Author: Dr. Marcy Forta

As the holiday season is rapidly approaching, levels of anxiety tend to go up. Here are some practical tips to curb our Tishrei Tension:

1. Get enough sleep – often sleep is the first thing to go when we have lots to do and lots to cook. We stay up late into the night, making sure all our best dishes are prepared and ready. While a night or two of missed sleep may not seem like a big deal, getting less than the recommended amount does have real, measurable consequences. Studies have shown that lack of sleep leads to a drain on your mental abilities, is linked to a number of health problems, including weakened immunity, mood changes, memory issues, high blood pressure, as well as an increased risk for heart disease.  When our sleep is lacking, we tend to become more impatient and our decision-making processes as well as our creativity can be compromised. Lack of sleep has also been known to change hormones that are directly linked to our feelings of hunger and fullness.
2. Try to eat in a healthful and mindful way – when we are stressed or busy, our meals may be eaten on the run without attention paid to exactly what it is we are eating. If we want our bodies to function at maximum capacity, we need to fuel them properly. This will also help with mood swings and hormonal changes, too. Sometimes we need to step back and see what our body is asking for so that we can support it supporting us.
3. Take the time you need – we all need alone time sometimes. If you need some time to regroup and refresh, go to your room to read or rest for a bit, take a walk, or arrange times with your friends so that you can watch each other’s kids for even 30 minutes, giving each of you a well-deserved break. Maybe you need more socialization with friends and family, so make a schedule for a coffee date. Don’t be afraid to ask for help if needed. Yes, Yom Tov can be expensive, but getting a little extra household help can go a long way to ensure your sanity and everyone’s happiness.
4. Keep stress levels under control – we all know how damaging, both mentally and physically stress can be. According to webmd.com, mayoclinic.com, and the National Institute of Mental Health, stress can play a part in problems such as headaches, high blood pressure, heart problems, diabetes, skin conditions, asthma, arthritis, depression, and anxiety. Stress effects all of us and while not all stress is necessarily bad, especially when it helps to raise our fight or flight ability, nevertheless, stress that lasts for days or weeks, can disturb our immune, digestive, cardiovascular, sleep, and reproductive systems. Easier said than done, right? For sure, but we can manage stress through regular exercise, being organized and planning ahead, and making sure we stay connected with family and friends. We should also be vigilant in noticing those things that make us feel more stressed, so that we can try to do them less.
5. And finally – try not to lose sight of what really counts. Yomim Tovim are full of family and friends, a time to connect with Hashem. If everything is not perfect on the outside, but we feel spiritually, emotionally, and physically connected and fulfilled, our homes will be happier places, that are more contented and full of simcha!

If we can take the time to internalize these messages and put a plan in place for when we falter, as we all do from time to time, our Tishrei season will be more fulfilling, accomplished, and much more relaxed! Kesiva V’chasima tova!!

There has been a lot of talk about how online social media images/messages/recommendations harm people’s body and self-image, how high levels of social media use by adolescents is associated with poorer mental health and self-esteem, and, in particular, increased body image concerns. The overall idea is that the social media vendors should take more care in ensuring that what is seen by the younger generation is less inappropriate and damaging or at the very least, less suggestive of the unattainable ideals that are being espoused and less access to products that promise to give us the “perfect” figure and the ensuing happiness that comes from it.

Now I am not saying that there shouldn’t be some level of concern and care social media wise, but realistically, I do not believe that we can ever completely control what our children are seeing and ultimately exposed to on social media. And while we can maybe change small things here and there, overall, the idea that those changes are the remedy to the problem is way too simplistic and basically impossible. I do believe, however, that when we offer our children from a young age, the proper tools with which to support their own self-confidence and self-esteem, and how to question these skewed and erroneous types of messages, as well as how to live comfortably in their own unique and beautiful bodies, social media will have less of an influence and hold over them. Currently, there is a lot of negativity surrounding how we should approach our body and self-image. We are told that the messages we are being given are bad, wrong, and harmful to people who live in different body types. Certainly, this may be true and while we can choose to be angry about these messages, ultimately anger breeds more anger which has little constructive outcome.

