Author: Dr. Marcy Forta

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.

I recently came across an article titled “Pandemic has fueled eating disorder surge in teens, adults”.  I was dismayed to read about how eating disorder diagnoses and needs have increased exponentially since the start of the pandemic. Wait times for treatment can be months and there is a shortage of beds in inpatient facilities as well as appointments with therapists. The Alliance for Eating Disorders Awareness, which started offering virtual therapist-led support groups for adults during the pandemic, have also seen a huge surge. Since January more than 7,000 people from every state and 32 countries have attended their support groups and hospitalizations have increased greatly as well. The article above reports that medical records data from 80 US hospitals found a full 30% eating disorder patient increase since March 2020, that was compared with data from the 2 previous years. I was disheartened to hear that among girls aged 12 to 18 there were 1,718 admissions in these hospitals alone – interestingly however, there were no increases among boys.

Sadly, there have been large surges in all types of mental health illness since the onset of Covid-19. According to the Kaiser Family Foundation (KFF), a nonprofit organization focusing on national health issues, since the pandemic onset there has been a fourfold increase in symptoms of anxiety or depressive disorder. People are reporting difficulty with sleeping, difficulty with eating, and increased alcohol and substance use. Children and teens have been hit particularly hard as this is a time when they struggle with their emotions and how to express them. As parents and educators, we must inform ourselves about the signs and symptoms of stress and strain on our children to best help them cope and to reduce the possibility of turning into something more serious.

Different people cope in different ways and so their signs of stress will vary. Young children might struggle with their sleep schedule, develop more separation anxiety, be more aggressive with siblings and friends, may have more stomach discomfort, or crying more than usual. For older children and adolescents though, things such as changes in mood, changes in behavior including stepping back from personal relationships, any loss in joy or interest from activities that were previously enjoyed, changes in eating patterns or appetite, reduced effort or interest in academics, any risky or reckless behaviors, or appearance changes such as decreased personal hygiene or taking less care of themselves, are all warning signs that your child could use some help.

We have to work to keep the lines of communication open with our children. We have to notice how they are acting and reacting. Encourage them to speak with someone if they are struggling. We must keep an eye out for any changes in behavior of any kind and not delay in speaking to a professional if you have any concerns. Eating disorders are much easier to address and treat when they are discovered early on, but even better, of course, is if they do not develop at all. Educating ourselves on the risk factors for them as well as their symptoms has been scientifically proven to help reduce their onset.

And while I do not have any specific numbers for how the pandemic has affected our community specifically, it is a good reminder that although we always need to pay attention to the signs and symptoms, it is even more important to be diligent in times of acute stress. Let’s keep working together to eradicate these devastating illnesses.

As of late there has been a lot written and talked about regarding the Health at Every Size (HAES) approach to weight control. I was fascinated at the prospect of an approach to health and wellness that does not directly advocate the frustration and potential dangers of dieting, restricting, abstaining, etc. As I work to better understand HAES and how it can help people better approach their health and wellness, I wanted to share my thoughts and ask others for theirs as well.

HAES helps to reduce weight stigma and bias by shifting from a weight-focused to a health-focused paradigm, thereby challenging some of the key assumptions of traditional approaches to weight management ultimately allowing us to better accept our bodies wherever they are and have compassion for our shape and size.

The HAES approach does not claim that everyone is at a healthy weight, as some have come to believe. Rather, it is a paradigm that seeks to support and help people in the body that they currently have, whether or not they are at their optimal weight. HAES seeks to increase body respect, to shift from the focus that a person’s value is based solely on their weight and size, while increasing self-care and self-acceptance behaviors. This allows peoples weight to fall where it may based on intuitive eating, while recognizing that lifestyle is one risk factor for disease, but not the only one. Behaviors encouraged include eating a healthful diet (but not restricting intake), physical activity, getting the proper amount of sleep, stress management, finding joy in life, along with intuitive eating. Intuitive eating encourages an individual to respond to internal cues of hunger and satiety rather than external cues of specific meal times or events, and is thought to prevent negative body image and the disordered eating that often accompanies it.

