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Eating disorders in the Orthodox Jewish community may not be talked about openly, but Cindy Shore hopes to bring the topic some sunlight.

At the request of Relief Resources, a Brooklyn-based Orthodox organization that sets up those with mental health disorders with the appropriate care, The Renfrew Center, an eating disorder treatment clinic that serves the New York area, developed a treatment track for eating disorders that tailored to the Orthodox community that will open in the fall to girls ages 14 and up.

"We are embracing the tenants of the Orthodox community as the tools in which to help young women heal themselves," Shore, the vice president of The Renfrew Center and primary developer of the track, told The Jewish State.

The idea for the program began in February 2008, when Relief approached The Renfrew Center about creating a track tailored to the Orthodox population.

"After discussions with them as to why it was necessary and whether or not there was really a call for it, we set our process in motion to develop programming," Shore said.

Shore put together a team of observant Jewish therapists, a psychiatrist, and a nutritionist to address the specific needs of the Orthodox community, taking dietary laws, time to study Torah, privacy, and the pressure to marry young into consideration.

"One central concern was the importance of having a program that is kosher, as a focal part of treatment for eating disorders is about eating communal meals," Dr. Esther Altmann, senior consultant for the Orthodox track, wrote in an email to The Jewish State. "A track for observant women makes it more comfortable for them to eat a varied menu of kosher foods. In addition to observing kashrut, a key component of the Orthodox track is that it allows women to relate more comfortably in therapy groups with others who share their background and values."

Altmann added that time is included to say blessings before and after meals, traditional Jewish foods are featured at Shabbat and holiday meals to help integrate patients back into their communities, and therapists are trained to be sensitive to aspects such as the pressure to marry and being one of many children.

The Orthodox program will join a slew of other specialized tracks at The Renfrew Center, which include tracks that group patients according to age or underlying reason for the eating disorder. However, all patients at The Renfrew Center are mixed in order for them to form their own support group during treatment. The staff of the Orthodox track includes Jewish therapists and nutritionists. The patients are able, and sometimes encouraged, to involve their own rabbi in their treatment.

"What we originally thought was to have the rabbi on staff, but the rabbi from one place might not like the rabbi from another place," Shore said, mentioning that the program needs to remain available and open to as many patients as possible. "Rabbis are a welcome entity. In a multi-family group, the rabbi is welcome to come if he is an important figure [in the girls' life]."

The Renfrew Center makes as many accommodations as possible to protect the patient's privacy, even moving their New York office from the 12th floor of a building to the second floor to lessen the chance of a patient running into men, or someone who may gossip about the program, which could be a detriment to the recovery process.

"Part of the problem is that this is very hush-hush and not talked about," Shore said. "Getting people to come for treatment is a big deal -- who's going to come home and tell their families that they saw someone in treatment? Who will see them? It's one thing if it's just among girls. Imagine if there were men in the program! No men around means as little pressure as possible."

Patients first undergo a private assessment, which determines the level of care appropriate, from residential, outpatient, intensive outpatient, partial hospitalization, or inpatient treatment.

"We deal with the whole spectrum of eating disorders, including the diagnosis," Shore said. "Typically, the patients we are seeing are either anorexic or bulimic. We're not seeing a lot of binge eating or compulsive eating disorders from the Orthodox community."

Since the program developed, the main concern of The Renfrew Center staff has been reaching out to communities in which eating disorders are a taboo topic. The program received recognition from rabbis such as Abraham Twersky and Dovid Goldwasser, and Shore hopes that their approval will increase the chance for an Orthodox patient to seek help.

"Schools are asking for our help to come in and provide programs in school," Shore said. "We're working with the Orthodox Union to get the word out and bring this to the forefront. We will be doing three programs in the fall in major New York metropolitan area communities... [with] therapists talking about the signs and symptoms and the complications of not seeking treatment."

This series of programs kicks off June 7, with a conference at Ramaz high school, Manhattan, to educate professionals, clergy, and teachers on the signs of an eating disorder and how to handle a situation in which they may suspect someone has an eating disorder.

"It's creating an awareness," Shore said. "We live in a society where thin is in and beautiful, no matter what your religious affiliation is."

Shore sites the pressure in some Orthodox communities to marry as the ideal situation to teach girls with the disorder that being healthy is the only way to properly tend to a family.

"We are teaching young women that they need to feel good about themselves before they can take care of a husband or a family," Shore said. "We're not going to say, 'don't go through the matchmaking process.' If this is what you believe, we want you to go about it in a healthy way... we're not trying to change the essential person, but to utilize the tools available to them to reach a healthy lifestyle."

"We want to make these girls aware that thin is good from a health perspective, but normal healthy body weight is what you should strive for," Shore added. "Thinner is not better, just like being too heavy is not better. It's being healthy."