Once upon a time in the early 17th century, Flemish Baroque painter Peter Paul
Rubens painted voluptuous, nearly obese figures as the ideal female image. While
that is certainly not considered healthy, today the ideal woman – as shown in
fashion photos – is likely to be so skinny that her ribs stick
Anorexia, in which people may even starve themselves to death, or
bulimia, when they stuff themselves and them vomit it out, are increasingly
common, especially in women and girls. In the 19th century, only a handful of
cases were reported, but thanks to the influence of the world media, by the
1960s the figure ballooned to 0.25 percent. According to recent research, nearly
14% of Israeli girls and 7.1% of boys in the nine to 14 age group have the
potential for developing eating disorders.
Two percent of Israeli youths
suffer from bulimia, 1.2% from anorexia and 3% to 5% more from non-specific
eating disorders. One in 20 anorectics actually die of the disorder. Ironically,
a fifth of Israeli children are overweight.
Israeli girls have the
poorest body image of any other national group surveyed in a comparison study,
and large numbers of them are on permanent weight-reducing diets. Every year,
some 1,500 children and adolescents are diagnosed with eating disorders, but
more than 300 adults and teens get no treatment because of the lack of
specialized facilities and funding.
Although one would expect Haredi
youth to be less at risk because of their supposed lack of exposure to the mass
media, the phenomenon is spreading in this sector as well. Haredi teenage girls
– first in the US and now in Israel – who worry about finding a marriage partner
are pushed to lose weight to compete in the “good looks category.”
situation is so serious that Kadima MK Rachel Adatto, a gynecologist by training
and chairman of the Knesset health lobby, this month initiated a conference in
the Knesset auditorium to discuss the problem and report on progress in getting
her private member’s bills passed into law.
One would prohibit the
appearance on the catwalk of models with less than an 18.5 body mass index
(BMI), which is calculated by dividing body weight by the square one’s height.
Thus, an adult with a BMI below 18.5 is underweight; between 18.5 and 24.9 of
normal weight; between 25 and 29.9 overweight; and 30 and over obese. Their
photos also could not be published anywhere, whether in print (including
billboards) or electronically.
In addition, according to the bill, images
that are doctored (as by Photoshop) to make them look thinner than they are
would have to bear warnings stating that they are not authentic.
second bill, people under the age of 24 would not be dispensed laxatives without
a doctor’s prescription. Adatto, who visited facilities that treat eating
disorders before writing the bills, said she met a young woman who admitted to
taking up to 120 laxative pills per day to lose weight. A third bill she wrote
would monitor websites that give advice on drastically losing weight, vomiting
out food and tips to promote anorexia and bulimia.
Dr. Yitzhak Vorgaft,
head of the eating disorders department at Ziv Medical Center in Safed and head
of the Israel Association for Prevention, Treatment and Research of Eating
Disorders, was co-organizer of the conference.
He runs the country’s only
inpatient department for eating disorders that treats adults.
many factors involved in getting such bills passed,” said Adatto, who is also a
lawyer. “There are various ministries, the media, lobbyists. As we went deeper
into the issue, we learned more and more about problems in the health sector,
such as the lack of places for outpatient and inpatient care.”
some good news, however.
Soroka University Medical Center in Beersheba
will soon open its own unit for eating disorders in-hospital, joining that at
Ziv, plus Schneider Children’s Medical Center in Petah Tikva and Sheba Medical
at Tel Hashomer for teens. Rambam Medical Center in Haifa also has a eating
Only about half of anorectics and bulimics recover,
said Vorgaft in his lecture, “and it takes two to five years of treatment to
achieve a cure. Thirty percent have a partial recovery, while 15% develop a
chronic case and 5% die of the disorder.”
Vorgaft presented a
psychological profile of people with eating disorders; they are perfectionists
with rigid thinking, feel overwhelmed, have difficulty seeing the big picture
and can’t easily sort the wheat from the chaff.
