Jews.

“There is an amazing stigma attached to eating disorders — this is the real problem,” said Rabbi Saul Zucker, educational director for the Union of Orthodox Jewish Congregations of America, or O.U., the organization that issues the all-important kashrut stamp for food. “But hiding it is not going to make it go away. If we don’t confront it, it’s going to get worse.”

Referring to the high risk of death from heart problems and suicide in patients with anorexia, he said: “This isn’t a luxury type of disease, where, O.K., someone is a little underweight. People die.”

As a teenager, Naomi Feigenbaum developed bizarre eating habits that had nothing to do with Jewish dietary laws: Cocoa Puffs and milk in the morning, when she figured she had all day to burn off the calories, and nothing but Crystal Light and chewing gum the rest of the day.

At the kosher dinner table in her home near Cleveland, she said she would start arguments with her parents so she could stomp off and avoid eating. She lost weight so rapidly in high school that she used safety pins to cinch her long skirts around her waist.

By the time her rabbi came to visit her, she was emaciated. He told her that she must attend a treatment program that met on Saturday, the Jewish day of rest, even if she had to violate religious rules by riding in a car to get there. She could even eat food that wasn’t kosher.

“That’s when I realized it was a matter of life and death,” Ms. Feigenbaum said in an interview. “My rabbi does not take Jewish law lightly. But he told me the Jewish laws are things God wanted us to live by, not die by, and that saving a life takes precedence over all of them.”

Now 24, she has written a memoir, “One Life” (Jessica Kingsley Publishers, 2009), about her recovery from anorexia after treatment at the Florida branch of the Renfrew Center, the nationwide eating-disorders clinic.

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.

Demand for treatment programs that accommodate Orthodox teenagers prompted the Renfrew Center to start offering kosher food at its clinics in Philadelphia, New York, Dallas and Florida, while a new residential facility catering to young women from the United States opened last year in Jerusalem. It is not affiliated with Renfrew.

Relief Resources, a mental health referral agency that serves Orthodox communities, runs an eating disorders hot line, and last year the O.U. teamed with a social worker to make “Hungry to be Heard,” a documentary about eating disorders among the Orthodox.

Most of the young women interviewed for this article said they did not blame the culture for their health problems and said they derived support from their religious faith. But they spoke openly about the enormous pressure they feel to marry young and immediately start families , and the challenges of balancing professional careers with the imperative to be consummate homemakers who prepare elaborate Sabbath meals.

Experts say that eating disorders usually emerge during adolescence and other times of transition. And in large Orthodox families, the girls are often expected to help care for their younger siblings, leaving them little time to pursue their own interests. Experts suspect that anorexia may provide a way to stall adult responsibilities by literally stopping the biological clock: the drastic weight loss can halt menstruation.

Young Orthodox women are also expected to conform to a rigorous code of conduct, with few outlets for rebellion. They are expected to be chaste until marriage and do not date until they start looking for a husband. Even gossip is considered a sin.

Once matchmaking starts, they may be expected to choose a life partner after only a brief courtship. Known mental illness in a family can affect the chances of a successful match, not just for the individual but for siblings as well, so young women may well avoid psychiatric treatment.

In addition to fulfilling the traditional roles of caregiver and homemaker, many Orthodox women also assume the role of primary breadwinner so their husbands can pursue religious studies full time.

“It’s too much,” said a 23-year-old woman from the New York area who is recovering from an eating disorder and asked not to be identified by name to protect her privacy. She is married and a full-time student, but has postponed having a baby.

“A lot of my friends are going to work and support their husbands,” she continued, “but part of my recovery is to say that I can’t do everything — I’m not superwoman.”

Food plays a central role in Jewish family and religious life, and both the Friday night dinner and the midday Sabbath meal, as well as holiday meals, can be multicourse affairs. But fast days — when no food or water is consumed for 25 hours — are also sprinkled throughout the year, often preceded or followed by a large meal.

Next week’s Passover Seders, which traditionally include matzo and four cups of wine, along with soup, gefilte fish, brisket and potato kugel, are a particular challenge, experts say. For women who struggle with eating disorders, they can be an invitation to purging.

“There are a lot of mixed messages,” said a 27-year-old woman from a strict Orthodox community in Brooklyn, who once carried less than 100 pounds on her 5-foot-6 frame. “My grandmother would see me and say, ‘You look so good, you’re so skinny — come eat, eat.’ ”

Many rabbis find themselves being asked to resolve conflicts between religious obligations — like the requirement to fast on Yom Kippur, the Day of Atonement — and doctors’ orders that patients not restrict food intake under any circumstances.

“A patient will call and tell me their weight is down to 82 pounds, and they have weaknesses in their body, and I’ll tell them there is no question they must eat during a fast — not that they can eat, but that they must eat,” said Rabbi Dovid Goldwasser of the Bais Yitzchak Synagogue in Flatbush, Brooklyn, who has become known in the Orthodox world as an expert on eating disorders and counsels women from all over the world.

“They have great difficulty with that,” Rabbi Goldwasser went on, “and they say to me, ‘But isn’t it true that by fasting you get atonement for your sins?’

“I try to answer the spiritual conflict and say that no, God wants you to eat. Your eating on that day is considered as if you fasted.”