RESEARCH Nutritionists, educators, and health professionals should be

RESEARCH Nutritionists, educators, and health professionals should be

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Holocaust Survivors Report Long-Term Effects on Attitudes toward Food A M Y J. S I N D L E R, MS, RD;1 N A N C Y S. W E L L M A N, P H D, RD, FADA;2 O R E N B A R U C H S T I E R, P H D3 1 Peace Corps, Lesotho, Africa; 2National Policy and Resource Center on Nutrition and Aging, Florida International University, Miami, Florida; 3Department of Religious Studies, Florida International University, Miami, Florida INTRODUCTION ABSTRACTObjective: To gather information from survivors on the effects that the Holocaust had on their current attitudes toward food. Design: Qualitative study: one-on-one semistructured interviews with a script shaped by a pilot study. Setting: South Florida homes and community sites, including the Miami Beach Holocaust Memorial. Participants: Convenience sample of 25 Holocaust survivors: 14 men, 11 women; ages 71 to 85 years.

Phenomenon of Interest: Current attitudes toward food in relation to Holocaust experiences. Analysis: Themes and illustrative quotations from transcriptions of audiotaped interviews.Results: Food attitudes were influenced by Holocaust experiences. Five themes emerged: (1) difficulty throwing food away, even when spoiled; (2) storing excess food; (3) craving certain food(s); (4) difficulty standing in line for food; and (5) experiencing anxiety when food is not readily available. Empathy for those currently suffering from hunger was also reported.

Conclusions and Implications: Food-related issues from the Holocaust remain for survivors. Now in their 70s and 80s, many use health care and related services. Nutritionists, educators, and health professionals should be aware of such issues.Food and nutrition programs should minimize uncomfortable food-related situations for Holocaust survivors and others who experienced food deprivation. KEY WORDS: Holocaust survivors, food attitudes, food deprivation, starvation ( J Nutr Educ Behav. 2004;36:189-196.

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…. Address for correspondence: Nancy S. Wellman, PhD, RD, FADA, National Policy and Resource Center on Nutrition and Aging, Florida International University, OE200, Miami, FL 33199; Tel: (305) 348-1517; Fax: (305) 348-3184; E-mail: wellmann@fiu. edu.

n2004 SOCIETY FOR NUTRITION EDUCATIONThe Holocaust (1939-1945), one of the darkest periods in human history, was ‘‘the systematic, bureaucratic, statesponsored persecution and murder of approximately 6 million Jews by the Nazi regime and its collaborators. ’’1 As part of the Nazis’ Final Solution to destroy European Jewry, Jews were forced into ghettos and labor or concentration camps. Ration cards were the official source of food distribution in ghettos, although soup kitchens and the black market supplemented the meager ration amount of 785 to 1665 kcal/day. During the first 18 months of the Warsaw ghetto’s existence, 15% to 18% of the people starved to death. In other ghettos, the situation was much the same.

Deportation to concentration camps most often meant immediate death or postponement of death through slave labor. 3 Prisoners fed diets of diluted soup and bread were expected to die within 3 months, after ‘‘burning up their own body weight. ’’4 Food was so scarce that prisoners scrounged for grass, leaves, or paper and occasionally resorted to cannibalism. Research on the long-term effects of these experiences is limited.

An Italian study showed a higher rate of binge eating among former Nazi concentration camp survivors than in a control group of persons of similar age and gender. During those interviews, many told about persistent and specific thoughts about food and eating, sometimes reporting that food controls their life. A study of prisoners of war also found higher levels of binge eating than in controls, the highest levels being among those with the highest weight loss during captivity. 6 Classic and well documented, the 1944-1946 studies by Keys et al at the University of Minnesota addressed the physiological and psychological effects of starvation and expectations when access to food resumed after the war. ,8 The 32 conscientious objectors who volunteered for 6 months of semistarvation displayed uncontrollable binge eating and an increased preoccupation with food when they were able to eat again. A more recent review of the effects of human starvation was published in 1993.

9 The present study examined the relationship between food deprivation during the Holocaust and attitudes toward food 50+ years later. The results can help nutritionists, 189 190 Sindler et al/HOLOCAUST SURVIVORS REPORT EFFECTS ON ATTITUDES TOWARD FOOD Table 1.Demographic Characteristics of Holocaust Survivor Interviewees (n = 25) n (%) educators, and health professionals understand and support formerly food-deprived populations.