The HAES approach is important as it supports the idea that physical presentation and weight should not be the primary way that people are looked at or judged. This is a critical first step to achieving body acceptance and body positivity. And since some studies show that up to 70% of an individual’s weight can be dictated by genetics, 90% of people fail on diets, and 60% of them end up gaining more weight than they lost, we have to find a way to be comfortable in our bodies, even while we work to keep them healthy.

That said, there are those who misinterpret this approach to mean that it is ok to let yourself go and not care about your weight and what you eat. Those practitioners who use HAES and intuitive eating have found that it can only work in conjunction with a significant amount of education and understanding. HAES then can be considered a tool to help us achieve body positivity, but, like all tools, must be implemented in a mindful and thoughtful way in order to properly benefit from it.

Please share your thoughts on HAES and any personal experiences, whether positive or negative, with me. Thank you!

I came across a devastating statistic this week which stated that by age 13, 53% of girls are unhappy with their bodies and this number grows to 78% by the time girls are 17! How can we, as mothers, grandmothers, sisters, aunts, and teachers work to reduce these numbers and replace these negative thoughts and beliefs with ones that support body image and overall self-esteem?

As we’ve established previously, our own attitudes and beliefs about our bodies, our appearance, our weight, and our shape can influence the way our children and anyone who looks up to us as role models, think about and see their own bodies. Understandably, it can be very difficult to always be positive about how we look, but it is nevertheless critical that we try not to criticize our appearance. For example, saying things such as “I’m so fat” or “I feel fat” or “this makes me look fat”, etc. when around young girls only reinforces the misconception that our physical presentation is what is most valuable. Rather, trying to find something else about ourselves or our bodies that we can praise on occasion can go a long way to helping girls feel more comfortable in their bodies. Negative speech, attitudes, and behaviors only breed more negativity in both behavior and emotion.

Further, it is also essential to praise things about ourselves and our daughters that are NOT related to appearance in any way. Through the use of these kinds of comments, our daughters understand that there are many ways to be valued and that our appearance is not the only way or even the most important way, for us to appreciate our bodies. We must instead recognize our bodies for all the wonderful and important things they do for us, not just for how they outwardly look. Our bodies carry us, carry our children, build muscle, build endurance, heal themselves, provide signals when we are in danger or in need of food or drink, store our memories, store our emotions, and give us so much more. Focusing instead on all these amazing things our bodies can do, removes appearance related stress and pressure.

Another way to create body positivity is to work to create an atmosphere in our homes that is one where negative body and appearance comments are discouraged and unwelcome. It is important to not greet people with comments about how they look, but instead with things that are not appearance related. Some examples might include saying things such as how nice it is to see someone as it’s been so long, or commenting on something you’ve missed specifically about that person, or perhaps something you’re excited to hear about that they’ve experienced.  Sadly, it has been ingrained in us from a very young age that when we see someone often the first comment we make is about appearance. We say things such as, “you look so lovely” or “you look so thin” or “your outfit is so slenderizing”, etc. While there is no malice or ill intent in saying these things, they nevertheless reinforce the importance of physical appearance and its value above all else.

Ultimately though, we need to teach our children that a person’s worth is tied to their personal qualities, middos if you will, and not their physical appearance. Complimenting others for non-appearance related qualities in front of our children while also promoting healthy, strong bodies over thin or skinny ones, can go a long way in increasing body and self-image, as it is no longer the yardstick by which their value is measured. Children who are confident and have good feelings about themselves are less likely to develop body dissatisfaction and eating disorders. Helping your child build good general self-esteem is also likely to help your child be resilient to pressures from others and maintain healthy eating patterns.

Stay tuned for more practical and usable strategies for helping our children develop better body image and greater self-esteem.

In listening to a wonderful and informative talk by Operation Survival on eating disorders given by the amazing therapist and eating disorder recovered Temimah Zucker, I was horrified by a statistic that she highlighted. She said that children as young as 6 years old are being treated in residential facilities for eating disorders, 6 years old!!! Not only is that scary, but it is so sad and so devastating that such young children are struggling so mightily with their self-esteem and body image.

