Diet Culture Shouldn’t Be Welcomed in Our Communities

By Devorah Kamman, MSN, PMHNP

In light of recent events and the coverage on COLlive.com about eating disorders and depression, I would like to complement the discussion with a professional but also Lubavitch perspective.

As a Bais Rivkah alumnus, Yale graduate, and Psychiatric Nurse Practitioner, I have been treating high acuity eating disorders and mental health comorbidities over the past five years, with some of the leading national experts in the field. While the journey through an eating disorder in light of the teachings of Chassidus is a beautiful and truthful tale, it is also important that we recognize the fine but important line between disordered eating and eating disorders.

In a world where thinness and self-discipline are idolized, it can be difficult to distinguish a disorder from a diet or regimented way of eating. While the difference in some ways is simply a matter of degree, the distinction is still critical. That is because eating disorders, unlike diets, are a psychiatric condition with undoubtable medical complications of the utmost severity, contributing to an astonishing fatality rate of 20% among individuals with anorexia. This is higher than any other psychiatric disorder and means that a shocking 1 in 5 individuals with this disease will die from complications related to it. What you may not know is that more than half of these deaths are from suicide, not the medical complications of starvation themselves. There is a critical link between malnutrition, structural changes in the brain, and suicide risk.

We can think of the relationship between diets and anorexia as analogous to the link between alcohol consumption and addiction. Clearly, they’re related, and while it may be problematic that alcohol is so normalized in our culture, we still have to recognize when we cross a line into a medical and addictive danger zone.

It’s vital that we highlight these conditions like psychiatric disorders, in large part so that people access the resources they need. Chassidus is the most powerful tool we have for the healing of the soul and mind. There is no doubt about that. But we all know that to be a receptacle for the light of Chassidus, we cannot be a broken vessel. The Rebbe always encouraged us to seek experts in the field, including knowledgeable second opinions, and to heed medical advice when dealing with illness. As I’ve heard quoted from Rabbi Shais Taub, “there’s depression for a Rabbi in a black coat, and depression for a doctor in a white coat.” While this line is at times subtle, we can’t afford to risk missing that distinction. Often, we need professional input to help us recognize this line.

For many reasons, it seems that people think they can see a general therapist for the treatment of eating disorders. While therapists of all approaches can be a great resource, this is the equivalent of going to a general family doctor for cancer treatment. It simply is not the solution. We may go to a generalist as a first step, but we must follow through with a referral to specialists because these are the people who have amassed knowledge but also years of experience treating these very same conditions! They know what to do.

Eating disorder specialists know to look for bone density loss, changes in heart rate and rhythm, loss of menstruation, and specific patterns of changes in psychiatric functioning and rational thought processes that occur predictably with behaviors such as restricting, purging, and even binging. Specialists understand which psychiatric medications that work for depression can actually worsen depression in people with eating disorders, which forms of psychotherapy are helpful or harmful, and how to form an interdisciplinary team, including at times cardiology, endocrinology, neurology, or specialized nutritional consultations.

Understanding the line between disordered eating and eating disorders doesn’t mean we wait to cross that line to seek help. In fact, preventing malnutrition, especially during adolescence, when nutritional deficiencies can impact our developing brains, is the ultimate cure! This is where we can’t be afraid to seek resources early on to help us develop a well thought out plan. Contrary to what we may think, drawing attention to a problem is not what makes it worse. Yes, bad treatment can worsen problems, but good treatment should always empower us to overcome our struggles efficiently, to become more active in our lives, and to grow increasingly independent and well.

Finally, we need to get together as a community and recognize that diet culture is not welcome here. Too many of us think scales are a normal household item, and that counting calories is an appropriate way to manage weight or be healthy. While these methods may work for some people, they put too many others at risk. There are 101 ways to maintain an optimal weight without counting any type of numbers! The book “Intuitive Eating” by Elyse Resch and Evelyn Tribole, is a great resource that provides factual data to support an alternative approach to nutritional health.

In these times, nobody should feel like they can “wait it out,” or “get through it,” by keeping busy. If these approaches were working, you wouldn’t still be struggling! Getting help doesn’t mean becoming a victim, failing in Avodas Hashem, or getting stuck in a self-centered “journey.” It means simply that you’re being resourceful, acquiring specialized and professional guidance, and getting back on your feet in the best way that you can.

As a community, we’ve already come a long way over the past ten years. There is more mental health awareness and acceptance, including the organization Neshamos and their advocacy. Let’s add to this progress, and remember that while eating disorders can look like extreme dieting to the naked eye, they can in fact become the deadliest psychiatric disorder of all.

By creating an open dialogue about eating disorders, connecting individuals to professionals early on, and shifting away from a dangerously diet focused mentality, we can undoubtedly save more lives. Collectively, we can inhabit our bodies with acceptance, freeing up our peace of mind to engage meaningfully with our lives, bettering the world, one healthy person at a time.

RESOURCES:

• Dr. Gaudiani’s amazing medically oriented must-read, Sick Enough
• Virtual support groups
• National Eating Disorders Association
• Kamman’s body-positivity focused mental health virtual support forum

–Devorah Kamman (Bogart) is a proud Bais Rivkah alumnus, graduate of Yale University, and a psychiatric practitioner specializing in eating disorders and associated mood and trauma-related health conditions. Divi has led psychiatric and therapeutic programming for a number of high acuity mental health programs in Connecticut. She is now consulting and providing treatment for eating disorders at Newport Academy, a family-based residential program that offers kosher meals, while also running a private virtual integrative mental health practice. She lives with her husband, Rabbi Eli Bogart, and four children in the Lubavitch community in New Haven, Connecticut.