From THE JEWISH PRESS Friday, May 26, 2000

Teen Health Forum Focuses On Nutritional And Emotional Needs Of Our Youngsters

Maimonides Medical Center and Bikur Cholim of Boro Park recently sponsored a special Teen Health Forum to deal with the nutritional and emotional needs of our youngsters.

Douglas Jablon, Special Assistant to the President of Maimonides Medical Center, and Sarah Tannenbaum, of the Bikur Cholim of Boro Park, were program coordinators. The forum was initiated by Helene Gerber, former member of Community School Board 20 and a longtime advocate for the protection of the health of our area's children, in response to the current crisis concerning the health of youth in our community.

Hundreds of people in the audience heard from Rabbi Dovid Goldwasser, Rav of Khal Adas Yitzchok, Jewish Press columnist and renowned lecturer and author, and a panel of prominent physicians led by Dr. Henry Anhalt, Director of the Division of Pediatric Endocrinology and Metabolism, and Medical Director of the Kids Weight-Down Program at Maimonides Medical Center.

Stanley Brezenoff, President and Chief Executive Officer of Maimonides Medical Center, who was also present, stated, "Maimonides Medical Center is grateful to Bikur Cholim of Boro Park for its leadership, and we are committed to working with them and the community to attack this very serious problem. Maimonides Medical Center is working on a pragmatic follow-up on these vital health issues facing teens and their parents."

Dr. Steven P. Shelov, Chairman of the Department of Pediatrics, received an award for his outstanding and exemplary service to the community. Dr. Shelov spoke of teenagers at risk and the goal of making them healthy and well.

In her welcoming remarks, Mrs. Gerber, the program chair, directed the public's attention to the urgent need to address the serious and complex problem of dating disorders and the emotional health of our youth. "Attention must also be given," she stated, "to proper approach to healthy eating and regular exercise."

Dr. Henry Anhalt, who has addressed students in several yeshivas on health and nutrition and is currently in the midst of a study on bone strength of Orthodox Jewish teenagers, spoke about adolescent osteoporosis. "The results are alarming," said Dr. Anhalt, "because teenagers are entering adulthood with a bone mineral deficiency.'

Dr. Anhalt stressed the importance of preventing osteoporosis, which is usually a disease of the elderly but is occurring in adolescents due to the lack of enough calcium in their diet and the lack of proper exercise. Dr. Anhalt stated, "You need to gain bone strength during adolescence; it's the single most important period of time to gain healthy bones. Children need physical activity to build strong, healthy bones. Swimming doesn't work because you're suspended in a situation where gravity is taken away. Jumping, running and weight-bearing activity is what does it. You can build normal bone strength just by jumping in place for 15 minutes daily.' He recommended increasing calcium intake to 1300-1500 mg daily and having an exercise program that includes weight-bearing activity.

Rabbi Dovid Goldwasser discussed the growing number of young people who suffer from eating disorders. He described how an eating disorder takes form. In response to a question concerning why eating disorders happen, the Rabbi suggested three possible reasons: 1) The media today has inundated young people with the idea that,being thin is not good enough; to truly be beautiful, you have to be skeletal. The proliferation of thousands of diets, diet pills, and exercise programs has added to the problem of everyone dieting and everyone trying to lose weight - whether they need to or not. 2) It has been found that often, when a child does not have enough freedom of expression at home, or has been stifled, the child looks to express him/herself in other ways. Having an older sibling who is constantly praised because they are so "perfect" and/or an overbearing parent contribute to the further erosion of a child's self-esteem and make him a prime candidate for an eating disorder.

3) The tremendous amount of pressure that exists in today's world has devastating effects. There is pressure to learn well, to succeed, to be the best in class, to graduate elementary school with honors, to be accepted to the best high school, to excel in all, subjects, to get the highest marks on midterms, finals, and Regents, to get into the best Beth Midrash/Seminary, and finally to, get married. An eating disorder is all about a young person wanting to take control of their life.

Rabbi Goldwasser discussed the dangers of not treating an eating disorder how the body begins to weaken and the vital organs begin to break down. In the end, the one who suffers from an eating disorder has in actuality lost the control they were hoping to gain. The rabbi suggested two excellent books for further reading on the subject of eating disorders, The Twelve Step Program for Overeaters and Dying To Be Thin.

