"I cannot breathe." With these heartbreaking words, Yehudit Bauman summed up the feeling of losing her daughter, former Israeli model Karin Bauman, to anorexia, who battled the eating disorder for over a decade.
Karin, who was cared for by her mother with endless devotion, became a symbol of the fight against anorexia, a terrible disease that causes extreme malnutrition, and in some cases, death. A disease that has begun to alarm the government as it grows more widespread among the young generation.
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"I'm afraid I won't have time for more activism and raising awareness, afraid of losing my life," Karin said in a trembling voice when she arrived at a meeting by the Knesset's Health Committee in January of last year, where she tried to promote treatment for eating disorders.
Despite the increase in cases, especially after the coronavirus pandemic, waiting times for treatment and hospitalization are months-long, and many parents find themselves fighting on two fronts: against the eating disorder and the health system, to seek appropriate treatment.
Shirley Trello, whose daughter N., 16, suffered from anorexia for three and a half years, said, "The wonderful relationship we used to have has become difficult because I fight with her over the thing that scares her the most - eating. Now, years later, N. thanks me for not giving up on her, but at the time, it was not like this."
Orit Meoded, whose daughter B., 19, also suffered from an eating disorder shared, "We went through a major crisis. Even when B. was hospitalized, we had to look after her 24/7, as if we had a baby. But this is a 17-year-old girl who needs to make sure that she eats and is happy, and deal with outbursts of anger and pain, when, as a parent, you just want to help."
Vicky Richter-Israeli still fights for the life of her daughter, 19-year-old L.
"You take your child, a part of you, and entrust it to the care of other people. You have to trust them to take the best care of your treasure, and when she is at home you need to become her police officer, but you just want your daughter to feel well."
The three women agreed to share their stories with Israel Hayom in honor of World Eating Disorders Action Day, which was marked on June 2. And all three, like Karin, expressed the need to fight for the health system to provide better care for eating disorder patients.
Eating disorders are complex mental health conditions characterized by an obsession with food, body weight, or body shape. Common symptoms include severe restriction of food, food binges, and purging behaviors like vomiting or overexercising. A variety of factors may contribute to eating disorders, such as perceived pressures to be thin, cultural preferences for thinness, exposure to media promoting these ideals, and genetics.
According to Health Ministry data obtained by Israel Hayom, the rate of anorexia in Israel between the ages of 15-24 stands at 1.2% among women, and 0.2% among men. About 1,500 children and teenagers are diagnosed with an eating disorder in Israel annually. In 2020, there were 333 eating-disorder-related hospitalizations in Israel among those under the age of 15, and in 2021, the number stood at 468.
Eating disorders are among the deadliest of mental illnesses, and according to Health Ministry data, have a death rate of 8-20%.
"There were nights when I would sleep with B. the whole time, constantly checking that she was breathing, because of the fear of her heart rate dropping," Orit said. "It is about constant fear and helplessness. Because when a child is diagnosed with an eating disorder, and there is no proper guidance for the parents – we are left without an answer. These children grow weaker as they await treatment, and if there is a drop in heart rate, God forbid, you can wake up in the morning and find that your child is not breathing."
Orit has four children, and B., the second child, was diagnosed with anorexia at the age of 16.
"B. is asthmatic, and after one asthma attack, she began to cut back on food. It was quite sudden, there was no process here. She had bacteria in her stomach and relied on the claim that it made it difficult for her to eat. But something didn't make sense to us, because it was too extreme. She lost about 20 kilos [44 pounds] in a month and a half, would faint at school, and felt very weak. A pediatrician referred us to the emergency room, where she was immediately diagnosed as anorexic."
B. was hospitalized for two and a half weeks, after which Orit immediately began to look for appropriate treatment.
"Although we had a diagnosis and a referral, we had to wait four months for treatment. I know that current waiting times are six-seven months, which is insane," she said.
"While waiting, you – as a mother – must keep your daughter alive. Make sure she doesn't suddenly experience a drop in her heart rate during sleep, and that she doesn't suffer from depression. It's a big fear and a very serious shock for the whole family, who has to live in a pressure cooker. And while waiting for treatment, she occasionally had to be taken to the emergency room. She did not feel well, and was released after her specific problem was taken care of."
Finally, when the time for treatment arrived, the center told B. that she would need to be able to eat in order to begin. For weeks, Orit took her daughter to a nutritionist to make sure she began eating. After about three months, B. began hurting herself and was referred to a psychiatric hospital.