DESCRIPTION OF STUDY PROCEDURES The study population was a convenience sample of 25 Holocaust survivors who reside either permanently or seasonally in South Florida’s Broward and Miami-Dade counties. A Holocaust survivor is defined as any Jew who lived in a country under a Nazi or Nazi collaborator regime or under Nazi occupation, as well as any Jew who fled owing to a Nazi regime or occupation. 0 Participant recruitment involved community support. The Holocaust Documentation and Education Center, Inc.

supplied a list of presidents or representatives of survivor club organizations in South Florida. 11 From this list, 5 presidents and 1 companion were interviewed. The director of the Miami Beach Holocaust Memorial arranged interviews with 9 survivor volunteers at the memorial. Others were located through personal and professional contacts and through local congregations.

The Florida International University’s Institutional Review Board approved this study.Participants signed and received a copy of the approved consent form before being interviewed. One-on-one semistructured interviews were conducted by a sole interviewer (A.

S. ) in homes (n = 12), at the Miami Beach Holocaust Memorial (n = 9), and in community settings (n = 4) (local mall, restaurant, Jewish Federation building). Based on pilot interviews with 6 survivors (nonparticipants in this study) that were read by a second researcher, questions were scripted regarding the food-related memories of the Holocaust nd at liberation and how the Holocaust influenced current food attitudes. Audiotaped interviews, ranging from 45 minutes to 3 hours, were transcribed verbatim by the interviewer. Using the transcripts, a manual analysis of responses by question was completed. Themes emerged based on the frequency of affirmative responses to questions and the content of quotations. Approximately 300 quotations were categorized by question.

A second researcher reviewed all themes and related quotations. Illustrative quotations were chosen that best reflected each category of responses.Age at Study in 2002, y (n = 23) 71-75 (8-12 in 1939; 15-19 in 1946) 76-80 (13-17 in 1939; 20-24 in 1946) 81-85 (18-22 in 1939; 25-27 in 1946) Marital Status Married Widowed Divorced Divorced and widowed Never married Birth Country Poland Czechoslovakia Hungary France Holland Germany Yugoslavia Location during Holocaust Concentration camp Hiding Labor camp Factory and concentration camp Hiding and labor camp Date Emigrated to United States (n = 21) 1946-1947 1949-1952 1962 1983-1985 1994 (26) 9 (39) 8 (35) 14 (56) 7 (28) 2 (8) 1 (4) 1 (4) 14 (56) 5 (20) 2 (8) 1 (4) 1 (4) 1 (4) 1 (4) 14 (56) 5 (20) 3 (12) 2 (8) 1 (4) 6 (29) 11 (52) 1 (5) 2 (9) 1 (5) QUALITATIVE FINDINGS Table 1 provides demographic information about the 14 male and 11 female survivors. The majority married other Holocaust survivors soon after liberation. Most were born in Poland (n = 14) or Czechoslovakia (n = 5), with 2 from Hungary and 1 each from France, Germany, Holland, and the former Yugoslavia. Most (n = 14) spent the war in concentration or labor camps, and 5 spent it in hiding.

All had been banned from school.After liberation, some continued their education. At the time of the study, socioeconomic status for most was middle to upper middle class. The participants were outgoing community members. Most, especially representatives of Survivor Club Organizations, were active in Holocaust-related activities, such as lobbying for Florida’s Holocaust Education Bill. Several others volunteered at hospitals and the Miami Beach Holocaust Memorial.

Table 2 summarizes responses to questions. The survivors reported experiences that influenced their current attitudes toward food and how and what they eat.Many expressed common views, whereas others had unique perspectives. Many said that their experience with hunger could not be described: I don’t think there’s such a thing as severe.

It was just hunger you cannot even describe. It’s very difficult to describe to a person who has never been. . . 7, 8 days without food and water, without anything. (M.