Rabbi Goldwasser had given excerpts from a group meeting that he held with anorexics. The audience sat spellbound as they listened to case histories, and the effect that an eating disorder has on the individual and the people around him. He pointed out several Maamarei Chazat and a quote of Rambam which give directions as to proper eating habits and diet. He also underscored the mitzva of "Venishmartem me'od Lenafshoteichem" - that people should guard their physical and mental health.

Rabbi Goldwasser discussed a responsum of Rabbi Moshe Feinstein, zt'l, which addressed the question of strict dieting and crash dieting, in halachic terms. Rabbi Feinstein sets the guidelines of what type of diet is permissible and when. Rabbi Goldwasser also discussed various Sheilos that he has received from people suffering with eating disorders. They helped to provide a better understanding of the situation. One question came from United Press International two days before Yom Kippur, when the rabbi was asked if an anorexic who is in a serious condition because of his eating disorder needs to fast on Yom Kippur. The answer was published in newspapers throughout the United States and Canada.

Rabbi Goldwasser profusely praised and thanked Maimonides Medical Center and the Bikur Cholim of Boro Park for finally bringing this issue to the forefront and allowing people to realize that they no longer need to suffer in silence.

Dr. Warren Seigel, Director of Adolescent Medicine, and Dr. Lauren Budow, Assistant Director of Adolescent Medicine, made an excellent presentation dealing with normal nutrition in adolescents and the eating disorders anorexia nervosa and bulimia nervosa.

Dr. Seigel presented a general overview of the psychological and social growth of adolescents. He explained how it is particularly important for people to understand that the normal growth and developmental issues put adolescents at risk for eating disorders.

Dr. Budow explained that anorexia nervosa is a disorder with medical and psychological components characterized by someone who has a fear of being, or becoming, fat. She has a distorted body image and her weight is at least 15% below the ideal weight for her age and height. The onset of this disorder may be related to the pressures in a young person's life. Developing an eating disorder may be the only way she can regain some control in her life. Warning signs might be someone who might be developing food rituals, i.e., cutting food in very small pieces, rearranging food on a plate, and spending an extraordinary amount of time eating a meal. A sufferer may exercise excessively and wear loose-fitting clothes to hide her weight loss.

Bulimia nervosa is characterized by recurring episodes of binge eating followed by some sort of purging behavior, i.e., vomiting, laxative use, fasting, or exercise.

Serious medical complications can and do occur - for example, irregular heartbeat, heart failure, kidney failure, osteoporosis, fainting, fatigue, overall weakness, loss of menstrual cycle, and difficulty in concentration due to the temporary deterioratioof the brain.

Eating disorders are common and they can be treated. Early detection substantially increases the chances of recovery. A number of individuals addressed the participants at the forum and expressed their concerns on the issues raised, and their desire to seek help. If you are concerned about a family member, a friend, or have an eating disorder yourself, you ' do not have to feel alone, or ashamed. Dr. Lauren Budow and Dr. Warren Seigel are seeing an increasing number of eating disorder patients at Maimonides Medical Center. They provide a thorough evaluation in a private practice setting and are sensitive to the needs of the Orthodox Jewish community.

Dr. Altshuler, the Co-Director of Maimonides Medical Center's Kids Weight-Down Program, spoke about the problem of pediatric obesity. This is a major health issue facing the Jewish community, as it is in the communities across the country, and the problem has grown worse over the past thirty years, affecting over five million children. Poor dietary habits and a sedentary lifestyle contribute to this problem. Few children and adolescents consume health foods such as fruits and vegetables; 30% of children do not average even one (non-fried) vegetable each day and 51% eat less than one serving of fruit per day. Similarly, almost half of young people between the ages of 12 and 21 get no regular physical vigorous activity. Even without weight problems, these trends toward unhealthy behavior are concerning, as it is in childhood that lifelong health habits are formed that will affect health in adulthood.

Promotion of healthy lifestyies requires collaboration between community, school, and family to address barriers to better eating and activity patterns. Communities and schools need to ensure that there are adequate facilities and programs to allow children and adolescents to enjoy physical activity throughout the year, and that healthful and tasty foods are available. Parents must remember that children learn by example, so parents must be good role models by showing moderation in eating (neither overeating nor being overly focused on restricting foods), and by exercising.

Families need to create new traditions and ways to celebrate social occasions that do not focus on food and that include physical activity. Finally, parents and children have to work together as partners, changing behaviors slowly so that new habits are formed that can last a lifetime. It is the parents' "job" to ensure that healthful foods are available at home, that children learn to accept themselves and their body shape, and that food does not become a substitute for other emotional needs. The rest is up to your child.

© The Jewish Press 2000