Dying to be thin

Doctors can help some victims of eating disorders, but a cure remains elusive.

girl covering face 88 (photo credit: )
girl covering face 88
(photo credit: )
Through the millennia, humans struggled to find or produce enough food to survive; today, some people struggle not to eat so they can die. Just as lung cancer was almost nonexistent over a century ago, before tobacco smoking became popular, exposure to the media that made thinness fashionabl has produced anorexia and other eating disorders that are fatal 20% of the time (more than any other psychiatric disorder). Anorexia nervosa ("nervous loss of appetite") was first identified and described in 1870 but became common mostly in teenage girls and young women about four decades ago. More recently, a minority of teenage boys have joined in. The medical term is misleading, as sufferers do not lack appetite - they just ignore it and try to starve themselves because their perverted body image makes them fear gaining weight. ANOREXIA WAS only one of the psychiatric conditions discussed at a recent International Conference on Eating Disorders and Obesity at the Maaleh Hahamisha Conference Center outside Jerusalem. The conference drew a number of foreign experts and more than 200 participants. Some of the stories were so sad that one had to think twice before eating the kibbutz hotel lunch. Studies show that young Israeli women and adolescents have among the world's highest rates of mistakenly thinking they are overweight. A recent study conducted by Dr. Liat Koren and Dr. Rahel Magnesi of the Ariel University Center found that 26% view anorexia as "a way to find work, friends and social acceptance" compared to older women - and only 28% of them know about the dangers. University of Haifa public health researchers Dr. Lital Keinan and Dr. Orna Baron-Eppel found that over half of Israeli Jewish women have normal weight. However, 17% of those up to 65 who are within the normal limits are not happy with their weight; only in older women does this trend decline. Those aged 45 to 54 who are not overweight are even more dissatisfied with their weight than women 21 to 34. More than half of Arab women surveyed were overweight, but dissatisfaction with their weight, especially over the age of 44, is much lower than among their Jewish counterparts. However, young Arab women are undergoing the same Westernization that idolizes thin women, the University of Haifa researchers found. SLOWLY, THE need to "do something" about eating disorders and rehabilitate those who have begun to gain weight is being realized. The country's first hostel for women aged 18 to 32 who are on the way to recovery from eating disorders has been budgeted by the National Insurance Institute, with private donors and professional assistance from Rambam Medical Center in Haifa and the approval of the Ministry of Welfare and Social Services. To be located in the north, it will support adolescents who have just begun to reverse their weight loss and want to recover. If it succeeds, said University of Haifa social work Prof. Yael Latzer (who pushed for the project), it could serve as a model for other such hotels, and the granting of an official basket of services for others suffering from eating disorders. After hospitalization during the acute phase, they have gone directly home, and many are unable to fight it alone, said Latzer. "There is now a consensus in government that a rehabilitation house for anorectics and other sufferers is needed," Latzer told the conference. Each resident at the hostel, to be called Tzeida Laderech, will pay NIS 700 a month for room, board and treatment, and must have high motivation. PROF. MICHAEL DEVLIN, a clinical psychologist at Columbia University's College of Physicians and Surgeons, lectured on binge eating disorder (BED) - another type of eating disorder - after arriving for his first visit to Israel. "It was regarded as a separate world from obesity, but now we know more about genetic, environmental and cultural factors that contribute to the risk of binge eating," he said. "Obesity is regarded as a medical disorder, but it's also a behavioral disorder. However, long-term behavioral changes are not impossible. Our eating disorder clinics at Columbia were originally meant for anorexia and bulimia [in which sufferers gorge and then purge themselves so as not to gain weight], but not BED. We realized that an important disorder was being missed, so we set up a facility for them." BED is described in the Diagnostic and Statistical Manual of Mental Disorders:Volume IV as recurrent episodes (at least twice a week) of distressed, rapid eating of large amounts of food (up to 3,000 calories at a sitting). "BED is quite common, affecting about 30% of the obese, and causes even greater impairment of work and social functioning. Sufferers also often have other adverse medical outcomes such as high cholesterol and insulin resistance," Devlin said. Possible treatments include antidepressants, appetite suppressants and anticonvulsants, he added, but these do not constitute a cure. Long-term studies will be needed before other treatments are considered. "It may be that some drugs will work for some but not all. Even Internet support groups may be of help," he suggested. ANOTHER EATING disorder called "night eating syndrome" was discussed by psychology Prof. Allan Geliebter of the Obesity Research Center of St. Luke's-Roosevelt Hospital Center of Columbia University. Geleibter, who spent some months as a college student at The Hebrew University, explained that night eating is characterized by not eating in the morning, eating a lot at night, sleep disturbances and awakening to eat. It has been found in 12% of moderately obese and 68% of very obese people - and about 1.5% of the general population. He said it can also be found in people of normal weight. Some sufferers are aware of what they are doing; some are sleepwalkers. There are even cases of people who go to the refrigerator and eat a can of cat food. Depression and low self esteem are more common among night eaters, and stressful events play a triggering role, Geliebter added. About three-quarters of them recall a stressful event just before developing the syndrome. "They don't necessarily eat much more, but the pattern of eating shifts to much later at night. There have been studies showing that the drug sertraline (Zoloft) may help, but they are only preliminary." Some have even tried cognitive behavioral therapy or keeping tempting food out of reach, he said. Some night eaters have suffered abuse as children. The psychologist cited the case of a stock trader he treated who used to wake up in the middle of the night to carry out stock trades on the Internet, eating an inordinate amount of food while working on the computer in his bedroom. "I suggested that he take his computer out of the bedroom, and this helped a lot." Another unusual case was a woman of Italian origin who got up to go the bathroom and detoured to the kitchen. She ate 1,200 calories of pasta without even remembering it the next morning. "She couldn't understand how she had gained so much weight." DR. SARAH WEINBERGER-LITMAN, a religiously observant experimental psychologist from New York who has studied eating disorders in the Orthodox community and is currently a post-doctoral fellow, noted that even though women in the haredi community are much less exposed to fashion models, eating disorders are appearing among them as well. Feasting and fasting are big elements of Jewish religious observance, she said Her research found that "anorectics report feeling closer to God, while bulimics feel farther from God. Even though Jews don't believe in the concept of Original Sin, Adam and Eve first became aware of their nakedness and sexuality when they sinned in the Garden of Eden, so it seems that guilt unites both food and sex. Jews have complex relationship with food. Many overeat on Shabbat and festivals. Food brings families together; providing food is a way of showing love. Are there more eating disorders in observant Jews? I don't know yet for sure, but there are some unpublished studies that indicate this." In Israel, haredi girls seem to have a lower prevalence of eating disorders than their secular counterparts, Weinberger-Litman said, but in the US, therapists say their practices are full of religious women." But she also identified different views and experiences within the Orthodox community. "I have found that the intrinsically religious who keep their belief and actions inside are less likely to suffer from eating disorders than those described as extrinsically religious, who are intensively involved in communal and social events," she said. Pefectionism and gender-role conflict, as well as feeling you have to be a "superwoman" in every domain from kids to career, are liable to increase the risk of eating disorders in religious women - especially the modern Orthodox - the New York researcher stated. Much new data about eating disorders were disclosed in lectures, abstracts and poster sessions, but much is left to be discovered and even more effort needed to find successful treatments and cures.