Helping a Friend with an Eating Disorder

Help with Eating Disorder

In the United States, it is estimated that eating disorders will impact roughly 20 million women and 10 million men in their lifetimes. Despite the prevalence, 50% of people with an eating disorder (ED) are unsure if they deserve help, and 75% will go untreated. Seeking treatment for an eating disorder can be scary, but the good news is that mental health professionals have been very successful in treating ED, and having a strong support network is linked to even greater chances for a full recovery.

If you have a loved one who is impacted by ED, they may be unaware that there is a problem or too ashamed to reach out for assistance. Family and friends can play a key role in encouraging a loved one with eating or body issues to seek help, but it’s important to provide support in a way that avoids causing further harm.

If someone you care about is battling an eating disorder, we understand this may be a tough time for you. It can be difficult to understand the problem and how to help. In order to offer support, it’s important that you gain a better understanding of eating disorders and validate the fears and struggles of your loved ones without judgment. Here are some thoughtful suggestions for supporting a loved one with ED:

Validate your loved one’s difficulties so they feel like they’re being understood.

Low self-esteem is a common characteristic of individuals with eating disorders. Those who experience ED know all too well the feelings of guilt, shame, and embarrassment that accompany their disordered eating. The strong emotions triggered by ED often result in a tendency to self-blame, and those who are struggling may feel like they should be able to “fix” their problems on their own, resulting in a belief that those around them will not understand the issue.

They also tend to believe that they need to exert more restraint, and may feel unworthy of love because of their inability to do so. The reality of recovery for eating disorders is very different, and not as simple as stopping or changing a behavior. 

Although it might seem helpful to offer up suggestions about what to eat or how to alter one’s appearance, the reality is that this type of feedback frequently contributes to greater feelings of self-doubt and shame. Research has shown that shame isn’t an effective motivator to adopt healthier eating habits, so it is critically important to validate your loved one’s difficulties without chastising or diminishing them. 

Be a good role model by adopting healthier, sustainable eating patterns (no dieting). 

Being a good role model for establishing healthy eating patterns may take many forms, including cooking nutritious meals, avoiding “good” and “bad” food labels, and practicing intuitive eating. According to the National Eating Disorders Association, intuitive eating is about trusting your body to make food choices that feel good for you, without judging yourself or the influence of diet culture. You can learn more about the principles of intuitive eating here.

Avoid dieting or talking about diets in front of them.

Eating disorders are often triggered by diet culture and societal idealization of thinness. Ironically enough, there is ample evidence to support that diets and weight-loss programs increase the risk of developing an eating disorder. In 2008, one such study determined that 79% of weight-loss program participants reported coping with weight stigma by eating more food (Andreyeva, T., Puhl, R.M., and Brownell, K.D.).

Similarly, a 2016 study involving teenagers found that dieting was “the most important predictor of developing an eating disorder,” and teens who practiced extreme restriction were 18x more likely to develop ED compared to teens that did not diet (Golden, N.H., Schneider, M., & Wood, C.). Whether it’s a cleanse, intentionally skipping meals, or excluding desired food groups, it is well known that stringent diets put individuals at greater risk for developing ED or relapsing from ED recovery.

Encourage your loved one whenever they take a small step in the recovery process.

Compliment your loved one’s personality, successes, and accomplishments. If the person you care for is already in treatment, encourage all activities recommended by the treatment provider and remind them to celebrate the small victories. Show your loved ones that you have confidence in them, and remember that recovery takes time and relapse may be a normal part of the treatment process. 

Check-in every now and then to see if there’s something you can do to better help. 

Before you offer to help a loved one with ED, it’s important to learn as much as you can about their eating disorder. When you’re ready to talk to someone you care about, set a private place and time to talk and approach the conversation from a place of compassion.

Resist the urge to offer advice or simple “solutions”, and instead ask your loved one what they need (i.e. ask what would be helpful during mealtime, ask if they would like you to do the grocery shopping for them, etc.).

If your loved one responds with anger, frustration, or denial, don’t take it personally. Some people with ED are glad to receive support, but others may struggle to realize their problem or have a difficult time opening up.

No matter the response, listen openly and reflectively, and remember to be kind and nonjudgmental. Remind your loved one that you care and let them know that you are there to support them when they’re ready. Be patient and encourage them to see a professional or offer to help find a treatment provider.

Avoid talking about or commenting on other people’s weight or size.

It is common for individuals who suffer from eating disorders to base their self-worth on their weight or physical appearance. Battling a negative body image can be debilitating and distressing, and is most intense after being in a triggering environment.

Whether you’re directing your comments at your loved one or someone else, commenting on people’s weight and size establishes standards of “worthiness” to a person with ED. It’s important to recognize that what you say can have a profound impact for days or even weeks to come. Be careful to avoid comments like these:

  • But you aren’t that skinny, so you can’t be anorexic.

  • Why don’t you stop eating so much?

  • You can’t have bulimia if you don’t throw up.

  • You look great, there’s nothing to be worried about.

  • If you stop caring what people think, things will get better.

  • You’d look a lot better if you gained some weight anyway.

  • Don’t worry, I think we all struggle with an eating disorder every now and then.

  • It’ll pass with time, just wait.

  • Did you see how much weight so and so gained/lost?

  • Does this make me look fat?

  • You don’t look like you have an eating disorder.

Professional support is vital to the treatment of eating disorders, but the role you play as a friend, family member, or partner can go a long way in helping your loved one get better.

Read a great post from Fleurine Tideman who understands how someone with an eating disorder can still feel valid in their experience.

If you are in search of additional tools to support someone with an eating disorder such as bulimia nervosa, binge eating disorder, anorexia nervosa, or other disordered eating behaviors you can find more information on the NEDA website and in the Parent Toolkit, located here: https://www.nationaleatingdisorders.org/parent-toolkit

Terms to Learn

Anorexia nervosa

Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.

Bulimia nervosa

Bulimia nervosa is a condition where people have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or overweight.

Binge-eating disorder

Binge-eating disorder is when people lose control over their eating and have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorders often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Avoidant restrictive food intake disorder

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.

Sources

Andreyeva, T., Puhl, R.M., and Brownell, K.D. Changes in Perceived Weight Discrimination Among Americans, 1995-1996 Through 2004-2006. Obesity, 16: 1129-1134. doi:10.1038/oby.2008.35

Golden, N.H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649

The Original Intuitive Eating Pros. (2017-2019). 10 Principles of Intuitive Eating. http://www.intuitiveeating.org/10-principles-of-intuitive-eating/

NEDA. (2022). Parent Toolkit. https://www.nationaleatingdisorders.org/parent-toolkit

Flores, A. (2022). What Does Intuitive Eating Mean? NEDA. https://www.nationaleatingdisorders.org/blog/what-does-intuitive-eating-mean