Yes, speak up, even if it’s difficult to do. Eating disorders can lead to serious (and even fatal) illness. The best way to start the conversation: Point out the behavior you’ve observed without mentioning an eating disorder, which could unnerve her. For instance, you might say, “You’re such a great friend, and we always have each other’s backs. I just wanted to tell you that I’ve noticed you’ve lost a lot of weight, I don’t see you eating that much, and I’m concerned that something is going on. I’m here to support you if you need it.”
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If your friend insists that you’re wrong, then simply say, “I’m sorry, but I didn’t want to take a chance, because I care about you so much!” If her weight really deteriorates, you may need to approach her family. Be circumspect here, as well—tell them she looks thin to you and you’ve shared your concerns with her, and you wanted to let them know, too.