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Important Interview

Just wanted to share this great interview by Rabbi Eli Portal speaking with Aliza Blumenthal about eating disorders, her personal struggle, journey, and ultimate success. I recommend taking the time to listen. She is courageous, inspirational, and offers much to think about moving forward.

S1 E7: Blissfully blisterful (Epidermolysis Bullosa Simplex) with David Beiss Rolling with the Punches with Rabbi Eli Portal

Epidermolysis Bullosa is one of those famous diseases you may know nothing about. EB is a rare genetic connective tissue disorder, causing a lack of protein in the body that binds the layers of skin together. This leads to fragile and blistering skin. In this episode, we will hear from a courageous individual with EB simplex. Though few things are simple about his disease, he shows us how to live life positively even when it is filled with blisters. A big thank you to David Beiss for sharing his story and experiences with us. To learn more about Debra and the work they do check out their website at debra.org. Send us a screenshot of you leaving us a review and get entered into a raffle to win a limited edition “Rolling with the Punches”  zip-up sweatshirt. The raffle will take place on July 1st. If you would like to appear on the show to represent a particular challenge, or if you have questions or comments, email us at rollingwiththepunchespodcast@gmail.com. To partner with us or sponsor an episode email us at rollingwiththepunchespodcast@gmail.com. This show is available wherever you get your podcasts. Follow us on Facebook, Instagram, and Twitter to submit your questions for upcoming episodes. https://www.facebook.com/Rolling-with-the-Punches-101669291863891 http://instagram.com/rollingwiththepunchespodcast http://twitter.com/PunchesPodcast All information exchanged on this show is intended for educational and support purposes only. This information should not be considered treatment or medical advice. You must always follow your medical professional’s advice and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition or mental disorder.
  1. S1 E7: Blissfully blisterful (Epidermolysis Bullosa Simplex) with David Beiss
  2. S1 E6: Single, but not alone (Life as an older male single) with Izzy Root
  3. S1 E5: Starving for Acceptance (Eating Disorders) with Aliza Blumenthal
  4. S1 E4: Living life to the fullest with FD (Familial Dysautonomia) with Yehuda Blonder
  5. S1 E3: A Life without sight but plenty of vision with Michael Levy (Blindness and Disability advocacy)
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Call to Action: Reducing the Stigma

When we left off last time, I alluded to the stigma surrounding eating disorders in our community. There are several types of stigma we experience. One type of stigma refers to the shame and guilt sometimes surrounding a young observant girl has who is struggling with an eating disorder. Being religious, she may feel conflicted as she wonders, “How can I be having this experience when I believe in G-d?” or “Why is my spiritual connection not solid enough to free me from my food and eating struggles?”  This can, sadly, lead her to suffer in silence as she perceives she will be stigmatized if she admits to or gets help for her illness.

Another stigma pertains to someone being diagnosed with an eating disorder and getting help for it. Data shows that it is one thing for someone to look like she might have an eating disorder, but is another thing entirely to receive a clinical diagnosis and/or go into treatment for one. This type of stigma affects not only the person struggling with the disorder, but the entire family as well. Parents often hesitate whether to take their child to therapy, as having an eating disorder is a label that will follow this child, as well as their others, possibly for life. Alternatively, they get their child the help they desperately need, but, as I’ve heard numerous times, parents hide it from the rest of their children, extended family, and community out of feelings of shame and the stigma that will most certainly follow.

Many people interviewed for my own study revealed that eating disorders are not often talked about and shared in our community. This is due in part, to the overall stigma that surrounds any mental health issue, but is also because there is a particularly large stigma to admitting to and receiving help for an eating disorder. Part of this has to do with the shidduch system, as any perceived flaw or defect is considered unacceptable and can render a girl and her siblings “damaged”. It creates a real challenge as we know, since I mentioned the dangers of modeling perfection last week, so by brushing things under the rug and not acknowledging the realities of our struggles, we perpetuate the stigma and ultimately make things worse for our children. This results in them feeling that they are not good enough as their struggle brings shame and embarrassment to their family, that they are unimportant and misunderstood.

It is critical that we acknowledge the eating issues and disorders experienced in our communities. In order to fix a problem, admission that there is one is needed. If parents, rabbis, teachers, or principals do not acknowledge or worse, tell someone struggling that she does not have a problem, the one struggling then does not know she has a real issue and ends up suffering in silence, thinking she is one who is wrong and/or confused. She has no one to turn to to get the help she so desperately needs. If stigma is reduced, the surrounding shame would disappear as well.

