Why some people develop an eating disorder has to do with many factors—a psychological predisposition, for example, or our society's complicated relationship with food, exercise, and weight.
But though experts are gaining a better understanding of why they happen, these life-altering disorders continue to strike. Some 20 million women and 10 million men in the United States are thought to be affected by an eating disorder, according to the National Eating Disorder Association (NEDA).
“I think it might start off as wanting to diet or exercise to lose weight, but when it becomes an official diagnosis, it becomes a mental illness,” explains certified eating disorder specialist Dena Cabrera, PsyD, executive clinical director of the Rosewood Centers for Eating Disorders. “It’s not about [wanting] attention or even about food—it’s not a choice. It’s an illness and has the highest mortality rate out of all psychiatric illnesses.”
If you know someone who has an eating disorder, or you suspect they have one, it’s only natural for you to want to help. But the sensitive nature of eating disorders can make it tricky to know what to do or say. Here, experts share their wisest tips for supporting a loved one, no matter where they are on the journey toward healing.
Ask how you can help
“It’s easy to assume that if our friends need us, they’ll let us know because we’re good friends,” says certified eating disorder registered dietitian Marjorie Nolan Cohn, owner of MNC Nutrition in Philadelphia. But IRL, we don’t always reach out when we need help; your friend could be waiting for you to ask the right question, she says.
Asking a simple “Do you want to talk?” on a regular basis can be extremely helpful. “Eating disorders don’t go away overnight. Just because a friend seems to be fine doesn’t mean she’s not struggling in different ways that aren’t as obvious outwardly,” says Cohn.
Everyone’s experience with an eating disorder is different, Cabrera says, and there's not one right way to help. One person might want a friend to hold them accountable to their healthier meal plan; another might just want the occasional text letting them know you’re thinking of them, she says. You won't know what your friend needs unless you ask.
Hear them out
After you've asked how you can help, sit back and really listen. Resist the urge to comment, which could be seen as judgmental. Avoid responding in ways that might put too much emphasis on food, weight, or bodies—such as by saying, “But you don’t look like you could have an eating disorder!” Cohn suggests.
Once you've taken in everything your friend has to say, try a supportive response like, "It took courage to reach out. I want you to know I believe you, and I want to help support you in getting better,” says Lauren Smolar, director of programs at NEDA.
RELATED: Subtle Signs of Eating Disorders
Don’t be dismissive
An eating disorder is a mental illness, and no, a person struggling with one cannot just eat more or exercise less and make it go away, Cabrera says. “Those [suggestions] are probably not helpful—and they’ve probably already tried those things,” she says. “They really need professional help. One thing that’s really important for you as a friend is to try not to feel like you can or have to fix it. There are complicated biological, psychological, and social issues going on.”
Look for resources together
If your friend is fearful or hesitant about finding professional help, take away some of the burden, Cabrera suggests. “Say there are lots of credible resources online,” she advises, and compile a few links. (For starters, try MyNEDA.org, or recommend NEDA’s text or phone numbers—text 741741 or call 800-931-2237.)
If you’re a close enough pal, grab info about their health insurance provider and do some research into psychiatrists or dietitians who specialize in eating disorders. It can go a long way to simply offer, “I found three professionals that are in-network near us, who do you like best?” Cohn suggests.
Take their kids to soccer practice
When a friend has a serious illness, you probably do all you can to assist—deliver casseroles, pick up their kids from school, stop in and do the laundry. A person with an eating disorder also has a serious illness, but most of us don't think of it that way, Cabrera says, so we don't offer to lend a hand as we would if they had the flu.
“Eating disorders are life-threatening diseases too,” she says. “Making those special efforts, taking those steps, can be really helpful." In the meantime, it frees your friend up to contact doctors or go to outpatient treatment, or just take time to destress.
Buy a thoughtful gift
Cohn says that her eating disorder patients draw meaning from gifts themed around reflection and healing. A few examples: semi-precious stones with therapeutic connotations, or jewelry with mantras like the MantraBand ($25, mantraband.com). Let your friend know you’re thinking of her with a token of your support that can inspire her during a particularly tough moment. Journals to write in are also another thoughtful option, Cohn adds.
Go out and have fun together
Spending time together is a great way to show your support. Just make sure to pick an activity that doesn’t add to anxieties or stress about food, Cohn says. “Shopping for shoes is generally fine, but bathing suits can be sticky. Suggest getting your nails done, but not necessarily going to lunch,” she recommends.
Avoid trigger words
Lead by example, Smolar says, and don’t talk unnecessarily about food, calories, or your own weight. “That can be difficult for someone with an eating disorder to hear, or potentially dangerous,” she says. Make your time together a safe environment free of those stressors, she says.
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Set up a support system ahead of time if you know you and your friend will be at a food-centric event together, like a catered work event or mutual friend's birthday party. Ask specifically what you can do that wouldn't involve pushing food on her—which might have a negative impact on her prescribed meal plan. Try, “Want to go outside and take a breather?" Cohn suggests. "It’s an opportunity to get out of the situation or environment for a little reprieve.”