F. ) Journal of Nutrition Education and Behavior Volume 36 Number 4 Table 2. Holocaust Survivor Responses Regarding Food Attitudes and Issues Today Focused Interview Questions Some people find it difficult to throw away food. Do you? Is it your custom to fast for religious holidays?If it is your custom to fast, has this been difficult for you since the Holocaust? Is it difficult for you to throw away food that has spoiled? Do you have a tendency to store an excess amount of food? Does the abundance of food here in the United States influence your attitudes toward food? Is it difficult for you to stand in line for food? Do you have a health condition that has made you change your eating habits? y Do you have a craving for a particular food that relates to the Holocaust? Do you feel a sense of anxiety when food is not readily available? Are there any foods you will not eat today?Do you dream about food today? Do you have any ‘‘unusual or idiosyncratic’’ food habits? Some people find themselves preoccupied with food. Do you? Do you keep food in your house anywhere other than your kitchen? Yes (%) 22 (96) 16 (70) 0 11 (61) 11 (52) 11 (46) 10 (56) 10 (48) 10 (43) 8 (38) 6 (28) 4 (19) 2 (14) 1 (5) 1 (6) No (%) 1 (4) 6 (26) 16 (100)* 2 (11) 9 (43) 7 (29) 5 (28) 6 (28) 9 (39) 9 (43) 7 (33) 16 (76) 5 (36) 16 (80) 14 (88) July . August 2004 191 Other 0 1 (4) 0 5 (28) 1 (5) 6 (25) 3 (16) 5 (24) 4 (17) 4 (19) 8 (38) 1 (5) 7 (50) 3 (15) 1 (6) Did Not Respond 2 2 0 7 4 1 7 4 2 4 4 4 11 5 9 All who currently fast for Yom Kippur stated that it is not difficult; 2 are unable to fast all day owing to health conditions.

yNot all health conditions can be directly related to the Holocaust. Five themes emerged from the interviews: (1) difficulty throwing food away, even when spoiled; (2) storing excess amounts of food; (3) craving or intense desire for certain food(s); (4) difficulty standing in line for food; and (5) experiencing anxiety when food is not readily available. Difficulty Throwing Away Food Almost every survivor (n = 22; 96%) said that it was intensely difficult to throw away food.

Several said that it was a sin to throw away food: I can say this with all confidence, that when I fill the plate, I will make sure that it’s eaten. I will not—I cannot think of many instances where I would leave food on the plate. And that’s a throwback to the fact there was a lack of food, a tremendous lack of food. (H.

I. R. ) No! No. No. I get MAD when my children throw something out.

‘‘Don’t fill your plate so full you cannot eat it to throw out. ’’ (R. R. ) You see this is one thing it would really hurt me, to throw away food. . .

; whatever we don’t eat I save, . . . nd I reheat it in the microwave, and this is dinner.

That’s it. But I don’t throw away, and I taught my children it’s a sin to throw away because people were hungry and people are still hungry. There are so many people in the world that are very hungry, that have not enough food. We must never, never throw away food. No. (G. G.

) Some were concerned that so many in the world are suffering from hunger now. When there was no one to give food to, some said that it should at least be given to animals. H. J. mentioned, ‘‘I hardly ever throw away bread in my life. I always put it outside.

. . or the birds. ’’ Discarding spoiled food was even difficult for some. They had learned to eat anything. I.

J. recounted that his ‘‘best find’’ during his death march was spoiled vegetables in a pigpen. When faced with spoiled food today, K. S. ’s solution is to ‘‘close her eyes and. .

. throw it away. ’’ Storing Excess Amounts of Food About half of the survivors (n = 11; 52%) reported keeping plenty of food on hand today. With a mixture of pride and enthusiasm, some showed their completely full refrigerators and freezers: I have food in the house that I don’t want to eat. I don’t want to eat it.But I’ll leave it staying over there. It should be in case something happens, a can of sardines, a can of tuna.

I have eggs in the refrigerator, which I don’t use— maybe 8 eggs a year. It stays there. It stays why? It’s in my mind. (I.

C. ) Concern, yes. We always—my wife feels the same way. We are always careful not to be without; maybe something will happen.

We won’t be able to go shopping. I tell this to my kids too. .

. .You might not be able to get to the store. Because hunger, hunger pains are so bad. (K.

R. ) 192 Sindler et al/HOLOCAUST SURVIVORS REPORT EFFECTS ON ATTITUDES TOWARD FOODSeven of the 12 survivors interviewed at home offered the interviewer food or drink from a snack to lunch. It was just as H. V. explained: I have to have food. If anybody comes in, I have to put food out,. .

. and people come to my house, they always say it’s a banquet. I put it out, and people should feel at home. The tendency to stock up was not universal, even in couples in which both are survivors: I always want to accumulate. My wife says, ‘‘The fridge is full. There’s no room. ’’ I said to her, ‘‘I feel more secure.

I feel the security. ’’ But this is what I feel.Yeah, and this is in the household of most survivors, and you can’t help it. Even in the plenty of America, I’m still a Holocaust survivor, and I still feel the hunger is, the accumulation is.