A more positive and constructive strategy is needed then to support our children, their self-esteem and self-confidence. We must institute programs in our schools from a young age, that support our girls in this way, educate their parents and their educators in how we can bolster this objective. Programs must be instituted that are designed specifically to increase self-esteem, self-confidence, body positivity, and reduce the focus on outward appearances. By helping our children find positive ways to appreciate and live in their bodies, while concurrently educating and promoting healthy behaviors and habits, we will strengthen our children from the inside out. Social media only works from the outside in. And we cannot rely on removing or altering every negative influence that may occur, because as quickly as you can eliminate one, another will crop up. This doesn’t mean we should stop trying to remove these clearly unrealistic and negative influences, rather it just means we have to attack this epidemic from every angle possible!

This week I read a recently published book that I found to be an extremely compelling, inspiring, and personal book called The Girl in the Red Boots by Dr. Judith Ruskay Rabinor. I finished it several days ago and I am still thinking about the valuable and insightful lessons I was able to glean from it. The book is officially about the authors journey with her mother and ultimately, how she made peace with her and their unique relationship. Interwoven throughout the book as well are vignettes from her clients. Dr. Rabinor is a psychologist who specializes in eating disorders and the patients she highlights in her book struggle with these devastating illnesses. There is so much to absorb and learn from the book. It is both painfully and refreshingly honest, with such candor and frankness.

One of the most meaningful realizations from the book for me was about perspective. We’ve talked before about how eating disorder risk factors influence people, how the same risk for one person may not result in an eating disorder, while for someone else, it can be volatile and dangerous. We’ve mentioned the idea of how a person internalizes a message or how an experience effects their understanding of it as well as how they respond to it. This book takes us on a journey of growth from the starting point of a limited, personal perspective of Dr. Rabinor for her mother, to a place of understanding, sympathy, and appreciation for her mother’s own journey into who she is and how she got there. The book makes us give pause and really think about our own relationships with our mothers. It allows us to appreciate and acknowledge their perspectives, experiences, and how they were raised in our valuation and judgement of them, but most importantly in how we relate to and love them. It allows us to take a step back from our interpretations and understandings of what transpired and see things as our mothers have, in a more holistic, complete way. This is such a beautiful and inspiring lesson.

Logically, of course, we understand that our mothers are the sum of their collective experiences, but practically we don’t often internalize or fully appreciate what that means or how we can internalize and harness that. The overall theme of compassion, not only for our mothers, but for ourselves and what we’ve each experienced is both refreshing and uplifting.

And this book is not just for applicable to the mothers and daughter relationship, rather it is for anyone in any type of relationship with another person. It acknowledges how painful experiences and circumstances can leave emotional scars, yet at the same time, gives us a refreshing and different perspective from which to approach these very real and legitimate traumas, how we can go from pain and grief to gratitude and acceptance.

My initial interest in this book was in reading about the eating disorder patients, their struggles, and how Dr. Rabinor helped them, but I feel like I learned so much more about my own life and journey as well the realization that healing is really a never-ending, ongoing process and that that is perfectly ok.

I highly recommend this book.

The news continues to alarm me as multiple outlets from the world over report sharp increases in incidences of mental health issues and diagnosed eating disorders among adolescents. This week in Ontario it was reported that admissions to their teen eating disorders ward has jumped to 223% capacity, an increase of over 100% of what was reported in January. In fact, one of the heads of the eating disorders program there revealed that this is the worst and most dire situation that she has ever seen in over 30 years, no question.

Another finding by the University of Michigan reports significant increases in medical admissions among adolescents with existing or newly developed eating disorders during the pandemic. In fact, the hospitalizations in their hospital among children aged 10-23 for eating disorders this past year has more than doubled than what it was for the years of 2017-2019. Even more concerning however, is that the numbers may represent only a fraction of those with eating disorders affected by the pandemic as only those with severe illness that actually led to hospitalization were included in the count. Some figures suggest that as many as 77% of people with an eating disorder never receive treatment, 77%. That is huge!

