How to Help Someone with an Eating Disorder

This is the second post in a two-part series about eating disorders. In the previous post, we highlighted some critical facts to know about eating disorders. Eating disorders can be deadly, they are not a choice, and they cannot be identified purely by appearance.

Once it’s become clear that someone is struggling with an eating disorder, what can you do to help? Read on to find out.

1. Your Words Can Harm – Or Heal

There’s a lot you can do to make someone’s experience even more difficult, and there’s also a lot you can do to alleviate her pain and help her feel more hopeful. Below are some things my clients would like you to know:

Please do not:

· Think that I’m doing this because I all I care about is looking thin. There is so much more going on for me than you can see on the surface.

· Talk incessantly about dieting and needing to lose weight or using the word “cheating” when you know I have a complicated relationship with food.

· Make fun of anyone's body size or shape when I'm around.

· Talk about how little you ate today. Following my meal plan is hard enough as it is - I don't want to feel even more ashamed about my food intake than I already do.‎

· Go on and on about your workouts – how proud of yourself you are for being so strict about your exercise, how great your workouts make you feel. My job right now is to cut down on exercise. In my head I know that’s what’s healthier for me. But it is very hard for me to hear you talk about how amazing it makes you feel when I feel so stressed about not being able to exercise now.

· Make me feel like I have a “fake” illness. Trust me when I say I would have never chosen to suffer with this.

· Think that EDs are only in skeletal-looking individuals. I have a hard time saying that I have an eating disorder because I don't feel or look thin enough.

· Increase my already-tremendous sense of guilt by talking about much time and money my treatment requires.

· Make me feel like an eating disorder is a moral failing. I already stress so much about being good and doing good and I feel so bad about having this disorder. I wish I didn’t have it and when you make me feel like a bad person for struggling with this, it just makes it harder to do gather the strength I need to recover.

· Judge me for having an eating disorder. If you can’t help, please just leave space for me to struggle with my ED.

‎Please don’t say:

· “But you don't look you have an eating disorder!"

· "Everyone binge eats. It doesn't mean that it's a disorder!"

· “"THAT'S what you're stressing about!?"

· “Why can't you just eat something?"

· “You have to eat MORE? You’re so lucky!”

· “I wish I had a little anorexia.”

· “Look at how much stress you are putting on this family. Just do what you need to do and get over it.”

Please do:

· Understand that you may never understand my eating disorder, and that’s ok. I just need you to know that it is real to me and to respect my struggle.

· Understand that it is a real struggle for me. And no, it is not just for attention.

· Understand that giving support to someone that's struggling is doing a huge favor. It doesn't require too much effort- just sitting at a meal and keeping a fun conversation going can make it that much easier. ‎And if that's not a possibility, the least you can do is to keep unwanted drama and stress until after mealtime.

· Understand that “doing my best” might seem laughable to you, but it may be taking every ounce of strength I have. Every step I take away from my eating disorder and toward a healthier self is an achievement, no matter how small.

· Understand that recovery from an eating disorder in a world that is obsessed with dieting can feel very lonely. I need your friendship and your company more than ever, but I also need you to talk about things other than weight and food and looks. You may need to think twice before you speak but I think you’ll be doing yourself a favor, too.

· Understand that my goal is not to hurt, anger or manipulate you. My eating disorder is a coping mechanism that I latched onto as a means of self- preservation. My eating disorder is what keeps me sane when I feel like I’m losing it - it is not a prank that I'm pulling in order to get your attention. ‎ I know it's a lot to ask, but please give me your understanding and patience while I figure this all out for myself‎.

2. Dieting – Don’t Do It

Why not? Because it is a huge risk factor for the development of an eating disorder as well as a tremendous trigger to others in recovery. If you are trying to gain weight or get an eating disorder, there’s really good evidence for dieting. One of the most striking studies comes from the University of Minnesota. It followed over 2,000 teens who dieted and found that five years later, they were at approximately three times greater risk of being overweight than teens who did not diet and the incidence of eating disorders was higher in this group as well[1]. Another study revealed that 35% of “occasional dieters” progress into disordered eating and as many as 25%, advance to full-blown eating disorders[2]. Young people who diet are six times more likely to develop an eating disorder, and those who go on extreme diets have an 18-fold risk[3]. The bottom line, as stated by Natalia Zunino, Ph.D., of the American Anorexia and Bulimia Association, Inc., is that regular dieting is the leading cause in the development of any eating disorder. That may make you think twice about your approach to food.

Even if you feel confident about your own dieting, it’s critical to consider the effect that your eating has on others. Many people are under the impression that what they do with their own food is their own business, and I wish that were true, but as long as you are in contact with other people, some of your business is going to be their business, especially if those people are children or teens. There’s a young person somewhere who looks up to you, and what you do with your food and how you relate to your body is filtering down to that person. Be careful about what you attach importance to, because that’s going to be imprinted on someone else’s brain. If you equate weight with worth, or if your shape and size is of extreme importance to your identity, you can be sure that this will become a focus to someone who admires you, even if you never criticize his or her body. Your own actions talk louder than any words ever will.

If you are already “talking the language of dieting” by discussing your restrictive eating with others or commenting on their intake, please know that your words can encourage disordered eating and will definitely make it harder for those already struggling with an eating disorder. Do them a favor by keeping your thoughts about food and weight to yourself, and do yourself a kindness by considering whether your beliefs and habits are enhancing your well-being or constraining it. Remember that “weight-watching” is not a spectator sport. You never really know what’s going on for someone else, so even if you intend your comment on someone’s weight to be a compliment, you’re probably best off just saying, “It’s great to see you!” instead of, “You look great!” Show others that you value the person instead of the package, and you will be doing your part to make it harder for someone to develop an eating disorder and easier to someone to recover from one.

Thank you for taking the time to read this article. By trying to understand the struggle of those battling an eating disorder, you’ve done a tremendous kindness. If you are concerned about someone you care about, contact a qualified professional or referral agency.

[1] Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M. Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later? Journal of the American Dietetic Association. 2006;106(4):559-568. doi:10.1016/j.jada.2006.01.003.

[2] Shisslak, CM, Crago M, Estes, LS. The spectrum of eating disturbances. International Journal of Eating Disorders. 1995:18 (3), 209-219.

[3] Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ 1999;318:765–8.