A Jewish woman faces a unique set of circumstances when battling an eating disorder, and these, as well as research into binge eating — a subject oft-ignored, in favor of bulimia and anorexia — were the topic of a seminar hosted last week in Palm Beach Gardens and Aventura by the nation’s leading eating disorder foundation.
Marjorie Feinson, a consultant with The Renfrew Center Foundation and a researcher at the Falk Institute for Behavioral Health Studies in Jerusalem, began the seminar with her recent — and surprising — findings on the subject of binge eating in adult Jewish women.
Of 500 adult female Jewish respondents who submitted to an hour-long phone interview, 22 percent admitted to serious binge eating behaviors.
Feinson cautions this doesn’t mean that those respondents would necessarily receive a diagnosis of binge eating — her survey was not a clinical interview — but it could.
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And that 22 percent also isn’t completely out of line with the prevalence rates previously found in the United States for disordered eating — the catch-all term used to refer to many of the problematic eating behaviors consolidated since 2013 under the diagnostic category of binge eating.
Feinson also found that while respondents displaying severe binge eating behaviors were more likely to be obese than those not reporting those behaviors, two-thirds of respondents reporting severe binge-eating behaviors weren’t obese. One third were slightly overweight, and one third were of a normal, healthy weight.
“What I was cautioning the [seminar] participants about is … linking the two categories together in a way that looks causal and looks informative,” Feinson said. “By looking at a woman that is obese, you’re not going to be able to tell if she’s a binge-eater or not.”
Feinson also presented findings from a related study — she received additional funds to expand her sample of Orthodox women — which showed that religious observance had no significant impact on the likeliness to binge eat.
“We expected to find that where women are more traditionally oriented in their roles and have more responsibility for feeding the family, [that] you would expect to find more disordered eating or binge eating,” she said. “But you don’t.”
What did? Unsurprisingly: body image concerns. Of the original 500 respondents, 70 percent of the serious binge eaters reported significant body image concerns.
But more telling for Feinson were the 32 percent of binge eaters who reported being highly self-critical. According to Feinson, the medical community has long interpreted eating disorders through the lens of anxiety and depression. But she thinks that recognizing deep-seated feelings of inadequacy in patients might better explain why binge eating can be such an intransigent illness.
“The reason may be — and we need more data to support this — that self-criticism, the sense of not being good enough may be so embedded in their psyche that they’re constantly feeling bad about themselves, that they turn to the food for comfort,” she said. “That doesn’t mean we need to forget about anxiety and depression, what it means is that we need to broaden the lens to include self-criticism.”
After Feinson’s presentation, Sarah Bateman, a therapist specializing in eating disorders, spoke to participants about common triggers in the Jewish community. The dominance of food and food preparation in the rituals surrounding Jewish holidays and the weekly Shabbat — along with traditional assumptions that women do the cooking — can be a minefield for a woman battling disordered eating, she told them. Fasting, too, can be equally triggering.
“Men that are alcoholics — we don’t expect them to serve drinks for two hours,” Bateman said.
Birth control is sometimes prohibited in certain observant Jewish communities, and Bateman hypothesized that in some cases, restricting calories might be a conscious or unconscious means for women to reassert control or inhibit reproduction.
Ultimately, Bateman warned seminar participants not to pathologize Jewish traditions themselves, but instead to understand a culturally sensitive approach to be necessary for successful treatment.
A patient’s Judaism is not as an obstacle to recovery, she told the crowd — but a tool. She encouraged them to explore how rabbis might be resources in treatment because their approval of treatment strategies often helped patients — or their family, especially spouses — accept and commit to them. Bateman also reminded participants that health and life are divinely ordained in the Jewish tradition, and that this could serve as an important motivator for religious patients.