. . concern it is for me.

I feel it. (I. F.

) Craving or Intense Desire for Certain Food(s) Ten (43%) survivors reported current food cravings that related back to their Holocaust experiences. Six craved sweets, chocolate in particular. A. E. said that for 4 months following liberation, she ate nothing but chocolate. K. S.

reported a need for sweets: When I was liberated, I needed the sweetness, so I cooked the oatmeal with lots of sugar on it.It should be sweet, like pudding. Even today I need this sweetness in my life.

K. R. had a sweet tooth as well.

He and his survivor wife now go to a particular restaurant for breakfast because of nostalgia for the dark brown sugar served there: In the Lodz ghetto, there was never enough bread, never enough oil, and never enough brown sugar. But when they gave you that brown sugar in the ghetto, it was like heaven. (K. R. ) Five survivors craved bread.

Bread had a poignant power for survivors. K. A. recalled being sick with typhus in the camp infirmary when a friend outside the window held up a piece of white bread that signified liberation.

Ever since, the toast at breakfast each morning reminded her of freedom. B. F. mentioned how just bread for dinner made her survivor husband happy. H. I.

R. speaks for others: Bread, potatoes, and butter are a mainstay of our present diets throughout the last 50, 60 years. . .

; that is what we linger on. . .

. ‘‘There are foods I eat because it brings back memories,’’ K. S.

reported. Before the war, for example, K. S. ’s father said that there might come a time when she would look for barley soup. In Auschwitz, this time did come, and since then, she has enjoyed barley soup. The prisoners’ hunger was heightened by watching guards eat.One survivor craves those foods: We used to watch the Germans eating the bread, margarine, and jelly.

How we would do that the first thing. The first chance we’d get. .

.. Well, I still eat bread and jelly. Still, if I’m hungry for a snack, I’ll still run to the refrigerator, get a slice of bread with some jelly, cream cheese. And that takes care of it. (C. L.

) Difficulty Standing in Line for Food Ten of 18 survivors (56%) stated that today they would rather leave a restaurant than wait in line: For me, if I get to a restaurant, if I have to stand in line, I’d just as soon give up and not stay and not have the food.And that’s a throwback to the days where we, even for that measly, tepid soup, we had to be lined up. (H. I.

R. ) There used to be a roll call in the morning, roll call at night, and if they made a mistake, you had to stay till they counted over, and over, and over again sometime. So standing in line waiting is a bad memory.

(C. L. ) Two others acknowledged that standing in lines was inevitable in the United States, and they had gotten used to it, more or less. Experiencing Anxiety When Food is Not Readily Available Anxiety when food was not readily available was a problem for 8 (38%) survivors: Yeah, yeah, I get worried.I start looking already. This is leftover, a phobia leftover, and a hunger still there.

(I. C. ) To avoid this, 3 stated that they always took food with them: The only thing is if I go on a trip, I always take some food with me. Always. That probably is a reminder. You know, something that is left after.

That I never wanted to be without food. (Z. N.

) Others said that they had this anxiety for several years after liberation, but not today. Other Food-Related Issues Abundance of food in the United States. Almost every survivor acknowledged the abundance of food in the United States. If you had the means, food was always available.A. E.

stated, ‘‘As long as you make a living, you can go to the store and buy it. You don’t lack it. There you couldn’t buy it. ’’ Eleven (46%) were concerned that this abundance led people to waste food. Portion sizes at many restaurants are too big. Although the question was not asked directly, most expressed compassion for the hungry today, saying that they know the exact torture of minimal calories: The thing that bothers me very, very much is when you go to a restaurant and there’s so— they give you such huge portions, and you have to send it back because you can’t eat that much.

And I thought, my God, how much food is wasted here. Journal of Nutrition Education and Behavior Volume 36 Number 4 July . August 2004 193 Where everywhere there are many parts of the world that people are starving.

(Z. N. ) No, I just, you know, think that if the restaurant.

. . , they have a basket with rolls and the people don’t take home; they throw it out. I say there’s so many hungry people in this world, why throw it out? Put it in a bag.

Give it away to some hungry people. Even here there are a lot of hungry people. (K.

S. ) C. L. however, was indifferent to America’s abundance, saying that even when he could not afford more, bread, butter, and jelly were sufficient. Foods avoided today.

