Weight is a huge issue (no pun intended) for many people, and as society and the media place increasingly more emphasis on being thin, more people are presenting in my office with weight concerns and eating disorders. While some of these people are actually overweight, many are not. In fact, most who present with anorectic behavior, while actually average in size, see themselves as "fat". What separates these women, young adults, and more recently young teens, from those who are "simply" overweight, is a disturbance in body image and an excessive preoccupation and obsession with thinness to the neglect of their health and well-being, to the point of extreme weight loss and feeling unwell. Some may also have periods of binge eating and purging (with laxatives or vomiting). When severe, they can have cognitive distortion with difficulty making decisions, irritability, difficulty in concentration and loss of menstruation. In extreme cases, cardiac irregularities and other medical problems have resulted in death.

Food plays a prominent role in just about every Jewish home. A friend recently told me that, in some circles, a young lady's dress size has become the main criterion in the search for a prospective bride. It might almost be funny if it weren't true. That said, parents must be aware of the pervasiveness of this thinness craze within their children's peer group, on television and in advertisements and recognize the serious problem this presents when society's values emphasize the external versus the internal attributes of an individual. When thin gets equated with happy, the child, family and the entire community ultimately suffer.

Here are a few suggestions for helping your child develop a healthy relationship with food: Be a good role model for your child. Your attitude towards food and your respect for your body will be echoed by your child. Are there subtle or mixed messages which family members send that sabotage good eating? Must your kids, for example, "finish what's on their plates"? Examine your family's value system. Do you stress internal values, a healthy outlook towards relationships, good self image, and making time to look after yourself through, among other things, appropriate exercise? Or does the home atmosphere reflect constant dieting, shame, guilt around eating or pressure with respect to outer beauty? Does thinness get equated with happiness and are expectations around food realistic? Emphasize education around nutrition, good food choices and awareness of both amounts and types of food consumed. Encourage a heath focused lifestyle rather than yoyo dieting with food restriction, deprivation and guilt. Teach children to be attuned to their feelings. Do they eat when they are hungry and stop when they are full? Do they take the time to figure out just what it is that they are hungry for? Are they eating out of boredom, anger or disappointment? Can they talk about how they are feeling? Does food get used to comfort or soothe? How does your child's personality contribute to eating problems? Do they have, for instance, overly perfectionistic tendencies, resulting in feelings of guilt and shame? Help the school, youth groups and other organizations that influence your child be aware of the role of peer pressure in contributing to and sustaining an eating disorder. I recently was told of a school where children were weighed and kids then compared their weights, which set up a lose-lose situation where all the kids compared themselves to the thinnest in the class and ultimately no one was happy. Subtle remarks made at the scale can influence a child for life. Get help for your child if you feel they are constantly thinking about food and weight issues, over-eat or under-eat to extreme or are self-abusive and perfectionistic.

Treatment of eating disorders is often prolonged and complex because the feelings sustaining the aberrant eating are often deeply entrenched. You are asking someone who believes that once they achieve thinness (which may be forever elusive) they will be happy to let go of this belief, and adopt instead, a healthy eating approach which will require eating and a disdain for being thin. The emphasis must be on making changes in behavior that enable the client to learn to listen to one's own body's internal physiological cues around hunger and letting this help guide appropriate eating. The meaning and feelings attached to food are explored and one is taught how to disconnect these and adopt instead more appropriate strategies for expressing and meeting one's needs. For example, if food has been used as a source of comfort for anger, one is taught more appropriate strategies for dealing with the underlying issues of anger. Therapy focuses on establishing good emotional, physical and nutritional health. Those who have the best treatment outcome become less preoccupied by food and thinness and learn instead to achieve and maintain a normal weight. For many, this is a difficult struggle and at times a roller coaster ride.