England too is reporting a sharp rise in number of children that are seeking help for eating disorders as well as increasing struggles for them to access the help that they desperately need. The National Eating Disorders Association reported a 41% increase in messages to phone and online help lines in January 2021, as compared with January 2020. A recent study from the International Journal of Eating Disorders found that symptoms worsened across the board for people with anorexia, bulimia and binge-eating disorders nationwide since the pandemic began. This is both worrying and alarming as we have discussed the issues with eating disorder treatment and outcome.

I am personally hearing stories about more and more stories of young girls struggling with eating disorders every week.

With numbers so compelling I struggle to understand why we are not making prevention a clearer, more pressing, accessible priority.  Why are prevention programs so difficult to implement in our schools? Why aren’t we talking about this more for our educators and parents? Prevention programs have been both tested and proven to improve self-esteem, self-confidence, overall body positivity, measures of shape and body concerns, as well as reducing internalization of the thin-ideal, determinants of body dissatisfaction, and eating disorders overall.

Let’s talk to our schools, our educators, and our fellow moms and push the need for these critical, lifesaving programs! I am here to help. Message me anytime.

Working toward a positive relationship with one’s body can be a lifelong process. As we are well aware, worries about weight and appearance begin in early childhood. Girls as young as five years old are talking about wanting to be skinnier as well as their fear of becoming fat. And while accepting our bodies doesn’t mean that we’re always comfortable with how we look or feel, the ultimate goal is to reach a point where we experience positive feelings more often than we do negative ones. After all, it is both natural and human to experience occasional insecurities and/ or doubts.

So here are some tips on how we can develop a more healthy and positive body relationship:

• Commit to wanting a positive relationship with your body.
• Take the time and energy needed to care for your physical body. When we take of our bodies, we learn to appreciate them as they are for what they do for us day in and day out.
• Make healthy choices for your body.
• Look at yourself as a complete entity rather than the sum of your individual parts.
• Find things about other people that you can complement or appreciate that are not physical or body related.
• Make a list of 10 things you like about yourself that have nothing to do with your appearance and review it often.
• Avoid any negative or berating talk about yourself.
• Stop judging other people’s bodies. If you change the narrative, you stop believing that bodies are a valid measure of a person’s value.
• If you are not quite ready to be body positive right now, practice body neutrality by focusing on the function of your various body parts, versus why you are dissatisfied or unhappy with them.

While these tips might seem small or inconsequential, if you are able to commit to even a couple of them, you will be surprised to see how they can affect the level of comfort that you feel in your own skin. And, studies find that practicing body positivity leads to better overall mental health as well as less disordered eating behaviors.

If you have any suggestions or tips for things that help you better appreciate your body and build a positive relationship with it, I’d so appreciate if you would share them.

I’ve been reading through a curriculum addressing body image, eating, fitness, and weight concerns called Healthy Bodies by Kathy J. Kater. In it, the various costs of negative body image for girls were discussed. Negative body image refers to an over or hyper-focus on comparing one’s size and shape to unrealistic or unattainable social ideals.

In the book, four specific consequences of negative body image were highlighted:

1. A drain on time, energy, self-esteem, and motivation for self-care.
2. A serious disconnection from self
3. Reduced and unbalanced nutrition/diet as well as overall weight gain
4. & Last but certainly not least, the possibility of eating disorder onset

Each of these costs individually are significant and worthy of discussion, but today I would like to examine the second consequence, that of disconnection from self, as this is a very serious and alarming adverse result of negative body image. Disconnection from self is when a child is not comfortable in his or her own skin and/or in his or her own physical body. Ultimately, this is detrimental and damaging to the child’s formation of their personal identity. Children experiencing this disconnection from self, struggling with their body image tend to value themselves looking from the outside in, rather than from the inside out. The outcome of this type of thinking results in the “how I look” taking precedence over the “who I am” question. This struggle is not only heartbreaking but preventable and unnecessary.