Six (28%) survivors avoided some foods today because they were reminders of the Holocaust. Two did not eat turnips or turnip soup, and another did not eat kohlrabi, a vegetable resembling a turnip. A. A. disliked a certain type of bacon, which he had to steal when hiding.

K. A. could not recall the exact name of a food avoided but stated, ‘‘It’s a barley actually.

But it was like a big bean that they boiled to death, and that was part of the soup.And whenever I see that, I cannot eat that. I throw up actually. ’’ On the contrary, others said that there was not enough food during the Holocaust to compare with any food today. Dreaming about food.

Four survivors reported dreaming about food recently: You dream about the past, the Holocaust times you live through. (A. A. ) Yes, for example, I used to dream that I worked in a bakery and the aroma of the bread, even I felt in my sleep. .

.. Since even now, yeah. (K. R. ) Preoccupation with food. H.

V. was the only one who reported a preoccupation with food. However, H. I. R.

replied, ‘‘I think generally we all are.No, I guess we are preoccupied with food. No question about it.

I see it not in my case, but I see it among survivors. Yes, no question about it. ’’ Participants discussed preoccupation with food as if admitting to something they would rather not claim. Fasting for religious holidays. A majority (n = 16; 70%) said that they fasted for Yom Kippur. Most explained that they grew up in religious homes and were used to fasting for a day. Even nonreligious Jews said that they fasted: ‘‘No, I’m not a religious person, but on Yom Kippur, we don’t eat.

. .. No, it’s not difficult for us ’cause fasting is not a stranger to me.

’ They explained that it is easier if you realized why you are fasting: Absolutely. . .. No question about it. Take it into your mind. And you remind yourself of what, why you’re doing this.

Why you are fasting? For whom are you fasting? Are you fasting in honor of your family that passed away? They gave up their lives so you can live. They gave their lives for the upkeep of the religion and the tradition. So you must keep it up too. (I.

C. ) Six (26%) did not fast for Yom Kippur today, with the most common reason being that they had ‘‘fasted enough’’: And like we have holidays like Yom Kippur where everybody’s supposed to fast.I never fast.

No, because I think in my heart that I fasted so much in my life that it’s not necessary for me to do it anymore. . .. Yeah, I don’t believe that I should. I don’t.

It’s like my revolt against God for allowing, for what He let them do to us. (Z. N.

) When asked if hunger during the Holocaust influenced the way she eats today, Z. N. immediately responded that she did not deny herself certain foods: If I go to a grocery store and I see something that I like, even if it costs I don’t know how much, I’ll buy it. Because this is— I’m not going to deprive myself of something I want to eat and I can’t because of money.

M. F. agreed: I would never eat at an ‘‘early bird special’’ just because it’s cheaper. I go when it’s convenient for me to go.

Some people will stay in line just to save 5 cents. I don’t do that. Neither does my wife. He later advised, ‘‘Never save on your stomach! ’’ H.

V. explained how food was a priority: ‘‘I try, even if I don’t have the money for something else. But food I’ll buy. ’’ DISCUSSION The 5 themes that emerged in this study supported the conclusion of Favaro et al that ‘‘specific thoughts and behavior with regard to food are still present among survivors of Nazi concentration camps. ’5 I.

F. seemed to speak for all when he said that even with the abundance of food in America, he was still a Holocaust survivor and still felt the hunger. The director of the Kosher Food Bank in North Miami reported that Holocaust survivors request less food for home deliveries than other Jewish participants. Their modest requests show pride, strong desires not to waste food, and empathy for others who are hungry, as described in Kladjman and Kladjman’s postliberation writings: As I reflect back on the events of my childhood, my many experiences have taught me above all how precious life is.

Surviving daily misery was an education in appreciation. I learned to savor the joy of simply breathing fresh air. Eating a good meal was like being in heaven. 12 Others who experienced prolonged hunger also tend to limit food waste.

Falk et al gathered reports from older adults on childhoods during the Great Depression, when they were encouraged to eat what was served them. 13 Although half a 194 Sindler et al/HOLOCAUST SURVIVORS REPORT EFFECTS ON ATTITUDES TOWARD FOOD century had passed, not wasting food was a strong ideal. One man remarked, ‘‘I hate to see it wasted. .

. I grew up in the Depression. . . , and that carried over on me to this day.

