COCONUT CREEK, Fla. — Hilary Waller remembers begging her mother to let her fast on Yom Kippur. At 10 years old she was a bit too young, but embracing the rigid discipline seemed desperately important.
"It felt like I was practicing not eating. It was something that was reassuring and gave me strength and a sense of pride," said Waller, a 28-year-old teacher at a religious school in Blue Bell, Pa.
It was the same rush she got years later in college each time she saw the scale tip downward. Waller, who suffered from anorexia, starved herself until she stopped menstruating, lost some of her hair and was exercising several times a day.
Health experts say eating disorders are a serious, underreported disease among Orthodox Jewish women and to a lesser extent others in the Jewish community, as many families are reluctant to acknowledge the illness at all and often seek help only when a girl is on the verge of hospitalization.
Several studies indicate a rise in the problem, and those who treat eating disorders say they are seeing more Jewish patients. A new documentary, books and facilities have cropped up to help.
Waller's family, which belongs to the Conservative branch of Judaism, fasted only on Yom Kippur, but she began fasting other holidays. "And not for religious reasons," said Waller, who checked into residential treatment after college – more than a decade after she began struggling with the illness.
As eating disorders have become less taboo in mainstream U.S. culture, they're still widely ignored in Orthodox Jewish communities, as families worry the stigma of mental illness could ruin arranged marriages for the patient and even her siblings. Strict food rituals of fasting and remaining kosher can also exacerbate the problem.
Israel has one of the highest rates of anorexia, bulimia and binge eating in the world, said Dr. Yael Latzer of the University of Haifa. No organization tracks the numbers of eating disorders among Jewish women, which experts say is partly because of a cultural reluctance to divulge the illness, but studies in different countries and Latzer's research indicate a high rate in Israel.
Some patients view eating disorders as a more culturally sanctioned form of rebellion in a religion where smoking and drinking are discouraged.
When Dr. Catherine Steiner-Adair arrived in Israel more than a decade ago amid pleas from Jewish activists alarmed by a spike in eating disorders, she recalls patients were so afraid to get help that they sent a proxy.
"A nurse would come up to me on the street and say, 'Please help me. I'm here on behalf of a 19-year-old girl who's lost 30 pounds but she can't ask for help because she comes from a very religious family and they think it's good (for her to be underweight) because it's better for marriage making,'" said Steiner-Adair, a clinical instructor in Harvard Medical School's psychiatry department. "I was overwhelmed by the needs and the requests."
Experts say the Orthodox community is sending mixed messages to young women. Parents, matchmakers and potential mates want a svelte bride, but may shun a woman who divulged she has an eating disorder because of the stigma of mental illness. For arranged marriages among the ultra-Orthodox, the first question matchmakers ask is about physical appearance, including weight and the mother's weight, which feeds the message that thinner brides are more desirable, said Dr. Ira Sacker, who practices in New York and has written several books including "Regaining Your Self."
In 1996, Sacker studied ultra-Orthodox and Syrian Jewish communities in Brooklyn and found that 1 out of 19 girls was diagnosed with an eating disorder – a rate about 50 percent higher than the general U.S. population.
"It is of prime importance within the Jewish Orthodox community the bride appear to be as flawless as possible," said Rabbi Saul Zucker of the Orthodox Union, which represents Orthodox synagogues in North America.
A mental illness, such as an eating disorder "would be a terrible, terrible blemish and people will go to unbelievable lengths to hide it," he said.
But recent efforts are aiming to stop the trend. The Orthodox Union, which has been an advocate for treating drug abuse and other taboos in the Jewish community, recently released a documentary "Hungry to be Heard" about the illness and started two support groups in New York City.
And after writing "Full of Ourselves," which became a phenomenon in the eating disorder community, Dr. Steiner-Adair worked with the Hadassah Foundation to write "Bishvili, For Me," a Jewish guide to her previous book for day schools and camps.
Experts say preoccuptions with food are more pronounced in the Jewish community, whether it's planning an elaborate Shabat dinner and following strict kosher laws. A lot of thought goes into what is eaten and abstained from.
Kosher laws forbid eating meat and dairy at the same meal, and forbid eating pork and shellfish. Separate dishes, silverware, sinks and microwaves may also be used for meat and milk products.
"This rigidity can really be a perfect breeding ground for an eating disorder. If you're already struggling with an eating disorder and now you have all these foods that you can't eat, it can be very difficult," said Jodi Krumholz, a dietitian at The Renfrew Center, a Philadelphia-based eating disorder treatment center with a branch in Coconut Creek.
The center treated nearly 200 Jewish patients this year, up markedly from 2009.
In Jerusalem, Rabbi Shimon Herskowitz said community activists approached him about starting a small eating-disorder facility where Jewish American parents would be comforted knowing their daughters were among staff that followed the same religious rituals. But even those parents have been reluctant.
"They only send the kids when they are totally, totally desperate, when the kid is on the borderline of hospital or residential treatment," said Herskowitz who opened Beit Chaya V'Sarah in Jerusalem last year.
Leaving treatment and re-entering the tight-knit Orthodox culture also presents hurdles. For many, fasting on Yom Kippur or another holiday could cause them to relapse, but patients worry about judgment from others.
Waller felt guilty one holiday as she loaded her plate at a salad bar shortly after leaving treatment. She felt isolated from the community, unable to join in the ritual fast with the rest of her congregation, until she realized her greater sacrifice would be eating.
"For me it became the opposite. I had to give into all the things that everyone else had been giving up," Waller said. "That was the lightbulb that reconciled the Jewish dilemma I was facing with needing to be in recovery."
Steiner-Adair says effective prevention highlights part of the religion that can inoculate girls against dangerous body messages in Western culture.
"When you have a religion that says your body is the temple of your soul and you find ways to make that meaningful at 13, that can be a very powerful way to look quite critically at Calvin Klein anorexic-chic models," she said.