If someone you care about has an eating disorder, knowing what to say — if anything — can be awkward. Tricky. Uncomfortable. You don’t want to make things worse, and you don’t want to risk losing your relationship. So what do you say to someone with an eating disorder to express your concern?
What makes helping a friend with an eating disorder tricky?
- Your friend may not be ready to acknowledge the eating disorder. This happens a lot. S/he may not be able or ready to process on the inside what you see or suspect from the outside.
- Many disordered eating behaviors are so common that distinguishing them from the less intense but still damaging effects of Diet Culture can be impossible. After all, dieting is praised and thinness is admired in our culture, often at high physical and psychological costs.
- Denial of an eating disorder is common among people who have one, especially if they don’t recognize they have a problem. Even if they do realize the problem, they may want it to remain a secret. Especially with binge eating and purging behaviors, shame is inextricably intertwined with the disorder.
Don’t know what to say to someone with an eating disorder? Start by educating yourself.A great place to start is with the National Eating Disorders Association, which also has a helpline and screening tool.
Other excellent informational and educational sites include the Academy for Eating Disorders and MEDA.
A basic understanding of how an eating-disordered mind works is essential. Otherwise, there is a good chance that any attempt to be helpful will only make matters worse.
Next, consider the approach to use in helping a friend with an eating disorder.
How do you anticipate your friend responding? With anger? Relief? Embarrassment? Denial?
Regardless of the response you anticipate and/or receive, try your hardest to remain calm and compassionate. Remember that your friend is in a lot of pain.
Let me repeat that: Your friend is in a lot of pain.
What you are witnessing isn’t about food. It’s about pain.
When you do speak with your friend, state your concerns clearly and concisely. Don’t go on and on or put your friend on the spot.
You’re not the Eating Disorder Police!
Your intention may be to help your friend. But s/he may not be ready to address the problem and could even resent your concern.
Do not get into a fight over it.
Four tips to consider when deciding what to say to someone with an eating disorder:
- Find a private space to talk without interruptions.
- Express your concern non-judgmentally.
- Offer your support. Let the person know you’re there to help in any way you can. For example, you could say something like, “I care about you. I want to help you get support to feel better.”
- Be prepared for a range of reactions. The person may deny there is a problem, become defensive, or feel embarrassed. Let your friend or loved one know you are there for support no matter what.
What to say and not say.
Knowing what to say to a friend who is suffering with an eating disorder can be really difficult.
Open-ended questions are helpful. You could ask, for example, how your friend feels about the eating disorder. Or ask how you can best be of support.
Maybe even suggest an activity for the two of you to do together that does not involve food, weight, or social media.
Below are examples of things you could say to someone with an eating disorder to express your concern:
- “I’ve noticed that you haven’t been yourself lately, and I’m worried about you.”
- “I care about you, and I’ve noticed some changes. How about we talk about how you’re feeling?”
- “I want you to know that I’m here for you and I’m concerned.”
- “I’ve noticed that you seem to be avoiding situations involving food. I’m concerned it might be impacting your health. Can we talk about it?”
No matter how well-intended, some comments will likely backfire and make matters worse. Here are some examples of what not to say:
- “You don’t look healthy.” Avoid making any kind of appearance-related comments. Also, for someone with an eating disorder, “healthy” is interpreted as “fat,” and fat is feared.
- “You look great! Have you lost weight?” See #1 for an explanation of why this is not helpful.
- “If you were any thinner, I would think you have an eating disorder.”
- “Jokes” about body weight, size, and food/eating, as these are rarely if ever funny to someone suffering from an eating disorder.
- “Just eat more.” That never works because eating disorders aren’t actually about food.
- “I wish I had your self-control.” Your friend is ill, and illness is different from self-control. Your friend’s entire life revolves around food, and she is actually out of control.
Friends and therapists: a case example
Lilly is a 31-year-old single woman of mixed descent. Friends, family, and coworkers have commented that she is “weird around food” and that she appears “unhappy.”
She is tired of being preoccupied with food, weight, and “clean eating.” Although she’s not sure she ”really” has a problem, she has decided to have a consultation with an eating disorder specialist.
When Dr. Michaels first met with Lily, she noticed Lily’s thumb and pointer finger were wrapped around the opposite wrist. She recognized this as an eating disorder behavior known as body checking.
She also noticed Lily looking down at her phone, intensely watching TikTok videos while waiting for Dr. Michaels to start the appointment.
When the doctor asked Lily the reason for the visit, Lily said, “people are telling me they are concerned, but I don’t think they have anything to be concerned about.”
Keep in mind that your role is “friend,” not “therapist.”
The role of therapist belongs to the therapist.
Avoid the temptation to “therapize” your friend, and instead focus on your friendship.
Do low-key things together (e.g. painting, doing a puzzle) that can distract from the eating disorder preoccupation.
Eating disorders are complex.
No two people have the exact same eating disorder, even though certain symptoms may overlap.
Eating disorders can be resistant to treatment.
And recovery can be something your friend feels ambivalent about, even while in treatment.
If you don’t know quite what to say, that’s okay, too.
Sometimes, the best thing to do is just listen.