Unfortunately, there are many people who do not realize the danger and depth of harm eating disorders create. They say, “I wish I could look like her” or “She could stop eating so much if she really wanted to”. The profundity of the illness and the prisoner that the afflicted person becomes to it, is simply not comprehended. We must reduce the stigma around all mental health illnesses, at least to the same degree as physical ailments, as neither are anyone’s fault and everyone deserves to get the help they need!

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Call to Action: Stop Modeling Perfectionism

In continuation of my previous posts elaborating on some usable and practical ideas for creating healthier mindsets toward reducing the risk of disordered eating and eating disorders, I will discuss the need to stop modeling perfectionism. Perfectionism, the inability to accept that anything less than perfection is acceptable, is one of the only absolute risk factors for eating disorders. Most risk factors for eating disorders are tied to context, experience, and development, but perfectionism has been scientifically proven time and time again to be a particularly egregious trait that predisposes those affected by it to developing eating disorders. And those with it who develop an eating disorder tend to struggle harder, needing more types and rounds of treatment and therapy as well as experiencing higher relapse rates. In fact, those who experience perfectionism tend to have higher levels of self-criticism overall. And sadly, when developed during adolescence, perfectionism is more influential and harmful than when developed later in life.

Unfortunately, there is a lot of perfectionism modeling in our culture. In my study of our culture and communities, I found that overwhelmingly teachers, mental health professionals, physical health professionals, principals, and rabbis all expressed great concern about how much perfectionism has infiltrated our communities and how much pressure this creates for our girls. This is evident in every area of our lives, from academic pressure to shidduch pressure to thin pressure to peer pressure to having to have the perfect marriage, children, and home to cooking and baking pressure, to always having to look beautiful pressure, and many others. There is a lot of praise for and expectation to be a “superwoman” someone who gets it all done flawlessly, without complaints, struggles, or failures. And certainly she is not someone who needs any emotional help or support. This mindset creates unrealistic and unattainable goals for our daughters.

Without ever seeing their mothers struggle, acknowledge it, or share it, the girls don’t realize that imperfection is normal, expected and even more importantly, part of life. This expectation is modeled to the girls from a young age and is so ingrained in them that when they can’t live up to it, they don’t know what to do or how to cope. They feel less than, and often don’t know who or how to ask for help. Sadly, this can lead to all kinds of mental and physical negative coping strategies that are damaging and dangerous.

Studies demonstrate time and time again that mothers are a huge influence in so many areas of their daughters’ lives, from body image to their relationship with food to how they cope with stress to how they value themselves to much more. And this is conveyed whether the mother means to do it or not, as children pick up on what we do and not what on we say. On some level girls aspire to emulate their mothers and make them proud, so if a mother never acknowledges her own struggles and stresses occasionally, her daughters will not either, nor will they have the needed tools and ultimately, this will be passed down to their own children as well.

Expectations of perfectionism, then, reduce self-esteem and prevent girls from acknowledging and getting help for their issues. For those afflicted with an eating disorder it is even harder, as many mothers can’t bear to recognize and accept this diagnosis or see that their daughter is struggling and in need of help. Eating disorders become shameful and can create significant stigma not only for the one affected, but for the entire family, but that is a topic for another week…

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Call to Action: Rethinking our Priorities

In continuing to highlight the points from the magazine article I wrote, I wanted to elaborate on the second idea raised, rethinking our priorities. In our community we teach our children from a young age that it is important to focus on middos, our positive traits or what is on the inside, as what matters and is fundamental to our relationship with Hashem. Sadly, however, often our behavior says precisely the opposite, as we model and reinforce the value of externality and physicality as things to aspire to, that being physically beautiful and thin are things of real value and worth. There is a great deal of time spent with young girls on their outward appearance.

Tznius is one such example. A tremendous amount of time both in school and at home is devoted to the topic of tznius and it is something adolescent girls hear about often. And while the concept of tznius is modesty in all areas of our behavior, speech, and dress, the primary message received is that it tznius is all really about how we look and present ourselves. This constant focus often results in the girls feeling that their physical appearance and what they look like on the outside is what people truly care about. There is this subtle underlying message that in order to be good, they have to look good.