"The hospitalization, which lasted for about a week, traumatized B. because she saw all kinds of other patients and told us that she learned from them methods of how to hurt herself or how to vomit.
"Two days ago she told me that she had a dream, in which they took her by taxi to the psychiatric hospital, forcibly admitted her, and tied her up – while she was shouting 'Mom, no!' When she told me, I stood helpless. I told her that luckily it was all just a dream," Orit said, with tears streaming down her face.
B. is now in recovery under the private care of a dietitian, psychiatrist, and follow-ups with the family doctor. Recently she even began working three times a week in a kindergarten.
"I really hope we will be able to say we've got over it, but we are still in the process. The treatment procedure is not easy either, because you have to find the right professionals who specialize in eating disorders, and there aren't many of them, and the expenses for treatments are about NIS 6,000 [$1,300] a month. It's a lot. I just want to save my daughter, I'm fighting for her every breath.
"People who met us would look at B. and say, 'She doesn't look anorexic,' because she wasn't really underweight. But that's exactly the problem, that this is a tricky disease that isn't always related to classic weight loss. If they had to decide to treat B. according to weight, she would not have received treatment until today, because she was a kilo over the underweight limit.
"A few days ago I told B.'s therapist that I always believed in my daughter. Although the recovery process is not easy, I believe wholeheartedly that she will come out of it and fulfill herself. That she will love herself the way she is, that she will feel loved, and start a family.
"And you know what her dream is? To establish a home that will help girls who are dealing with eating disorders, without coercion like there is in the wards. A place that will provide a supportive framework. I wish her that she should succeed in realizing her dream. I know that I will help her achieve it."
'Children don't need to slim down'
According to Dr. Yanai Groen Frank, an eating disorder expert, anorexia is not about "a diet going wrong. These are mainly girls who feel bad, who have been traumatized or feel worthless, and they feel so bad that they don't even ask for help, feeling that they don't deserve help. They will try to solve the pain themselves, by cutting back on eating.
"The problem is that at no point in the eating disorder will the patient feel better, and we know on a biological-medical level that the more weight she loses, the more the compulsive thinking of the eating disorder will increase and this pit of feeling worthless will never be filled. Therefore, first of all, we need to heal this distress."
According to Groen Frank, social media plays a role in eating disorders but is not the source of the problem.
"During the pandemic, all interactions took place through social media," he said. "And this made everything extreme. Teenagers used the platforms to feel better, and the interaction became distorted so that those who were more extreme and sick received more prominence in the media. The goal was not to get help but to show the sick in the community.
"These girls need mental health care and are dealing with a major disorder. And the sooner they seek treatment, even if it is the beginning of treatment with a dietitian specializing in eating disorders and a family doctor, the faster we can respond. If we had services to catch these problems early, and if mental health care was more available, maybe it would be possible to provide a real solution faster to these hardships."
Groen Frank also said that while anorexia is more prevalent among teenage girls, in recent years, there have also been cases of eating disorders among boys, such as binge eating.
Professor Silvana Fennig, Director of the Department of Psychological Medicine at Schneider Children's Medical Center, who specializes in the early identification of eating disorders among teenagers, said, "Some 40% of children who are diagnosed today come to us with a different anorexia that we knew in the past. In medical terms, we call it Atypical Anorexia Nervosa.
"There's now an entire population of children who used to be obese and lost weight in a significant way that hurt them, even though they are now not considered underweight. They come to us because they suffer from a drop in body temperature and blood pressure, and they have all the medical complications of anorexia, such as preoccupation with eating and periods of fasting, to drastically lose weight due to obesity.
"For the most part, the classic treatment for eating disorders is, first of all, reaching a normal weight, because without a normal weight there is no cure. But with atypical anorexia, there is no exact weight. After all, our goal is not to return to obesity, but to normalize eating, when the weight is less significant.
"The media and society encourage thinness, and the thinness ideal is not a good one. As medical professionals, we encourage young people to be healthy, and not to preoccupy themselves with aesthetics. Yes, obesity needs to be treated, but if the child is healthy – there is no reason to disturb him or her. I strongly advocate the concept that children should not slim down. They need to live a healthy life, and have good eating habits."
According to Fennig, in recent years, anorexia has been diagnosed in younger populations, and even girls as young as 10 have been known to receive treatment.
"This is also related to early puberty, but the pandemic certainly made its impact as well. After COVID, we saw an increase in applications for aid, and the waiting list increased accordingly."
