Supporting Loved Ones Suffering from Anorexia During Pesach
- Dr Sharon Galper Grossman
- 2 days ago
- 5 min read
Why is this holiday so much harder than all other holidays?
Anorexia Nervosa is a severe psychiatric illness affecting 3% of young women in the US. It has the highest mortality rate of any psychiatric condition, and, on average, 20% of those suffering die within 20 years. In the US, anorexia causes over 10,000 deaths annually, or roughly one death every 52 minutes.
The Orthodox community is not immune to anorexia. A 1996 study found that the rate of anorexia among Orthodox Jewish girls in Brooklyn was 50% higher than that of the general population. A 2008 study demonstrated higher rates of anorexia in Jewish girls than in their non-Jewish counterparts.
Many people believe that only girls suffer from anorexia. However, 20% of sufferers are men, and their mortality rates are higher since diagnosis is often delayed. Worldwide, eating disorders are on the rise. Israel has seen a dramatic increase in the number of cases of anorexia since October 7.
People with anorexia might have an appropriate weight and look healthy but be gravely ill. Treatment involves a team of social workers, dieticians, therapists, doctors and psychiatrists, following a carefully designed meal plan, and eating regular meals at designated times. For some, deviating from this plan for even one meal can undo their progress and set back their recovery. It has momentum and cannot be set aside for the week of Pesach.
Why is Pesach so challenging?
The difficulties of Pesach begin before the holiday starts. As families stop buying chametz products, they might make do with whatever is on the shelf, leaving someone with anorexia without the foods on which she relies.
Once the holiday begins, foods are limited. The thought of replacing familiar foods with kosher-for-Passover substitutes may make someone with anorexia anxious. At the same time, Pesach brings a staggering number of holiday meals. Someone with anorexia might avoid eating with others. She fears that they will stare at her and notice “how fat she is." Telling someone with anorexia that she looks great when she is at a dangerously low weight might drive her to restrict her eating even more. When she has begun to regain her weight, she might interpret this same statement as an affirmation that she looks fat. Seder night can be the most difficult with its requirements to drink four cups of wine, and eat the required amount of matza, karpas, maror, the maror sandwich, and the festive meal.
Here are some tips.
Plan:
Meet with the support team to discuss how the family will spend the holiday, balancing her needs with those of the rest of the family. Perhaps opt for a low-key Pesach with only the immediate relatives. See the extended family on chol hamoed for a non-food based activity such as a tiyul, a concert, or an amusement park.
Plan each meal for the week before Pesach and the holiday, discussing what she will eat, when she will plate her food or who may do that for her, when and where she will eat, and with whom, and who will sit next to her at meals.
Halakhic Challenges:
A halakhic authority, preferably one who understands eating disorders, can meet with the team to create an halakhic approach tailored to the individual’s concerns, triggers, and stage of recovery. It is important to understand that this is a life-threatening illness, and therefore the halakhic approach can take this into account. The following are issues to address with your personal halakhic authority:
Kitniyot: Not eating kitniyot and their derivatives is an Ashkenazic stringency, but in cases of illness they are often allowed. This includes kitniyot oils; mixtures with kitniyot (including rice or corn flour), peanuts, soy products, green beans, rice, beans and corn.
Seder: One can fulfill the mitzvah of eating and drinking according to the most lenient approaches with the smallest possible amounts.
Matza: Someone in the initial stages of treatment for anorexia may be disgusted by the thought of eating matzah. Poskim debate whether she is exempt from doing so. Some argue that she is exempt and should not make a bracha, based on the idea that for her, eating matzah may qualify as achilah gassa – coarse eating, or eating when one is stuffed. Others disagree, and believe that she is not exempt and should recite a bracha on matzah. Still others say that the decision of how to approach matzah at the Seder depends on the recommendation of the treatment team and whether eating matzah and reciting a bracha on it will have therapeutic benefit.
Chametz: For those whose disease is so severe that removing chametz from their diet could pose a life-threatening risk, halakha might permit eating chametz on Pesach. This should be discussed with a halachic authority.
Medications: In general, someone with mental illness who regularly takes medication should continue to take it on Pesach. They should check their medication for substances that are prohibited on Pesach. If they do contain a prohibited substance, they should ask a halachic authority about the permissibility of taking it.
Please discuss all of the above with your halachic authority to decide what is halachically permissible and appropriate in your case.
Supporting People with Anorexia and their Families: On Pesach, please be mindful of the needs of someone with anorexia, and respect when, how, and what she is eating. She does not want to be different and would prefer to carry on as if nothing had happened. But if she does, she might never get healthy. Parents and siblings of someone with anorexia also need support to make it through the holiday. Show them your care by checking in on them, giving a bit of extra love and encouragement, and being there for them. If you know someone who suffers from anorexia, encourage her and her family to make a plan with their team, including a halakhic authority, and to figure out in advance how to navigate this holiday so that this Pesach will be different from all other Pesachs. This year Pesach will not derail her recovery. She will continue her path on the road to freedom, free from the oppression of anorexia.
Sharon Grossman MD, MPh, is a radiation oncologist and former faculty member of Harvard Medical School where she also obtained a Masters in Public Health. She is a graduate of the Morot L’Halakha program for women’s advanced halakha learning at Matan Hasharon. She writes and lectures on women’s health and halakha and teaches for Matan, Machon Puah and the Eden Center where she is the director of community health programming. Dr. Grossman is the author of a forthcoming book on Halakha and disease prevention, written through the Kitvuni fellowship at Matan and to be published by Maggid Books.
https://archive.legmt.gov/bills/2019/Minutes/Senate/Exhibits/phs63a01.pdf
https://www.nytimes.com/2011/04/12/health/12orthodox.html. The study was never published in a peer-review journal.
Pinhas L, et al., “Disordered Eating in Jewish Adolescent Girls,” Can J Psychiatry, 2008 Sep;53(9):601-8. doi: 10.1177/070674370805300907. PMID: 18801223.
I use female pronouns in this article for convenience, not to dismiss these male sufferers.
https://nedc.com.au/assets/Fact-Sheets/NEDC-Fact-Sheet-Eating-Disorders-in-Males.pdf?2025032310
Female pronouns will be used even throughout the article though everything also applies to males with anorexia.
https://noagirls.com/assets/uploads/2024/04/2024.03-NoaGirls_PesachGuideCommLeaders8pagesV2S.pdf. One may cook kitniyot foods using Pesach utensils, ideally in separate pots.
Rabbi Chaim Naeh (Shiurei Torah L’Rofim 3:208, pp. 193-194) estimates that the smallest possible amount that one may eat to fulfill the mitzvah of eating matzah is one-third of a standard matzah. Rabbi Chaim of Volozhin (cited in Kehillot Yaakov, Pesachim 43) concludes that today the amount is the size of an olive. To fulfill the mitzvah of drinking wine, one must drink melo lugmav for each cup. (Nafshi B’She’elati p. 176, fn. 5)
Nafshi B’She’elati, pp. 177-178, fn. 7
Nafshi B’She’elati, pp. 177-178
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