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A concise guide to anorexia nervosa

Over the course of my tenure as a pulpit rabbi, I have learned a little about many things. Truth be told however, I have only scratched the surface and I still have much to learn. The following thoughts I experienced firsthand when a relative of mine became unwell with anorexia nervosa.

One thing that fascinated, intrigued and captivated me was the dreadful and horrific disorder, anorexia nervosa. I just could not wrap my head around it. As a foodie, I can grasp in concept bulimia nervosa, which is overeating way more than an average person on a consistent basis, and then resorting to inappropriate behavior to prevent weight gain. But I simply cannot understand how a person restricts themselves to extremely minimal intake of nutrition and hydration, day after day after day. I know that I would/could last a day at most severely restricting and exercising to boot.

I have put together some thoughts that I have learned from others that are educational, because when it comes to this disorder, ignorance is extremely dangerous.

I ask that if you know of a family who is struggling with AN, please send them these Cliff Notes. Who knows, it may save lives.

ANOREXIA (AN)

Anorexia is an eating disorder propelled by a severe and intense fear of gaining weight. To prevent weight gain or to continue losing weight, people with AN usually severely restrict the amount of food they eat. It is vitally important to point out that AN isn’t only about consumption of food, rather, it is also an extremely unhealthy way to try to cope with emotional problems. Let’s be clear, AN is a biological concern as well as a psychological one.

Furthermore, AN has the highest mortality rate of any mental disorder. A recent statistic I read states the mortality rate associated with AN is 12 times higher than the death rate of ALL causes of death for females 15–24 years-old.

And no, medications do not help. Medications are given to help treat depression and anxiety. Essentially, the only treatment is to refeed and restore the patient back to health, while simultaneously treating the underlying mental problems. What AN can do to the body if left untreated are too many to list, but the main issue is that it affects the heart, inner organs, and brain, all due to being malnourished because of minimal intake.

THINGS TO KNOW

A. This is something that a person cannot fight on their own. The power that AN has over the individual is incredible. AN can gain full control of the mind, and lead it down a path of self-destruction. Parents and caregivers need to act as soon as possible. The faster the refeeding starts, the quicker the recovery. The parents or caregiver cannot do this alone either. The patient needs a doctor who completely understands AN, as your typical pediatrician or family type doctor has very little knowledge on the matter and therefore a misdiagnosis is very common. There are doctors who specialize in adolescents, and they are usually very in tune.

The patient must have a therapist, psychiatrist and a nutritionist, and all three need to be in contact with one another. Some patients may need a higher level of care called IOP or Intensive Outpatient Program. Others may need to be admitted to a residential facility. Sadly, it is very common that many AN patients require hospitalization to stabilize the heart and blood pressure. Sometimes a nasogastric (NG) tube, which is a thin, soft tube that goes in through the nose, down the throat, and into the stomach, needs to be inserted for the patient to receive nutrition and stay alive.

B. It must be made clear that the parents are not to blame. The exact root and cause of the disorder is different for every person. It is complex as biological, genetic and environmental factors can influence the development of anorexia and associated symptoms. If anything, studies have shown that a trauma such as bullying and abuse opens the portal to allow AN to enter and control this beaten person. It has also shown that many patients who are athletes with a focus on the body resort to restricting food and a great proportion of AN patients face tremendous intense academic pressure.

C. Watch out for the early signs. There are a number of red flags.

Wearing huge oversized and baggy clothing to hide what they think is a hideous body can be a sign. I know someone who wore a thick sweatshirt and pants in blistering 90-degree weather. Ironically, the person was a size small but wore an XL.

An abrupt change to veganism or vegetarianism is another red flag.

Eating very healthy. An example would be cutting out all fats and carbs. This means no more mayonnaise, butter or oil, and no more starchy vegetables. This part of the journey is called orthorexia, which can very likely lead to Anorexia if not curbed. We need to be very in tune as AN is a hard one to catch early on.

Excessive exercising to the point of exhaustion every day and sometimes multiple times in one day.

When they no longer allow pictures to be taken because they despise their body so badly. The person feels, not only will the photo look horrible, they are not even worthy to have their picture taken. Self-loathing is a large part of this disorder.

