Eating disorders affect 1.25 million people in the UK, and anorexia carries the highest mortality rate or any mental illness.

With its emphasis on food – 10 festive meals in eight days, restrictions on foods that can be eaten and family being at the centre – Pesach poses challenges for Jewish people suffering from an eating disorder.

And it’s why Noa Girls, a UK charity that supports girls and young women through mental health struggles, has published its first guides to help those impacted. One booklet sets out the issues for rabbis, community leaders and parents to consider around Jewish laws and the triggers for people suffering from an eating disorders, and one guides professionals, ED services and GPs through the basics of Jewish Pesach customs so they can support patients with more sensitivity.

When Yael* recently heard about the guidebooks, she recalled wishing that somebody could have explained to the professionals what it had meant to be an observant Jew and in treatment for an ED when she was a hospital inpatient one Pesach, having lost half her body weight.

“Being there for a Jewish holiday was the hardest thing ever,” Yael says. “I was the only Jew. They didn't try to understand what it meant to be Jewish and religious. When you try explaining your food needs for Pesach to someone who's never heard of it before, and you're in a psychiatric hospital for an eating disorder, the first reaction is medication or a meal plan, and there's no way they're going to work with you on it because they feel like that's giving in to your eating disorder.”

She adds: “These booklets give people in treatment a voice. I wish I’d had that when I was there. If someone can say: 'This is what people with eating disorders are going through, you need to work with them,' then we stand a chance when we're in treatment.’”

Yael says that due to the lack of understanding from professionals, she emerged from hospital with even more trauma. “Now, for me, Pesach every year is a time of PTSD. I get flashbacks, nightmares, panic attacks. I can't eat any of the foods that I ate in treatment at that time because I was made to eat them.”

Noa Girls CEO Naomi Lerer says Pesach is a “really tricky time” for anyone battling an eating disorder or in recovery because of the focus on food and the social aspects of the festival, which often revolve around large meals with family and friends. Recovery can depend on specific meal plans, but restrictions disrupt these plans, while the “safe” foods for people with eating disorders, such as bread, are often absent. The lack of control can also be triggering for those in recovery.

“Often extended families will gather together on Pesach, and they'll be eating and sometimes even living together over this period, and it can  feel really uncomfortable eating amongst other people. For anyone suffering with an eating disorder, these challenges can be intense and potentially jeopardise any progress. It's important for everybody to understand you can't pause an eating disorder for eight days.”

Lerer has seen a “phenomenal response” to the booklets, which Noa Girls has shared with its network of people who support girls with eating disorders, including the North Central London Integrated Care Board and the Barnet health and wellbeing team. People within the Muslim community have also told Noa Girls that this is something which would benefit them. “So we’re looking at doing something like this around Ramadan,” says Lerer.

The booklets have led to an influx of referrals to the charity’s eating disorder programme, for which there is a waiting list.

Since Judaism places paramount importance on pikuach nefesh – saving and protecting life – the team is glad to have the backing of rabbis. Joint head of Noa’s ED programme and counselling psychologist Lubna Dar is used to asking rabbis to sign off leniency for her clients.

“In Judaism, these rules are not there to restrict life, so leniencies are there 100 per cent to help protect whoever it is that we need to take care of, and that always comes first. That's why I feel grateful that whenever I've had to speak to a rabbi, they've been wonderful in having open conversations.

“Now we have created this leaflet we are able to reach out to more families. The more we're able to educate the community, the more we break down those taboos.”

* not her real name

Information on Noa Girls’ eating disorder programme and the guides can be found here