'It started to get out of control'
N. Trello was diagnosed with an eating disorder at 12. Today, 16 years old, she receives private care that according to her mother, Shirley, is saving her life.
"As a child, N. was a little bit overweight, and asked to go on a diet to lose weight," Shirley said. "At first, I welcomed it, because it is important to exercise and eat healthy, but little by little it started to get out of control."
At the age of 13, N. began to exercise excessively and limited her food intake more and more.
"In the beginning, when N. just lost weight, she celebrated and bought a tank top and short jeans, but little by little she switched to big and long clothes, even when it was hot. The reason for the long clothes is not only to hide the thinness but also because those underweight are often cold.
"N., who used to be a talkative and happy girl, began to disappear. She sank. As a mother, you tell yourself that this is teenagehood, but you see that something bad is happening. Later on, she began to lie about food. She would tell me that she had lunch and went out, but when I would arrive home I would see that there was the same amount of food in the pot. Once I came home from work and my little daughter told me that she had weighed a shrimp on the cooking scale in the kitchen, and had only eaten that.
"It finally hit me what was happening and I realized that something had to be done, but I didn't really know what," Shirley continued. "A bad atmosphere began to prevail in the house, of anger and fights over food, and N. looked tired and sad. As a mother, I felt like I was talking to two different people, because when we spoke about other things, it was fine, but when it came to food, it was frustrating. We fought with her a lot about this, and mostly felt powerless."
Shirley then called her friend, a psychologist who works with teenagers who suffer from eating disorders and was referred to two clinics.
"I remember the day I called one of the clinics, and I had to say out loud that I think my daughter has an eating disorder. I couldn't get that sentence out of my mouth, because at that moment it became real. In the end, I gathered my strength and said it. They referred me to a clinic in Kfar Saba, and in the meantime, I received a list of tests that need to be performed before the treatment."
That same week Shirley made an appointment for her daughter with a pediatrician. Tests revealed that N. was suffering from bradycardia, a slower-than-normal heart rate, which weakened the heart muscles. In N.'s case, this was caused by malnutrition.
"The doctor sent us in a panic to Schneider, and N. was hospitalized in the children's ward because she was in a life-threatening condition. That night they also connected her to a feeding tube, so that the body would strengthen. After nine days of hospitalization, during which she was diagnosed with anorexia, she gained a little weight and was released from the hospital.
"We were released home without knowing when N. would be accepted for treatment in the clinic. After all, it is obvious that when there is no treatment, the situation deteriorates again. We were given general guidance on what to do, but nothing thorough. They told us how N. should eat her food, but no one explained what to do if she was not ready to eat at all.
"Fortunately, the dietitian at Schneider was willing to help us out of the kindness of her heart. It took about a month until we were admitted to the clinic, and it was a very tough and painful month, during which I had to watch N.'s every step. She received medication and emotional therapy that helped her cope with the anxiety from the weight gain, and to treat the factors that brought her to the disorder in the first place. Even after that, I had to be available for her all week. Drive her, prepare six meals a day, and sit next to her while she eats. It's like hospitalization, under the parent's responsibility."
In order not to overload a patient's system, which is already stressed, clinics usually work with eating disorder patients for two years. Although N. did not fully recover and still needs support, she was released from treatment at the clinic. Her parents took her to private therapy with a dietician and a psychologist.
"N. received treatment relatively quickly, and thus she was spared hospitalization, but not everyone is so lucky, which is why we speak out. We are constantly talking about increasing the budget for hospitals, and we say that hospitals are the final stop, so we need to invest in preventive care, at the community level. There is no reason in the world for these girls and boys to be hospitalized, and certainly not repeated hospitalizations. And when there is no primary care system, the patients deteriorate."
Q: In your conversations with your daughter, did you discuss what caused her anorexia in the first place?
"Anorexia is a complex disorder, and it doesn't arise just because of a comment someone else made. I had conversations with N. about social media, and she tells me to this day that Instagram models were not what triggered her eating disorder. At the height of her illness, she had a Tiktok account, and we decided together to close it, because when she uploaded videos she received comments that were sometimes very offensive. So her difficulty was not caused by other models, but by cyberbullying.
"Many times it also stems from perfectionism, which reaches a breaking point and self-harm. That's why I believe it's important for parents to emphasize empowering the child, even if he or she is not the right weight, you shouldn't bother with appearance. You never know where it will deteriorate."
'Like a bandaid on an open wound'
L., Vicky Richter-Israeli's daughter, is still in a hospital setting, and for three years she has been moving between treatment settings, trying to find a cure for her condition.