Then they’ll question, “how will wearing this longer skirt connect me to Hashem?”  or “how come my teachers are so focused on my elbows and neckline when they keep telling me that it is on the inside that matters?” This is perplexing and difficult for young girls to internalize. They become confused as they are taught that it is what is on the inside that makes them valuable and special, yet everyone is so focused on their outward appearance, especially as they enter the age of shidduchim where their physical presentation becomes the primary focus. Unfortunately, when we model these messages to our children and students, it doesn’t matter what it is we say to them. This must change.

Further, there is such a punitive focus associated with transgressing the expectation of tznius dress. Girls have been told that if you violate this expectation, terrible things will happen to them, their family, as well as the entire community. I personally know of a story where a teacher told her class that if they do not dress tznius, they will get breast cancer. Period. This is completely unacceptable and is a dangerous message for young girls to internalize. It creates tremendous feelings of shame and guilt and can lead to body-image issues and self-esteem struggles, both conduits to disordered eating and eating disorders.

This is not to say that physical looks have no value, but it is critical for women to know that that they are not the only valuable piece to each of us. It is imperative that we shift our focus back to what is important and really precious to Hashem.

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Call to Action: Shifting the Focus

Recently I was asked to write a magazine article highlighting some actionable things we can do to work toward creating healthier mindsets around food and eating for both for ourselves and for our children. Keeping the Jewish orthodox community in mind, I enumerated five ideas and would like to share them here. I’ll start with one in this post, and will discuss the others in subsequent posts. Hopefully this will open a healthy dialogue with everyone about how we can make some important changes.

The first idea is Shifting the Focus. Sadly, we are often paralyzed and controlled by the number on the scale or by the numbers/sizes inside our clothing. To combat this, we need to shift our focus and rethink our relationship with food. Food is nourishment, providing us with the energy for activity, growth, and all functions of the body including breathing, digesting food, and keeping warm. Further, nutrients from our food deliver us with the materials needed for the growth and repair of our bodies as well as for keeping our immune system functioning and healthy. Food sustains us and is needed several times a day, each and every day. Food cannot be removed from our lives if we are challenged by it, rather we have to learn to live with it in a healthy and constructive way.

As orthodox Jews, we believe that food is a wonderful bracha from Hashem that is both a promotion of health and a protection of life. Food plays a critical role in our Oneg Shabbos and Yom Tov, as well as in all our simchas. We spend a great amount of our time and energy in the planning and preparation of it. So, on the one hand, cooking and baking large meals is emphasized and expected, yet often the message given to women and girls is to be careful not to enjoy it too much ourselves. We should be able to cook and bake well, but not personally indulge in it. How then, do we create a healthy mindset, a balance between the joy of food but not the fear and overindulgence of it?

Firstly, food should not be used as a reward – not in school, not for losing weight, not for going to camp, not for anything. Food should never have to be earned. We need to eat to survive. Strings should never be attached to any type of food. Many schools and camps use food as a reward. I know that when my kids were younger, they were given pastries, soda, and candy regularly as rewards for all kinds of achievements, from attending minyan on time to winning a spelling bee to completing various learning programs to memorizing chapters of mishnayos to winning bunk competitions to rewarding class accomplishments, etc. And, no matter how much I begged, pleaded, and threatened, no one was willing to put a stop to it. I even offered to buy other types of prizes for the school, but to no avail. Using food in this way sends the wrong message around what food is and how it is meant to be used. This has to change.  

Secondly, just as food should not be used as a reward, it should also not be used as a punishment. I know of many stories where girls were not allowed to partake in certain activities or events until they lost a specific amount of weight or were compelled to lose weight by being given different foods from the rest of the family and so, for example, when the rest of the family was eating pizza, the child was only allowed grilled chicken. All of these exemplify using food in a negative way. While parents undoubtedly have their child’s best interest at heart, using food in this way is dangerous as it causes confusion, misperceptions, and outright contradictions regarding what food is meant for and how it is to be used. This undermines healthy eating habits and can potentially disrupt a child’s ability to accurately recognize and respect hunger and fullness signals.

Ultimately, food needs to be used as a tool for our health, and while it can and should be enjoyed and appreciated, it should not be used as a reward or as a punishment. We must be so careful how we speak to our daughters about food, what they eat, when they eat, how much they eat, and what they weigh.

I’d love to hear your thoughts, ideas, and personal experiences!

