Do you know someone with an eating disorder or perhaps suspect that someone you know may be struggling? Do you want to help but just don’t know what to do or say? Maybe you notice them skipping meals, picking at their food, exercising obsessively or perhaps tubs of ice cream and boxes of cookies or cereal mysteriously go missing.
Maybe they suddenly eliminate foods and go vegetarian, vegan or keto (whatever the diet de jour may be); or you find them standing over a kitchen counter, polishing off that cake you’d been saving. If any of this sounds familiar, this person is likely struggling with their relationship with food and should seek help if they haven’t already.
Eating disorders are complex mental illnesses that exist on a large spectrum. While there is the “textbook definition” of eating disorders, the reality is, not all eating disorders get formally diagnosed, nor do they all match up perfectly to the criteria which defines the diagnosis. Most eating disorders don’t look like the somewhat glorified versions of ED’s that you see on tv (you know, the starkly thin, young white female). If you don’t work in the field of eating disorders, or haven’t suffered from one yourself, they can be very difficult to recognize or comprehend.
People with eating disorders can’t just “eat normally”, as there is an immense cognitive dissonance occurring. They cannot escape food, because it is necessary for survival, yet it is both their obsession and worst enemy. They are likely acutely preoccupied with their body size, hyper-aware of how their body looks in clothes, their weight, or if people are watching them eat. It can be a very traumatic experience, causing intense physical and emotional distress. It’s not your job to fix them, but you can arm yourself with knowledge and skills to better support them in their recovery.
What not to say to someone struggling with an Eating Disorder:
You aren’t fat! You look so healthy!
To the ears of someone with an ED, this does not translate to the well-meaning comment it was likely intended. Healthy to someone with an eating disorder or a distorted body image does not have a positive connotation. The best thing you can do is to not comment on body size at all. Saying, “you aren’t fat” also perpetuates the belief that being fat (using the term fat as a descriptor) is inherently bad and to be avoided. You can’t tell anything about a person’s health just by looking at them, regardless of if they’re in a larger or a smaller body.
You are so skinny! What is your secret? I wish I had your willpower!
Okay, this is actually something you shouldn’t say to anyone, period. This can be especially problematic to someone with an active eating disorder or those vulnerable to disordered eating, as it can be the validation their ED is seeking. To them, it says that their efforts are not only working, but that their underlying belief that being in a smaller body makes them more worthy, acceptable and interesting is true. This kind of praise places emphasis on appearance being a source of value, reinforcing the idea that a smaller body is more valuable.
Why is there so much food disappearing from the kitchen?
You may notice that food has been disappearing at an alarming rate. Calling attention to this, and targeting the person likely behind it, is only likely to fill that person with more shame, on top of the internal shame they are already experiencing. Avoid confronting the person about it, as they likely already feel extremely embarrassed and are beating themselves up enough.
Have you taken your meds/seen your therapist lately?
To the ears of someone with an ED, this sounds like, “You are broken, you are wrong, you need to be fixed.” It’s just as unhelpful as saying something harmful like, “what’s wrong with you? Why aren’t you normal?” So, this is not a helpful comment, and only contributes to shame.
Maybe you should cut out flour/sugar/carbs, or, why don’t you go on a diet?
Perhaps the person you know is binging on sugary foods. The root of binging is restriction, so this is their body’s survival mechanism, a biological response to the threat of scarcity and starvation. Suggesting they eliminate the foods they usually binge on will only make them feel guiltier and out of control around food. Not only this, but the person with an ED has likely tried many diets!
Dieting is the biggest predictor of an ED, so suggesting more rules and rigidity around food is only going to feed into the disorder, making them even more afraid of food and unable to trust themselves around it. You can’t diet your way to a better body image or relationship with food.
You would look so much better if you just ate a hamburger.
For someone with an ED, food is the enemy. However, there is so much that lies beneath the surface that makes something as seemingly simple as “eating a cheeseburger” incredibly scary and difficult. Additionally, this perpetuates their belief that what they eat has a direct impact on what their body looks like, which isn’t true.
Why can’t you just eat?
If only it were that simple! More often than not, an ED has very little to do with food itself. They are a mental illness that often have co-morbidities such as body dissatisfaction, low self-esteem, perfectionistic traits, personality disorders, history of trauma, body dysmorphia and more. Boiling it down to eating is reductionist and unhelpful. Oftentimes, professional support and guidance, including a meal plan for structure, is helpful while working toward regulating eating patterns.
Just stop binging!
Binging is not caused by a lack of willpower or self-control. In fact, it is often caused by trying to tightly control eating, leading to feeling restricted and deprived. If you’ve caught them in the middle of it, they are likely deeply ashamed and embarrassed. If you’ve caught them purging, their deepest secret has been revealed and they are probably overcome with shame.
No one chooses to have an eating disorder. It serves some kind of purpose- a crutch, self-soothing technique, a coping strategy. They must develop the tools to cope in other ways, along with normalizing eating, before expecting those behaviors to disappear.
Isn’t that too much food? Do you know how many calories are in that?
First of all, commenting on anyone’s food choices is never a good idea. It’s likely to cause unnecessary food preoccupation and feeling self-conscious about food choices. A person with an ED is likely already hyper-aware of their food choices and feel that others are watching them eat. Commending on their food choices only affirms their fear that their eating is being observed and is on trial.
Just eat like I do and you’ll be fine!
While well-intended, this suggestion is not quite helpful. Someone with an ED is likely already aware that they don’t eat like others, and probably compare their intake and food choices to others on a regular basis. Avoid being their food police, as it is not your job to dictate what/when/how much they eat. They have to go throughout their own recovery process, follow their meal plan, and find it in themselves to work through it.
What to say instead
Are you okay? I can tell things are tough for you right now, is there anything I can do to support you?
Do you want to talk? I’m here for you if you want to talk.
No one is perfect, go easy on yourself.
Would you like to see someone who can help you through this?
I love you no matter what.
Overall, avoid being the food police, commenting on food choices, and swerve any and all conversation about body size, weight, shape, etc. We are conditioned to share a collective discontent over our bodies, and often bond over lamenting about body size. Do your best to avoid this kind of talk with your loved one, and instead support them, encourage them, and compliment them on things that have nothing to do with their outward appearance.
It is also important to know that it is not your job to fix the eating disorder. However, if your loved one is ready, you can help them find resources that will best support them through what is sure to be a trying time. For example, encourage them to reach out to a dietitian and a therapist. Or, share information about the NourishRX Eating Disorder PATH.
Have you found yourself struggling with what to say to someone with an eating disorder? Share your experiences with us! For more information and support make sure to join our newsletter to find out all our practice has for you.