Unfortunately, our culture tends to focus on a person’s “outside packaging” as the primary way in which to pass judgement on them. Children struggle to reconcile this contradiction with their own personal values, body confidence, and self-esteem. Instead of looking inward to find their self-worth as they should, they feel compelled to look to external cues as a measure of their value. This “dissociative crisis” as Ms. Kater calls it, allows adolescents girls to risk both their physical and emotional health in order to secure the physical outward appearance they perceive as critical to their acceptance and value in society. This confusing and complicated struggle takes a real and measurable toll on the girls, often barring the child’s true, authentic self to be recognized.

Over and over studies find that at least 70% of adolescent girls and 45% of adolescent boys don’t like their bodies. These are massive numbers.

According to berealusa.org:

These negative body image statistics are alarming. How can we help our children? Body confidence, self-esteem, and body positive programs are proven to create measurable, quantifiable effects on those who participate in them. In fact, they lead to better general mental health, increased classroom participation, reductions in negative mood, less unhealthy weight control behaviors, and even some risk reduction for future eating disorders.

We help our children with any problem or issue they encounter, why not give them the tools they need to support their physical bodies, their body image, and their self-esteem? We must implement these crucial programs in our schools. Contact me to find out more.

What does it mean to have healthy self-esteem?

Healthy self-esteem is being consistently able to value yourself for who you are, having overall positive feelings about yourself, and realistic expectations of yourself. Healthy self-esteem is about acting in ways that demonstrate self-respect and faithfulness to your values.  People with healthy self-esteem recognize the positive qualities they possess, but also accept that they are not perfect, that no one is, and that they will inevitably experience some disappointment and setbacks at various times throughout their life. The key is to keep things in perspective and not constantly berate themselves over their perceived flaws and imperfections.

People with healthy self-esteem trust their own judgement and can express how they feel and what they believe without fear of judgement. They are able to withstand the pitfalls of peer pressure and can avoid destructive behaviors and dangerous patterns. They understand that self-esteem comes from within and that external validation or approval does not have a bearing on their belief in themself. Easier said than done, right?

Why is healthy self-esteem valuable?

One of the most beneficial aspects of healthy self-esteem is about learning how to feel comfortable in your own skin. It is when you are able to rely on your ability to think, to reason, and to decide. And while you will still need advice and input, you will feel comfortable to reflect, mull, and ultimately decide for yourself. There is less second guessing and guilt over your decisions. You will become less paralyzed if you think that you made a mistake, as you accept that mistakes are inevitable and critical to your growth. Healthy self-esteem will give a positive balance between independence and dependance, will allow you to like yourself, and go through life with a healthier, happier sense of security in who you are. Healthy self-esteem is also protective against eating disorders.

Why is healthy self-esteem a particular challenge for adolescents?

During adolescence there is an exorbitant amount of pressure to fit in with friends and be accepted by them. Adolescents need to be well-liked, respected, and admired. There are challenges as they navigate their need for independence with their inability to be completely self-sufficient just yet.  Adolescents are confused about what they are going through and often don’t have the words to describe how they feel. Sadly, low self-esteem often goes hand in hand with anxiety and/or depression and it makes it especially challenging for teens to cope. Low self-esteem has been empirically proven time and time again to lead to self-harm behaviors, drug and alcohol abuse, and disordered eating behaviors.

So how can I promote my teens healthy self-esteem?

There are many, many books written on the subject and this can be a daunting topic to navigate, but there are some things you can implement immediately. First, start to notice any negative self-talk your child engages in, any distorted messages or irrational thoughts. This can include black and white thinking, minimization, assuming responsibility for anything that goes wrong, jumping to conclusions, or assigning themselves negative labels or names. If this is an issue, it is important that you help your child understand where these thoughts are coming from and how they can reframe them. Help them reframe their “I should” to “I could” or I’d like to” or “I choose to”.

Next try to notice if your child suffers from perfectionism, constantly striving to be perfect in the hopes that a lack of mistakes will give them validation and/or improve how they feel about themselves. This will always backfire at some point and will ultimately make your child feel bad about themselves. Speak with her, explore what might happen if things weren’t perfect, what that might look like, and discuss how each of us has our own unique talents and abilities. Explain that none of us are perfect, nor are we expected to be, and no amount of external validation will make us feel better about ourselves deep down. Instead, work to find some positive qualities that she can to focus on and perhaps, some positive affirmations she can practice.