’’ Stealing food was rampant during the Holocaust, even among prisoners. Guards stole prisoners’ food and sometimes killed prisoners whom they suspected of stealing food. 14 Klein wrote about this same food insecurity in All But My Life: I loved going to grocery stores and still do. In those days I had the handy explanation that it was a great way to learn English, since I would see pictures on labels of cans that would tell me what was inside—an easy way to learn new words. The truth was different.I needed to convince myself of the abundance of available food and of its never-ending supply.

I wanted the assurance of never being hungry again. 15 Bread, the main staple in ghettos and camps, represented life support much more than meat, which was seldom served in camps: Always bread, yeah. And bread when I was in camp, it was the source of life.

It’s the only thing we had. It was terrible bread, but, to us, it’s the main thing for our life. (Z. H. ) Bread’s importance is supported by reports of Klodinski’s research, in which a former musselman—an emaciated prisoner on the brink of death—writes: ‘‘. . .

I still morbidly eat a lot of bread and potatoes which in the camps were always not enough. ’’16 During most interviews in the present study, survivors explained that situations today do not compare with life during the Holocaust. Specifically, M.

F. challenged comparing standing in line today with standing in line in the concentration camp, saying, ‘‘You cannot compare the food things under normal circumstances with a time from the Holocaust. ’’ Anxiety when food was not readily available corresponded to earlier research in which some Italian Holocaust survivors ‘‘had to sleep with a piece of bread on the bedside table.

’5 Although not exactly the same, 8 participants in this study never wanted to be completely without food. As in the benchmark research of Keys et al,7,8 survivor interviewees dreamed about food during deprivation but not afterward. They said that they dreamt of food ‘‘day and night’’ in the camps but not as much today. Most said that they dream of other Holocaust aspects. According to a sleep and dreaming study of Holocaust survivors, well-adjusted survivors had significantly lower dream recall rates than less adjusted survivors.

17 Fasting for Yom Kippur during the Holocaust was a dilemma for Jews in many ways.Elie Wiesel, himself a Holocaust survivor and a Nobel Peace Prize recipient, grappled with it: Yom Kippur. The Day of Atonement. Should we fast? The question was hotly debated. To fast would mean a surer, swifter death.

We fasted here the whole year round. The whole year was Yom Kippur. But others said we should fast simply because it was dangerous to do so. We should show God that even here, in this enclosed hell, we were capable of singing his praises. 18 Today, fasting for Yom Kippur is a divided issue among interviewees. Yet many made it a point to fast on Judaism’s most sacred holiday.

In the present sudy, survivors in hiding in countries other than Poland and one who worked in a factory said that they suffered less severe hunger than those interned in concentration camps. The factory worker, who said that he was better off than those in camps, weighed only 70 pounds at liberation and could not stand up alone. Likewise, a man who described himself as one of the lucky few who did not suffer much hunger ate a dead horse after escaping a labor camp. The 6 not in concentration camps reported fewer Holocaust connections in their current attitudes toward food.The concentration camp survivors went days without food and said that their hunger was ‘‘indescribable.

’’ The extreme trauma of the concentration camp experience left its imprint. Survivors who termed themselves not ‘‘big eaters’’ during internment fared better. A. E. explained: ‘‘I’m not a big eater. And maybe that’s why I survived the hunger. Because I was never a big eater.

’’ Two other women used almost exactly the same words. Many reported that questions about the Holocaust’s connection to their current food attitudes are not as relevant as they would have been 50 years ago.For example, K. R. stated that he and his survivor wife ate anything after liberation, including hard bread and unappetizing dishes because it was food, and ‘‘how could food not taste good? ’’ Others said that not a day has gone by that they have not thought about some aspect of the Holocaust, but that they also have gotten accustomed to a better life. K. S.

summarized, You see, liberated 50 years after the war, you don’t forget, but you get used to the good life. . . and a good kitchen that you can cook in and clean your hands and clean your vegetables.

. .. You get used to it.

Although it may be difficult to locate the two 1950 volumes by Keys et al, The Biology of Human Starvation,7 we recommend it as a starting point for future research regarding the effects of starvation on subsequent food behavior. Whereas those in the Keys studies and others19 experiencing ‘‘natural starvation’’ were often deprived of food for weeks or months, Holocaust survivors in this study were deprived of food for years. Lacking food because of forced deprivation accompanied by the additional brutalities of the Holocaust is much different from food deprivation owing to natural causes.LIMITATIONS There was no control group in this descriptive qualitative study, and participants self-selected.