CAREGIVERS MINDSET

A. The first thing you have to say to yourself as a caregiver is that you will stand up to this disorder. It seeks to control your loved one’s heart, brain and body and you have to be ready to fight back. Remember, you are not fighting your child, you are at war with AN. There must be much love and attention given. However, there is no giving in when it comes to eating. There is no negotiating. All life stops until you eat. This approach is based on the Maudsley method or Family Based Training (FBT). It is evidence-based to be extremely effective. While it takes more stamina than simply dropping off the patient at a treatment facility, it is well worth it in the end.

The reason why there are so many relapses for AN patients is because when the patient comes home from being in a treatment center or hospital for the past four months, the parent or caregiver has absolutely no clue what to do. Parents don’t know how to handle objections to food. FBT teaches strength and principles, and it gives over the power to the caregiver who is and will be the main healer.

B. There is no such thing as junk food. All food is food. There are no junk food aisles in the grocery store and there is no such thing as a junk closet. Rephrase it to what the item is or simply state I will be in aisle eight. The term junk fits right into their disordered thinking that this food (like most food) is very bad and is junk. Make sure the home has no light mayonnaise or calorie light ketchup or maple syrup. Those days are over. Only full fat milk, whole fat yogurts and bread and butter. As an aside to ponder, baked potato chips have way more junk in them than typical chips.

C. Never ever talk about weight or body types. Don’t compliment a picture of a model and do not berate the way you look either. Remove all full-size mirrors and put them in storage. Do not bring home magazines that extol the virtue of the perfect body. Let’s face it, there is no such thing as a perfect body, and it is strictly a construct. God made us in all different shapes and sizes, and idolizing one particular type is foolish. Isn’t beauty in the eye of the beholder? So many of the billboards that feature the perfect body have actually been photoshopped, which is sick and deranged. You need to block to the best of your ability pro-anorexia websites that are despicable and should be illegal.

D. There is to be no dieting or talk of dieting as this can push the recovering individual down a black hole. I have heard that the single best thing a family can do is to eat pound for pound with the patient. It is true you may not like or need to eat as much as the patient, however, you must realize that this is the medicine for him/her. You proudly show that you are not afraid of eating ice cream or a second helping of noodle pudding or Lo Mein.

THE RECOVERY

A. There is only one cure. Only one! The AN patient must eat. The only way to beat this disorder that is in control of your loved one’s mind and heart starving them to death, is to have the person eat, and eat often. The patient needs to eat three meals a day and three snacks a day. Once the brain and heart start receiving nutrition thus begins the will to fight back. It will not happen right away, but if you stick to your guns, it will make all the difference.

B. The body has to be not only weight restored; the weight has to be higher than before the disorder grabbed hold. We need to remember that the BMI chart that dictates where our ideal weight should be has hurt more people than we can fathom. It sets a ridiculous bar of low weight expectations. No wonder so many of our teens resort to withholding food. There are so many body types that BMI chart does not take into account, such as bone structure and thickness.

C. I will tell you that the hardest thing for parents to witness is their child getting a little overweight. They ask why so much food? Why does he/she need to weigh more than he/she did before the disorder began? The patient needs to get to a certain magic number, and for each person it is different. This magic number will beat AN when it is down. It is proven time and time again that these extra pounds allow the glimmer in the eyes to return, and the focus begins to come back, and eventually you are rewarded with a smile. Do not fight the weight gain. Embrace it and realize that not only is this the best medicine, it is the only medicine.

PLEASE SHARE

It is alarming and astounding how so much disinformation is out there. This disorder needs intervention post haste. The lack of knowledge out there coupled with the fact that even most doctors have no clue how to diagnose or treat AN, precious time is lost. Time that we don’t have. Remember, the faster the treatment, the less of a war it is going to be.

This article is only an introduction to this dastardly disorder. While there are a great many books on the subject, there is a dearth of facilities that know what they are really doing. One should not go to a place that treats all and every mental illness, as they have limited knowledge. Go to the best of the best to seek counsel and guidance and treatment.

While this primer is missing the meat and potatoes, it is designed to be a cheat sheet to get the conversation going which will hopefully lead to swift action.

Godspeed. Praying for you.

About the Author
Rabbi Yakov Saacks is the founder and director of The Chai Center, Dix Hills, NY. The Chai Center has been nicknamed by some as New York's most Unorthodox Orthodox Center.
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