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The Danger of Diet Culture

What is the concept of diet culture in our society? According to Christy Harrison, MPH, RD, CDN:

“Diet culture is a system of beliefs that worships thinness, equating it to health and moral virtue…Promotes weight loss as a means of attaining higher status, compelling you to spend a massive amount of time, energy, and money trying to shrink your body… Demonizes certain ways of eating while elevating others, forcing you to be hyper-vigilant about your eating, ashamed of making certain food choices…Oppresses people who don’t match up with its supposed picture of “health,” damaging both their mental and physical health.”

Diet culture keeps us on dieting cycles by telling us that we are ‘just one more diet’ away from beauty, success, happiness, etc. Diet culture teaches us that our self-worth and abilities are tied to our physical appearance and positions ‘diets’ as the answer to all our insecurities, struggles and problems. But rationally we all know that this is simply not true.

Diet culture makes eating a moral issue, that you are either “good” or “bad” based on what you eat. This moralization of food leads to judgement of people who cannot attain our societies definition of beauty, because if these people would only eat “good foods” they would be able to achieve this beauty ideal. If, however, you are unable to achieve this ideal, then the fault must be yours, you must be lacking self-control or willpower. This is clearly false. There are many factors exist in someone’s weight and body size and implying that it is all based on their ability to diet successfully is harmful and damaging to their self-esteem and self-image.

Categorizing food as either “good” or “bad”, making every bite about how many calories we are eating, removes all pleasure and joy from eating and makes every meal and snack a moral decision with incredibly high stakes. It makes eating so unbearably stressful and demoralizing and contributes significantly to a disordered relationship with food. Not all people who are society’s ideal of thin are healthy and not everyone who is not is unhealthy, and certainly they are not good or bad because of that.

Diet culture is dangerous. It masquerades as health, wellness, and fitness. It bonds people over restrictive ways of eating. It’s why people are complimented for losing weight—even if their weight loss behaviors are harmful or unsafe. It’s what has made some parents put young children on diets. It’s what shames people for eating certain foods.

Subscribing to diet culture clearly and significantly increases risk for disordered eating and eating disorders and it is imperative that we find ways to combat the messages it espouses.

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The Body Project

Recently I completed my training to become a Body Project Facilitator. This means that I am certified to run The Body Project, an eating disorder prevention program aimed at helping high school girls and college aged women. It is intended to increase body acceptance, reduce the effects of the appearance ideal (what is portrayed in the media as the physical appearance paradigm), help develop a healthy body image, and aid in increasing self-esteem.

The Body Project was developed at Stanford University, as well as at the University of Texas at Austin, and the Oregon Research Institute. It has been delivered to over one million young women around the world. In numerous rigorous studies this program has been shown to effectively reduce body dissatisfaction, negative mood, unhealthy dieting and disordered eating. In fact, one trial found that implementing this intervention prevented 60% of the cases of eating disorders that emerged in the control group over a three-year follow-up, suggesting that for every 100 young women who complete this program, there should be nine fewer young girls who develop eating disorders over the subsequent three-year period. That is amazing!

Further, the organization NEDA that worked to developed The Body Project, has worked with religious leaders and specialists in order to help tailor it specifically to the Jewish orthodox community as well as other religious and cultural groups. This means no inappropriate or unsuitable information is being used and the issues that are challenged in the program and discussed are both relevant for and applicable to each group. That is really exciting.

For me, it was an incredible experience, as I trained with 13 other women. One thing that struck me was out of 13 participants, 12 of us, me included, had their own personal struggles with either body-image, disordered eating of some kind, and/or a clinically diagnosed eating disorder. It demonstrated a level of passion for and dedication to helping other women and girls create healthy relationships with their body. The program itself is run in small groups and provides a forum for dispelling the appearance ideal beliefs we hold.  Also, as it is not a long course, it is conducted in either 4, 1-hour sessions or in 6, 45 minutes ones, it does not take up a large amount of time.

Prevention of eating disorders is so important as it is the best way to head off these devastating, difficult to treat, and complicated illnesses. The earlier we can implement these programs, the greater our success will be. Please contact me to learn more and to schedule your school!

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Physical Factors

We have talked about the numerous categories of risk factors for disordered eating and eating disorders. These included genetic, religious, familial, societal, social, psychological, age, and personality factors. The final category is physical elements that can contribute to risk. While there is some overlap here with genetic, familial, and societal considerations, the category does merit its own discussion.