"I spent whole nights and days worrying that my girl was going to die," Vicky said, "I would set an alarm clock to get up and check every time she was breathing. I would put a piece of paper under her nostrils, to make sure air was coming out of her nose. I would be around her all day, to make sure she wasn't alone in the shower, or alone in the room, because you don't know what she's doing there, behind the closed door."
L. is Vicky's middle daughter, 19 years old. But despite her age, she has not been recruited into the military yet, due to her medical condition.
With a trembling voice, Vicky admits that she herself suffered from an eating disorder as a teenager, and was saved only thanks to the dedicated efforts of her mother who found a psychiatrist and psychologist for her.
When L. started to exhibit symptoms, Vicky was in denial. But reality hit her in the face when L. lost a lot of weight within a short period of time.
"L. was always outgoing and sociable, surrounded by a lot of friends who accompany her to this day, but at that time she closed herself off. Because I went through it myself, I knew what I was seeing before my eyes.
"When L. was first hospitalized, and the psychiatrist asked her why she wanted to be anorexic, she answered him: 'I want to shrink myself.' That is, it is not a desire to lose weight, but something much deeper, which characterizes many teenagers with eating disorders. Not everyone is someone who aspires to be a model or went on a diet that went wrong. L. wanted to reduce herself, and began to lose weight, but in every treatment setting they said she was not in danger of life, so she currently has no treatment.
"And while we wait for help, there is chaos at home. L keeps fainting and losing weight drastically, and we all live in anxiety. She doesn't know how to deal with the internal war that is going on inside her, and I see my daughter dying. Not just starving, but fading away.
"I went with her to our lovely pediatrician, and she fought for L. and sent her to the emergency room. We arrived at Hadassah Medical Center, but when they saw that her pulse was normal, they wanted to release her home. Luckily, the pediatrician insisted, and they agreed to keep her in the hospital. That's where our journey began."
L. was hospitalized for about six months. First in the children's ward and then in the psychiatric ward, although it is not a dedicated ward for eating disorders.
"When she reached a normal weight, they let her go. They followed the procedures, but for us it was a problem. Because with an eating disorder, the problem is not only the weight. It's the mental aspect as well. Reaching the target weight is like putting a band-aid on an open wound, and when there is no possibility of receiving continued treatment in the community, a child immediately deteriorates back."
Vicky's eyes fill with tears as she painfully remembers how every time L. was hospitalized, she begged in tears to go home, and how she, as her loving mother, had to tell her that she needed to stay in the hospital and recover. About a month and a half after she was released, L. was hospitalized again, this time for five months.
"When she returned home, I took time off from work to look after her. If I didn't have managers supporting me, I would have already been fired. Everywhere she was hospitalized I felt that they were fighting for L., but even the systems have treatment limitations. But I will never give up on her."
'The budget is almost nonexistent
According to the Knesset Research and Information Center data from February 2022, Israel has several dozen treatment and hospitalization centers for treating eating disorders, sometimes combined with other disorders as well.
In practice, these are several hundred beds while there are thousands in need of treatment. The lack of care and response led Vicky, along with other parents of children with eating disorders, to establish in October 2022 the Hamasa Shelanu (Our Journey) association for families dealing with eating disorders.
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Vicky said, "The state has failed in this treatment for so many years, and a fundamental change needs to be made in the treatment of eating disorders. The field of mental health is the backyard of the state, and eating disorders are the backyard of mental health. Many children are treated in the private system, and the parents collapse mentally and financially because they have to finance the treatments, and often resign from their jobs or reduce their work hours to be there for their children".
The association is poised to submit a petition to the Supreme Court against the government, demanding a significant budget to deal with eating disorders, that according to them is close to "nonexistent."
The Health Ministry said in a statement, "The field of mental health is at the top of the Health Ministry's priority list. Dealing with the coronavirus pandemic has overwhelmed the need to expand the response in this area.
As for eating disorders, "the Health Ministry is working to expand day treatments aimed at preventing hospitalizations while continuing the routine of life as much as possible. In 2022, another 40 positions were added nationwide. In addition, it was decided to allocate 23 more hospitalization beds for youth eating disorders in 2022 and 12 beds in 2023. Most of the beds have already been added to the medical institutions.
"Approximately 15 million shekels [$4 million] is earmarked for the treatment of eating disorders, both for shortening waiting lists at clinics and for the development of dedicated facilities to prevent hospitalization."
