By Jessica Smith, BSN, RN, CCRN-Alumnus
Seeking to understand a loved one who is experiencing an eating disorder (ED) is an incredible act of love. It can be challenging and confusing, regardless of where the person is in the process. The road to recovery can be long and arduous, but your continued support is crucial to the success of the person experiencing the illness.
Eating disorders are complex, layered, and not easily understood. As a person in recovery from an ED, I have experienced various attempts by friends and family to help me during the process. Some of these attempts have been intensely triggering and harmful; others have been healing in ways I didn’t know were possible.
Most people are well-intentioned, but even the most loving individual can deliver words that cut deeply when he or she is uninformed. Keep in mind the following information is provided for friends and family, not someone on the treatment team. If you’re ever unsure about how to proceed, please consult with a licensed professional about the best approach for your loved one with an ED.
1. Avoid all comments regarding physical appearance.
This is, in my opinion, the most important piece of advice. Eating disorders alter the mind in such a way that a compliment on one’s appearance, however sweetly delivered or well-meaning, can cause great distress to the person receiving it. Compliments as seemingly innocuous as “You look healthy!” can lead a person to relapse. The reason for this is because if a person has lost a noticeable amount of weight using disordered behaviors, it is likely he or she received many compliments on that weight loss. In recovery, achieving a healthier body and mind may necessitate some weight gain. The term “healthy” becomes twisted into “I can tell you have gained weight.” Having a higher body weight and softer appearance is often feared in the mind of someone with an eating disorder (though not always). Pointing out bodily changes can be very distressing for the person with an ED.
Another possible outcome is your comment reinforces eating disorder behavior. For instance, if I naturally exist at a higher weight but have recently begun restricting food and purging to lose weight, complimenting my weight loss strengthens my eating disorder behaviors (restriction and purging). A simple “I am so happy to see you!” is a much better alternative.
Our culture is very focused on aesthetics, and it has become second nature to compliment others on their looks. While there is nothing inherently wrong with offering up a compliment, focusing only on outer appearance can lead to a sense of identity and self-worth that is rooted solely in how we look. As we age, we can become despondent as we grieve our former selves, utterly distraught at what we see looking back at us in the mirror. In my own life, I have made great efforts to instead notice a personality trait, the sound of a friend’s laughter, or the way a friend makes me feel when I’m around her. Give it a try!
2. Never offer nutritional or dietary advice.
Unless you are a registered dietician treating the person, this is inappropriate. Coaxing someone into the latest fad eating plan or cleanse can cause irreparable harm. Our culture is obsessed with dividing foods into moral categories, espousing the magical wizardry of cauliflower, spirulina, and the like. The truth of the matter is this: All foods fit unless someone has an actual documented food allergy.
3.Do not make attempts to fix, police, or correct behaviors.
“Why don’t you just eat?”
“You better eat all of that, or else.”
“All you have to do is avoid _____. Then you won’t binge.”
“Are you sure you need cake and ice cream?”
“I’m so happy to see you eating.”
This is tricky because your objective may be to help, but comments like those above are not helpful to someone with an ED. People with EDs feel shame, embarrassment, or even pride while engaging in disordered behaviors. Simplifying a mental health condition by suggesting someone “just eat” is sorely misguided, and threatening fuels the disorder as it further damages interpersonal relationships. In my own experience, knowing others were watching me eat and taking inventory of my choices was tormenting, and it led to days of mental anguish. Sadly, feelings of shame and guilt can then trigger further ED behaviors, so the cycle continues. If you are concerned about your loved one’s behaviors, reach out to a member of his or her treatment team.
4. Be mindful of your body language.
Sometimes actions speak louder than words. Side-eyeing your friend as she painstakingly makes her way through the food line or raising an eyebrow when she passes on the brownies is not helpful. Staring a bit too long at the body of your friend who has recently left treatment can be devastating as well. People in recovery are especially sensitive to their changing bodies and potential judgment from others. Try as hard as you can to remain neutral, loving, and normal.
5. Do not discuss weight, eating habits, or various eating regimens.
Idolizing health, moralizing thinness, and unbridled obsession with the habits that get us there are examples of diet culture. Diet culture and it’s accompanying vernacular is dangerous yet nearly unavoidable. Engaging in diet culture perpetuates EDs and thwarts the recovery process, says Ragen Chastain, NEDA Ambassador, in her 2019 blog post “Recognizing and Resisting Diet Culture.” You can help mitigate its damage by providing a safe zone that is free of such chatter. Avoid discussing current or past diet trends, your own eating habits, or how your body compares to that of another person. It has become a cultural norm to lament about our body size while a friend reassures us we are not “fat,” as if that was something to be feared. You can be the change we need to see in our society and instead choose to discuss things that matter.
6. Be careful not to exclude or avoid your friend or loved one.
Eating disorders are isolating by nature as adherence to behaviors take precedence over maintaining relationships. There were many times I declined invitations to outings involving food or those interfering with my workout schedule. No matter how frustrating this feels as the friend or support person, please continue to extend these invites. If you notice your friend is detaching, try inviting the individual to activities that do not involve food such as a walk, a painting class, or a trip to the local animal shelter to walk the dogs. Connection is vital for recovery.
7. Please avoid professing to understand unless you really do
“Oh, I completely get what you mean. I ate dinner and ice cream last night. I felt so guilty after bingeing like that!”
Sometimes when I am sharing my story, I can tell the person on the receiving end is very uncomfortable. To relieve their own discomfort, they will do what comes naturally for most human beings: try to relate. If he or she has also experienced an ED, this can be helpful. If he or she hasn’t but tries unsuccessfully to compare stories, I feel at best misunderstood and at worst patronized. The above example was not a binge. Eating ice cream after dinner is completely normal eating behavior. Feeling full after a normal-sized meal is incomparable to what those with binge-eating disorder experience, so this is an unhelpful attempt to relate. If you find yourself feeling awkward or unsure, don’t feel the need to fill up space with words. Active listening goes a long way. You can also try, “That must be so hard. I am honored you have chosen to share this with me.”
Recovery from an eating disorder feels achievable with validation and compassion from others. If you know you have made a hurtful comment, have grace for yourself. Talk to your friends or loved ones in an open and honest way, reassuring them of your place as an ally. The National Eating Disorder Association is a helpful organization offering additional resources, including steps to encourage someone to seek professional help. Your presence and commitment matter, and you can make a difference.