One area of physical risk has to do with dieting. Any adolescent girl that is on a diet is at increased risk for developing either disordered eating or an eating disorder. Whether the diet is started as a means to get healthy or in order to drop a few pounds, it significantly increases a girl’s risk. As individuals’ progress in their diet, they start to receive increased attention for their weight loss and appearance. This can encourage further drastic weight loss methods in order to ensure continued praise and accolades. In fact, any significant dietary weight loss increases overall risk.

Additionally, there are studies which find that starting any regular exercise program during adolescence can also fuel risk, as these tend to increase overall body dissatisfaction and lower self-esteem. This seems counter intuitive, but scientific studies have found that any significant dietary and health behaviors developed during adolescence can contribute to weight struggles and body shape issues lasting throughout one’s life. Athletes or those who play in competitive sports of any kind are also at increased overall risk.

Gender is another physical risk factor, as women and girls are found to have higher prevalence of body-image concerns and a greater propensity for eating disorder development that can lead to inappropriate dieting behaviors. During adolescence the risk for eating disorders is further increased. And finally, being overweight is a risk factor for certain eating disorders as well.

Clearly, the psychopathology of eating disorders is complicated and exact causes are difficult to pinpoint. Their onset arises from the interplay of multiple types of risk factors and other circumstances that would generally be considered protective, such as religion. However, one thing is clear, eating disorders are serious medical conditions associated with numerous and devastating short- and long-term physiological and psychological complications.

This is why prevention is so vital and so needed. Prevention programs have proven successful in reducing eating disorder incidence and growth. Further, prevention programs work to help establish more positive priorities for women, help support their body image, assist in setting more positive and beneficial priorities for them, and work to increase resilience to negative messages. Sadly, studies find that girls as young as 5 or 6 years old are already struggling with body image and weight issues. The earlier we can intervene with education, awareness, and prevention programs, the more successful our results.

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Mishpacha Smoke and Mirrors

Mishpacha: Jewish Family Weekly

The Jewish family publication, Mishpacha, recently published letters from contributors about women, beauty, body-image, weight struggles, eating disorders, and more. These letters are both heartbreaking and inspiring. It’s an important topic and I commend Mishpacha for shining a light on it. There is much we can do to help people feel better in their bodies and I hope the conversation continues.

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The Psychological Impact

As we continue to discuss the numerous risk factor considerations involved in both disordered eating and eating disorders, psychological risk comes next. This category of risk has a logic and rationale behind it that some of the other risk factor categories do not. As eating disorders are psychological illnesses related to body image thoughts, feelings, and emotions, and most often coexist with other psychological conditions, underlying risk for them that is psychological in nature, is both rational and reasonable.

Often eating disorders are accompanied by psychological issues surrounding anxiety, depression, obsessive compulsive disorder, personality disorders, panic disorders, substance abuse, and low self-esteem. Rarely, if ever, will an eating disorder be diagnosed without any comorbid condition of some type, as often those affected by them are suffering with low self-esteem as well as weight and shape related issues. Further, any negative early childhood psychological or physical experiences can have a strong effect on the development of eating disorders and risk for them. Any type of abuse, whether physical, emotional, or even spiritual can negatively impact a child, thereby increasing risk. Negative body comments, weight related teasing or mocking of any type, as well as body-related bullying or discrimination greatly increase risk. This is true whether the source is a peer, a teacher, a religious figure, a relative, or one’s own parent.

Inversely, the same is true of too much positive attention surrounding weight loss. If someone is dieting and losing weight, when people around him or her heap on extra praise and attention about it, the likelihood of this weight loss leading to something clinical is also increased, as this praise reinforces feelings of validation and attention directly attributed to their weight loss. This can be especially dangerous and damaging for individuals who have a natural tendency to feel less noticed, are not used to receiving extra attention, and/or who are younger adolescents.

Risk is also increased for those who are shy or naturally inhibited. For those who feel a general sense of powerlessness over their life or overall feelings of the inability to control or effect change in their life, anxiety is increased as is their internalization of the thin ideal, both of which have been found to be more damaging to their self-esteem. Additionally, anyone who is unable to positively and constructively manage their emotions is also at increased risk for feelings of low self-worth and increased emphasis on body image and shape concerns.

Psychological risk factors are complicated and there is not consensus as to whether the risk factor is the cause or the result of the disordered eating and/or eating disorder. This further obfuscates an already confusing and complex issue.