Add this to living in a
world in which money and looks are very important, and the result is a person at
“Youngsters are sometimes victims of the society in which they
live,” he said.
He recommended early monitoring by a family physician or
pediatrician and close observation of pupils by the school nurse, “that is, if
schools had them.” Once diagnosed, children with eating disorders should ideally
be seen at a multidisciplinary clinic staffed by a psychiatrist, clinical
dietitian, social worker, psychologist and various therapists.
costs a lot of money, and inpatient departments for anorectics need to offer
enticing food to induce patients to want to eat, and that costs money,” said
Vorgaft, adding that his department is the only one to function five times a
week. It costs about NIS 600 a day per patient to treat these
“The Health Ministry has set a diagnostic- related group (DRG)
payment by the health funds for only NIS 340 a day. Thus any hospital director
with such units knows it will be a money-losing facility.
So who will
volunteer to open such units?” So there are too few specialized
Of 250 youths hospitalized for eating disorders in 2007-8,
less than 10% were sent to specialized departments with expertise in treating
and rehabilitating them so they can reintegrate into society.
went to general hospital departments, he said.
Asked later to comment,
the Health Ministry told The Jerusalem Post that ministry director-general Dr.
Ronni Gamzu had instructed the budgeting division to look into changing the
pricing for such services. In addition, the ministry will offer an incentive
payment of NIS 50,000 to each hospital that agrees to open (or expand) an eating
disorders clinic. He also asked four hospitals to open such clinics in the
Dr. Eitan Gur, director of the eating disorders department for
adults at Sheba, called for an amendment to the Psychiatry Law enabling doctors
and nurses to force feed anorectic patients in danger of death. After hearing
this plea, Adatto said she would positively consider initiating such a bill as
The average patient in his 24-bed department stays for three
months; every year, some 160 adolescents and adults (almost all girls and women)
“There is a long queue for admission, and the criteria are
strict; they must have a BMI of 10 or lower to get in,” Gur
Numerous patients are recidivists, returning every few
“I remember a woman who refused to remain for treatment; she was
hospitalized with us 14 times. It cost NIS 1.2 million only for occupying a bed,
without including the treatment. If she had agreed to medication and other
treatment, it would have saved the expenses of a rehabilitation home for 15
girls for a year,” he said.
Another extreme case was an 18-yearold who
weighed only 39 kilos but said she wanted to diet until she reached 22
“She had no menstruation for more than four years, suffered from
hypoglycemia and hypothermia and developed kidney insufficiency. Her BMI reached
an incredibly low figure of 9.”
As she was considered an adult, she
insisted on leaving Sheba but is now being treated in Jerusalem, Gur
“I hear she keeps trying to get out of bed and
Einat Tzuberi, head of the eating disorders clinic at the
Shalvata Mental Health Center in Ra’anana, reported on her study of seven
intermediate and high schools where dance is studied by
These included two high schools for the arts, which she
found were much more likely than regular schools to cultivate the rigid
thinking, perfectionism, feeling of being overwhelmed and the belief that looks
Adatto, who presented shocking images of starving women
models, congratulated Adi Barkan, who for years at his model agency ordered
young women to lose weight. Now he preaches the opposite advice and uses the
Internet to combat eating disorders.
Girls who return to normal eating,
said Miri Givon, a social worker and clinical director of Rambam’s eating
disorders clinic, need support not to relapse.
“It’s hard for them to
remain in school and to regular jobs. If they leave home, they have a difficult
time finding other housing. To prevent them from developing ‘revolving-door
syndrome,” she insisted, they need a hostel with 24-hour supervision.
these are few and far between, especially in the periphery.
The Kadima MK
concluded that despite strong pressure against her Knesset bill on models with
low BMI, she hopes it passes on its second and third readings.
describe my bills as violating freedom of expression. But these and other young
women deserve to live,” she concluded.