Eleven additional survivors who were contacted declined to participate. Two Journal of Nutrition Education and Behavior Volume 36 Number 4 July . August 2004 195 were ‘‘too busy,’’ and 3 were clearly skeptical. Another refused to sign the consent form, explaining that he always gave interviews but did not want to sign anything. The 5 others said that it was too painful to recall their experiences.

Among the 25 participants, two thirds were involved in Holocaust remembrance activities. The 9 volunteers at the Miami Beach Holocaust Memorial were accustomed to speaking about their experiences. Their answers may have differed from those of less involved survivors and from those, for example, who said that an interview would be too painful. Analysis of interview transcripts was subjective. Although others might have categorized responses differently, most responses were unambiguous. Following the script was problematic during several interviews.

Some questions were missed because some survivors deviated from talking about food-related issues into general Holocaust experiences. One survivor in particular explained that she had suffered greater tragedies than food, ‘‘Because it was a matter of life and dying and sending to gas chambers, so food was whatever you had; it was good enough’’ (O. V. ).

During this particular interview, food-related questions were limited. Although several themes emerged from these interviews, one cannot generalize to all Holocaust survivors. Survivors had unique memories of their experiences.

When discussing this project, many confirmed that their attitudes toward food were different from those of friends who were also Holocaust survivors. Some said that food-related issues affected them less than survivor friends: I’ve been with survivors who, without having the need for it, would just fill up the plate and then not eat because you’re afraid. Maybe it’s a psychological thing. They’re afraid it will run out. . .

. I can tell you something else that I shouldn’t be. But assuming there is a buffet, cocktail party before dinner. People just get, you know.

When it comes to survivors, they just are very impatient and would grab more than they can possibly eat. That’s a tendency of a Holocaust survivor. (H. I.

R. ) If the Holocaust had continued any longer, a new language regarding food and diet might have arisen. Words such as hungry or thirsty do not describe Holocaust survivors’ experiences. 20 H. J.

reflected on how ‘‘he will never be hungry like he used to be. ’’ Hunger during the Holocaust was still vivid for all interviewees. survivors residing in long-term care facilities are more or less likely to have Holocaust-related food issues.The Survivors of the Shoah Visual History Foundation has over 50 000 videotaped testimonies, the large majority being from Holocaust survivors. Using state-of-the-art media indexing technology, this searchable video database could enable qualitative projects based on locatable words, for example, starvation, hunger, and thirst, as well as words describing physical effects of starvation, for example, skeleton and musselman.

Concentration camp foods, including bread, coffee, soup, potato peels, and turnips, might all be studied in context, and phrases may be searched.Survivors reluctant to talk of their experiences have, for various reasons, provided testimony for the Shoah Foundation. Food attitudes among well-adjusted Holocaust survivors could be compared with those still traumatized. Many survivors are using or will use health care and related services.

Nutritionists, educators, and health professionals should be aware that food-related issues from the Holocaust remain. Accommodating survivors in long-term care facilities who want to store food in their rooms may be helpful. Many older diners enjoy generous portions, but care should be taken to reduce food waste.

A sit-down meal may be preferable to requiring survivors to stand in line. It is hoped that this study will remind nutritionists, educators, and others that issues may remain decades after traumatic food-related events. It is important for those working with Holocaust survivors and others who experienced food deprivation to avoid arousing painful foodrelated memories. Understanding the source of idiosyncratic food-related behaviors when providing nutrition education, counseling, and food will make it easier to help them improve their nutritional status and quality of life.ACKNOWLEDGMENTS Deepest appreciation is expressed to the 25 Holocaust survivors who, having survived life’s worst nightmare, willingly shared their horrific experience and its influence today.

The authors acknowledge the recruitment help of the Miami Beach Holocaust Memorial; its director, A. Mizrachi; and the Holocaust Documentation and Education Center. We thank V. H. Castellanos, PhD, RD, associate professor of dietetics and nutrition; D. O.

Weddle, PhD, RD, FADA, associate professor and chair of dietetics and nutrition; and L. D. Frazier, PhD, assistant professor of psychology, Florida International University, for their guidance.IMPLICATIONS FOR RESEARCH AND PRACTICE Research about the Holocaust demands immediate attention because most survivors are in their 70s and 80s. Future studies could limit intersubject variability by focusing on those from specific camps, birth countries, and/or liberators; by comparing those who married other survivors with those who did not and the strength of the Holocaust’s influence on their food attitudes today; and by determining whether REFERENCES 1.

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