I know these are some very high-level ideas and concepts, but they can be extremely helpful for anyone struggling with self-esteem issues, are beneficial for all of us, and are especially effective and valuable for heading off eating disorders of all kinds.

I am looking to put together a group of women with adolescent daughters who would like to meet to discuss strategies for supporting our daughters throughout their teenage years. Please pm me if interested.

F.E.A.S.T. or Families Empowered And Supporting Treatment for Eating Disorders, is an organization dedicated to supporting parents and caregivers of those struggling with an eating disorder. They are unique as all members of this incredible organization have experienced what it is to have a son or daughter develop an eating disorder. They are intimately aware of the intense worry, fear, and frustration that accompanies these devastating disorders.

I was honored to be asked to write a guest post for their blog. It is entitled My Journey, My Passion.

Just read an extremely compelling, poignant, well-written, compassionate, sad, but very important book on the seriousness of eating disorders, as well as the serious holes in our medical systems treatment of them. Linda and John Mazur, in their book entitled, Emilee, The Story of a Girl and Her Family Hijacked by Anorexia, recount the painful journey of their beautiful daughter and her unrelenting eating disorder. Raising awareness, supporting, and educating people about these serious mental illnesses is so critical to our treatment of them.

In prior posts we’ve looked extensively at eating disorders and risk factors. This week I’d like to focus on a pervasive issue/bias that may seem tangential but is actually a negative behavior deeply associated with disordered eating and many negative health effects. I’m referring to weight stigma.

What is weight stigma? Weight stigma is defined as the social rejection and/or devaluation of those who do not meet or comply with the prevailing acceptable social norms of body weight and shape by other members of society. Weight stigma refers to any biased or discriminatory acts that are targeted towards individuals specifically because of their weight and size.

Why is weight stigma so dangerous? Those who experience weight stigma and suffer from an eating disorder or any mental or physical health issue are less likely to be diagnosed and get the help they need, especially when they have a higher BMI or are considered obese. That is scary. In fact, patients experiencing weight stigma have been documented to have been denied the testing, therapies, and surgeries provided to thinner patients with the same health conditions, leading to poorer health outcomes.

What are some consequences of weight stigma? According to multiple empirical studies, weight stigma is tied to increased mortality, as well as increases in certain diseases and chronic conditions. People who are obese experience poorer healthcare. Further, people who experience weight stigma have more psychological distress with documented higher levels of disordered eating, low body-image, emotional distress, low self-esteem, and depression. Weight stigma also leads to greater levels of stress and all the unpleasant consequences that accompany it. Often individuals who experience weight stigma are stereotyped as being lazy, lacking self-discipline, weak willed, and/or non-compliant. Sadly, in a study that just came out June 1, weight stigma experiences worldwide were found to be most frequent in childhood and adolescence, and any associated distress due to them was found to be highest during these time periods as well once again highlighting the age of adolescence as a particularly stressful and precarious time.

How is weight stigma perpetuated? When society regards obese people as architects of their own ill health as well as being personally responsible for their weight problems due to their own laziness and overeating, weight stigma is established. Additionally, weight stigma is often viewed as a beneficial incentive for weight loss and an acceptable method for producing change by many healthcare practitioners, including doctors, nurses, health coaches, nutritionists, dietitians, etc. Further, the $72 billion that Americans spend on the diet industry each year adds considerably to the weight stigma struggle many experience.

How then can we stop the weight stigma? This is a harder question to answer. We need to work at eradicating the diet culture that is so pervasive and insidious in our society. We have to be so careful how we speak to people, the language that we use, the messages we espouse. Especially when it comes to our children who are so impressionable and vulnerable, we must teach them the value of treating all people with dignity and respect, regardless of their size or build. We must educate ourselves, our healthcare workers, as well as our educators about weight stigma. We all have our own paths to forge in life. Forcing others to conform to a certain mold does not help or support anyone’s mental or emotional health and is more often than not, unsuccessful.