In other research I read this week, a survey found that over 80 percent of ten-year-old’s are afraid of being fat, 80% of children who are only 10 years old! This study also noted that between 35 & 57 percent of adolescent girls engage in dangerous dieting behaviors, including fasting, diet pill use, laxative abuse, and more. Clearly something is going on and even more clearly, something must be done to change this.

What can we do? We must find ways to boost our children’s self-esteem as well as their body image from a very young age. We, as mothers, have to model this type of behavior as well, since children learn much more from seeing than they do from hearing. If a mother is constantly talking about how fat she feels or that certain foods are “bad” while others are “good” or if she is constantly checking herself in the mirror or talking about how so and so looks really great as they got so thin, or looks so bad as they put on a lot of weight, etc. then we are reinforcing and encouraging these erroneous beliefs and values. When we only comment and focus on how beautiful or thin people look, we reinforce the value that externals, a person’s physical presentation, are more valuable than their internals, that which is on the inside of a person.

These issues, however, do not come only from mothers. There are many places where our girls internalize the message that thin is good, thin is healthy, thin equates to someone who is hard-working, and that thin is just better overall. This can come from friends, teachers, Rabbis, principals, doctors, nurses, dieticians, even therapists. We must change that mindset. And for this, prevention programs are needed.

One type of successful prevention program is called The Body Project. It is a cognitive dissonance-based program, meaning that physical and body ideals people have been taught to be true are challenged thereby causing discomfort for the person as they begin to realize that their beliefs and actions are in contradiction with one another. In this program, adolescents and young women critique the thin-ideal in a series of verbal, written, and behavioral exercises, ultimately leading to a reduced acceptance of the thin-ideal and an increase in body acceptance.

There are other preventive things we can do as well, learning how to speak with our daughters about their bodies and their insecurities, listening to their concerns, not minimizing how they are feeling, allowing them to have some input into their eating and food decisions as well as educating ourselves around disordered eating and eating disorders can all aid in supporting our daughters and their delicate body-image.

As a community, we need to come together to learn more about what we can do and support one another. If anyone is interested in a support and/or informational group to learn more about what we can do or to have The Body Project instituted in their school, please contact me.

As Helen Keller put it so eloquently, “Alone, we can do so little; together, we can do so much”. We can help our daughters grow up with more confidence, greater self-esteem, and positive body-image so that they can learn to trust their instincts and like themselves.

It seems counterintuitive that an eating disorder may inherently not be about or because of food. How can that be, you ask? A good question in need of explanation.

Clearly, eating disorders of all kinds manifest through a person’s relationship with food. There is either limiting your food in some way, or bingeing, or purging, or both bingeing and purging, or overeating, etc. That said, the use of food in an eating disordered state is that of a vehicle to express ourselves when we feel that there is no other channel available to us. When used this way, food helps give voice to any inner emotional turmoil and struggle surrounding feelings of helplessness and being lost. Food becomes a mechanism for taking back control when one feels that this needed control is either unavailable to them or they feel deprived of it in some way. The eating disorder patient is looking for an outlet to help sooth their raw, painful, and difficult emotions and they don’t know of another way to express them. This is played out in the realm of feast or famine.

The groundwork for an eating disorder can be laid out many years in advance of the clinical onset. But then, this small seed that has lain dormant for years can sprout when any number of stressors are placed upon the person. The stressors can include anything from trauma to abuse to difficult or abusive parental relationships to low self-esteem, negative body-image, fear of the future, academic pressure, peer pressure, perfectionistic pressure, familial or religious expectations, anxiety, depression, any combination thereof or even a host of other factors. None of these are necessarily food focused or food-based triggers, but as food can be used to either nurture or neglect ourselves, it is a readily available outlet for emotions and feelings that are unchartered or complicated to process, especially for young girls and adolescents.

