In college, Shari Botwin was always dieting. Sometimes, the Cherry Hill, N.J., psychologist recalled, she would exercise three to four hours a day.
People would compliment her on how good she looked, she said, but eventually she couldn't deny that she had a problem. At 5', 5" tall and 112 pounds, she weighed just barely enough "to keep myself out of a hospital."
Today, Botwin, 41, uses her struggle to overcome anorexia as a tool to help others recognize and combat the illness.
Despite increased awareness of the condition, eating disorders are more prevalent than ever before, said Botwin, who will be teaming with two other Jewish therapists for a seminar on the issue to be held Dec. 7 at the Kaiserman JCC.
She estimated that as many as one in three women grapple with eating disorders at some point, with the vast majority developing in adolescence.
"The pressure that teenagers put on themselves to be successful, and all the different obstacles you have to face in life when it comes to not getting involved in drugs, getting into college, having a successful career," Botwin said. "They feel like they have to be perfect."
The number of people with eating disorders is difficult to track and statistics vary widely. According to the Renfrew Center, which operates treatment clinics around the country, as many as 10 million females and 1 million males in America are dealing with anorexia or bulimia, and millions more with binge eating.
While eating disorders have touched every culture, Jewish leaders have begun to acknowledge the issue in recent years, and in turn more Jewish women have been asking for help, said Dr. David Hahn, assistant medical director at the Renfrew Center facility in Andorra.
Renfrew staff have been doing presentations in Jewish communities and meeting with rabbis and religious school teachers all over the country to raise awareness of the troubling trend. The agency even began a treatment track geared toward Jewish patients in 2009 and offers kosher food at its clinics here, as well as in New York, Dallas and Florida.
The pursuit of the "thin ideal," promoted by mainstream media and the fashion industry, is especially challenging for Jews, who "tend to have curves" and use food as an integral part of celebrations, said Jane Shure, a Mount Airy psychologist who will join Botwin and Beth Weinstock in leading the seminar.
Given the culture's history of assimilation, Shure said, Jewish girls might be more vulnerable to the American obsession with thinness. She recalled a conference a few years ago where several observant women in their 20s told her how the mothers of potential "matches" were encouraging their sons "to go after a size-2 woman."
Aside from helping clients through treatment, Shure has co-authored a curriculum designed to prevent disorders from occurring by promoting healthy self-esteem in teens. The idea is to "inoculate young women from developing the inner conditions, the belief systems, the emotional conditions, that breed an eating disorder" -- or any other kind of destructive pattern, from substance abuse to self-mutilation, she said.
Since the curriculum was released in 2009, it has been adapted for use with all public school eighth graders -- boys and girls -- in Maine and at the Agnes Irwin School, a private girls academy in Rosemont.
One of the biggest misconceptions about eating disorders, Shure said, is that they revolve around body image.
"It really starts with a person who doesn't know how to fight against their inner negative voice," she said, which is why it's so important that teens develop emotional resilience. Those who don't have the ability to overcome feelings of low self-esteem and depression look for distractions that often become destructive, she said. "They're trying to cope with their insecurities and anxieties in ways that make them feel better about themselves," she said.
Family members who don't realize what's going on can inadvertently make things worse by being critical or negative, Shure said. That's not good for anyone, she added, but people with eating disorders are prone to unfairly compare themselves to others. Parents also may not notice early warning signs that often start out as socially acceptable behavior, like a middle-schooler suddenly declaring that she's going to become a vegetarian or spend more time working out.
For her part, Botwin said she believes that traumatic experiences she faced in her home life growing up had a lot to do with spurring her disorder, though she declined to be more specific.
Even once she realized the damage she was causing, she said, she had no idea what to do. Because of that, she added, it's become a personal mission to make sure others know where to get help and don't feel embarrassed seeking it.
She cautioned that it will take more than a seminar to make a dent in a problem of this magnitude. For one thing, she said, society as a whole needs to make it clearer that teens don't have to be perfect. Her message to them: "You're allowed to have fun."