Author: Dr. Marcy Forta

I want to get your thoughts. There was a New York Post article published at the end of October, highlighting parents’ outrage over retouched photos of their children’s school pictures. Services were being offered through the photography company to whiten children’s teeth, even their skin tone, take away blemishes and freckles. In fact, one of the kids whose mom had initially agreed to some touch ups, was shocked to find that her son’s hearing aids had been removed from the picture. She was livid!

At what point do you think these “touch ups” are harmful to a child’s self-image? Does changing or perfecting things about the physical image of your child send a message that there is something wrong with them, or at the very least, something that is in need of repair? Can this type of service make a child who is already feeling less confident, feel even worse? And for a child who has not yet thought about changing his or her physical appearance, can this give them the idea that it is needed or even more scary, that it is the norm?

In a different article there were talks of Chinese parents opting to put shape helmets on their children’s heads so that their skulls become rounder. Apparently, having a perfectly round head is desirable in China and parents feel this will help their child in some way down the road. Parents were quoted in the article saying things such as, “I think wearing a helmet has the same function as wearing braces, which is to correct a body part and make it more beautiful” or “I have a flat head and I know how painful it is for women who are chasing beauty. I don’t want my kid to grow up and regret this part of herself” or “You head shape determines your attractiveness. Give your children a good start and correct their head bones while you can.”

Where do we draw the line? How much is too much focus on our outward appearance? At what point do you think it becomes obsessive and unhealthy? On the other hand, is it ever ok, then, to focus on how we look? How do we find that balance in such an outward appearance fixated world?

I guess the question is, is there as legitimate difference between trying to “perfect” or “tweak” our children’s physical appearance and the overall message that their value and worthiness comes from their clothing size, the shape of their body, or how they look? These articles might be a bit more brazen, but the message is the same; to be good, to succeed in life, to really flourish, you have to look good. And looking good means that you conform to society’s expectations and standards.

I for one, refuse to stand by and let these harmful, toxic, and destructive messages wreak havoc on our girl’s self-image and self-esteem. The time has come to take a stand – through education, prevention, and awareness programs. This is Atzmi’s mission – to support the mental health and well-being of our girls through programs that improve their self-esteem, self-compassion, body acceptance, and reduce the intense focus on outward appearances.

I would love your thoughts on this topic!

I was recently interviewed by Rabbi Hershel Finman on the Jewish hour about Atzmi, self-esteem, self-compassion, body image, and eating disorders. I so appreciated having the opportunity to get the word out about our mission and work. The interview has now been published as a podcast. If you would like to listen, click to play below. The interview starts at about the 5 minute mark.

Up until recently, there have only been anecdotal reports about rising eating disorder incidence and consequence during the Covid-19 pandemic. Now, however, we have scientific data to back this devastating fact up. Sadly, inpatient admissions, hospital bed stays, as well as outpatient care for adolescents and young adults have increased significantly over the course of the pandemic¹, compared with the stable volumes of numbers previously. This raises legitimate concerns that the negative mental health consequences of the pandemic will remain massive, far reaching, and will be with us for the long term² .

We have also recently discovered how Facebook and their company, Instagram, have been aware of the detrimental effects of their social media platforms, as reported first by The Wall Street Journal³. In fact, it was discovered that in a 2019 Facebook slideshow to their employees about research on girls with body image issues, Instagram was found to make body image issues worse for one in three teen girls and most teens felt that Instagram was to blame for increases in their rates of anxiety and depression. Since about 22 million teens long on to Instagram each day, that is a huge amount of young people that are influenced.

Instagram makes body image issues worse for one in three teen girls and most teens felt that Instagram was to blame for increases in their rates of anxiety and depression.

WSJ

The Wall Street Journal article goes on to find that in five different company presentations over an 18-month period ending this past spring, researchers found that some of the problems girls experienced were specific only to Instagram, and not to broader social media. This was true especially regarding social comparison; when people assess their own value in relation to the attractiveness, wealth and success of others. The tendency of users of Instagram is to share only the best moments, those pictures that are perfect and flawless. This focus can create an unhealthy sense of self, increased body dissatisfaction, and depression. There are algorithms and aspects to Instagram that can create the perfect storm for insecurity, self-doubt, and lower self-esteem.

And while we recognize that this is a serious problem, we simply cannot blame all body image issues on Facebook or Instagram as there are myriads of influences on girls, including clothing stores, malls, books, magazines, other social media platforms, culture, peers, teachers, even parents. To reduce and/or eradicate a problem, we must get to the root of it. When we look at all the possible areas of influence for our girls and factor in the large increases of eating disorders and their complications during the pandemic, we see how critical prevention programs really are. These programs address the roots of the issues and give the girls coping mechanism and strategies.

Prevention programs cannot only address body image but must focus on self-esteem and self-confidence as well. These programs must address all aspects of risk, not just the physical dissatisfaction and discontent. If a girl feels happy, loved, and accepted for who she is, the likelihood of an eating disorder or even anxiety or depression cropping up, will be greatly reduced. We need to build the girls up and help them recognize and appreciate the unique talents and abilities each of them possesses.

Stay tuned as I have an exciting announcement regarding this idea that I hope to share very soon….

References:

1. J.A. Lin, S.M. Hartman-Munick, M.R. Kells, et al. The impact of the Covid-19 pandemic on the number of adolescents/young adults seeking eating disorder-related care. Journal of Adolescent Health, (2021).
2. G. Belkin, S. Appleton, K. Langlois. Reimagining mental health systems post COVID-19. The Lancet Planet Health, 5 (2021).
3. https://www.wsj.com/articles/facebook-knows-instagram-is-toxic-for-teen-girls-company-documents-show-11631620739

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.