The relentless stress on needing to look good and be thin that surrounds us on a continual basis is a real and consequential source of stress and struggle. It is almost socially and societally necessary and expected to be pulled into it on some level. This complicates how emotional health issues play out for people. Food becomes an expression of an underlying problem, not the problem itself. Therefore, by addressing the food issues only, you are only treating a symptom of the illness and not the underlying cause.

I met someone recently whose daughter had been in a local hospital for eating disorder treatment. She said that the program consisted of force feeding her daughter and not allowing her to be left alone. She was not suicidal and in fact, she had only started restricting for about a month or so. This young girl ended up getting worse as her emotions and underlying reasons for her restricting were not being addressed and she was being treated as someone without any control over her life. Obviously, life and death situations demand immediate attention, but clearly it is imperative to locate the source of the issue and work from there. Only addressing the symptoms will not suffice.

I recently posted a link to participating in a study for those who have experienced any type of eating disorder in their lifetime. The study, called EDGI (Eating Disorder Genetic Initiative) is an international research study designed to understand how genes can influence the risk for developing an eating disorder. As we know eating disorders are life-disrupting, complicated, and have the highest mortality rate of any psychiatric illness.

The notion that eating disorders may be impacted from or influenced by genetic factors was introduced in the 1990’s and has continued to be a strong component of their study. The genetic aspect of eating disorders could help explain why the Jewish community has been found to suffer from a higher percentage of both disordered eating and eating disorders overall. Interestingly in a 2016 study (Shih & Woodside), selected genetic variations were found to actually change the metabolism of certain nutrients. These variations lead to a statistically higher predisposition for developing an eating disorder. As we know that there is not one single cause or issue that can pinpoint those at risk for disordered eating or eating disorders since numerous factors influence ED development and onset, therefore understanding what we can about them is critical in helping to help prevent and properly treat them. This is precisely why the groundbreaking study of EDGI is so needed and critical to our understanding of eating disorder onset. As someone who struggled in my younger years with an eating disorder, I know first hand how insidious and destructive they can be, extending to all areas of the affected one’s life, with consequences encompassing the physical, the emotional, and the spiritual. Sadly, eating disorders are associated with multitudes of damaging consequences including not only the affected individual, but their entire family, as well as society overall. I urge anyone who has suffered or continues to suffer from, or even thinks they may have suffered from, an eating disorder at any time in her life to visit the website www.edgi.org and see if you are eligible to participate. Let’s all help one another better understand our potential risks and how they manifest for each of us. Ultimately this will lead to better treatment for and prevention of these devastating disorders.

Clearly from all we have discussed previously and our own experiences around food, there is a need to better understand how to develop an appropriately healthy relationship with it. Habits, attitudes, and perceptions regarding food are developed in children as young as 6! That is really, really young. There have been studies conducted on this age group that have found 5 to 6-year old’s to be clear on concepts such as fit versus unfit and even worse, that are struggling with body image and weight issues, verbalizing their desire for thinner and leaner bodies. This is such an unnecessary and harmful burden for them to bear.

In order to create positive and beneficial patterns and alter any unhealthy ones, we must institute positive body image and self-image programs at the most appropriate and helpful ages.
That said, the girls are not the only ones who need help and guidance. Parents, educators, and health professionals all need to understand our community’s unique and contributing risk factors for both disordered eating and eating disorders, how to recognize the symptoms and signs that accompany them, and the specific, unintended role that they might play in creating these food and appearance issues. These programs also offer suggestions and support in how to help our daughters if they are beginning to struggle.

In order to successfully do this, eating disorder education, awareness, and prevention programs must be instituted in our schools as well. These programs also work to bolster healthy eating habits, increase nutrition knowledge, and offer that much needed body-image and self-esteem support. Knowledge is power and education is the most positive and informed path forward. When we take the time to better understand the evolution and onset of eating disorders, how they take hold, and how to head them off, there will be less of our girls struggling with them and along the way the rest of us may learn how to improve our own relationship with food and our body-image.

There is a great deal of research supporting the success of these programs when implemented with the appropriate age and audience in mind. Let’s give our children the tools they need to develop positive relationships with themselves. This will pay itself forward to our future generations. This is my passion – let me help in your daughter’s school.