Know someone with an eating disorder? Here are 6 key ways you can help

By Kristen Rogers, CNN

If you think or know a loved one has an eating disorder, supporting that person can be game-changing for them.

Eating disorders affect at least 9% of the world population, which includes around 30 million Americans. More than 10,000 people die from eating disorders every year, and that’s just in the United States. And the pandemic has led to an increase in the number and severity of cases, according to a January study published in the journal The Lancet Psychiatry.

Those closest to someone with an eating disorder play “a huge role in just paying attention and identifying potential risk factors or signs,” said Alvin Tran, assistant professor of public health at the University of New Haven in Connecticut. Tran does research on eating disorders and body image.

One of the easiest things to do is ask how to help, said Joann Hendelman, clinical director of the National Alliance for Eating Disorders. But you need to get educated first, she added, since not knowing enough can be harmful.

Here’s what else you should know about supporting someone struggling with an eating disorder.

1. Know the signs

Since early intervention is key, being able to recognize signs of eating disorders is important, Tran said. Knowing the facts about weight, nutrition and exercise can help you reason with someone about any myths fueling their habits, according to the National Eating Disorders Association.

Here are some common signs that can indicate weight loss, body size or shape, and control of food are becoming primary concerns, according to NEDA:

Emotional and behavioral

• Frequent looking at reflection for perceived flaws
• Preoccupation with weight, food, calories, carbohydrates, fat grams and dieting
• Refusal to eat certain foods or whole categories of foods
• Discomfort eating around others
• Food rituals such as eating only a certain food or food group, excessive chewing or not letting foods touch
• Skipping meals or eating small portions
• Withdrawal from friends and activities
• Extreme mood swings

Physical

• Noticeable increases or decreases in weight
• Complaints of gastrointestinal problems, such as stomach cramps, constipation and acid reflux
• Difficulties concentrating
• Dizziness, especially when standing
• Fainting
• Feeling cold often
• Cuts and calluses on finger joints (from intentional vomiting)
• Discolored teeth, cavities or tooth loss
• Dry skin and hair, and brittle nails
• Swelling below the ears
• Fine hair on body (lanugo)
• Weakness

The National Eating Disorders Association has lists of warning signs for each eating disorder, but know that symptoms don’t always fit into a box.

2. Share your concerns

If you want to confront your loved one about the signs you’ve noticed, rehearsing what you want to say can help alleviate some of your nervousness, according to NEDA.

Schedule a time to talk in a private setting. Instead of asking if someone has an eating disorder, making accusations or giving opinions, use factual “I” statements about what you have noticed.

That could mean saying, “‘Hey, I noticed that you’re fixated or that you’re talking more about dieting,'” Tran said. “Or ‘I noticed that you’re uncomfortable eating in front of people. Please know that I’m here to offer that support should you ever need it.'”

Bringing up someone’s weight or appearance is rarely appropriate or helpful, Tran and Hendelman said. And don’t give simplistic advice such as “just eat” or “just stop eating,” NEDA suggests.

“It’s like going to somebody with an addiction for a substance or somebody who’s a smoker and saying, ‘Just quit,'” Tran explained. “It’s not that simple of a process, and oftentimes you will experience backlash when you make comments like that.”

Be prepared for defensive reactions to your educated advice, too. Some people might get angry if your awareness threatens their chances of getting what they want from their eating disorder. If this happens, repeat your concerns, but don’t force it — say you care and leave the door open for conversation, NEDA says.

3. Encourage them to seek help

People with eating disorders need professional help to heal. If they don’t have a physician or therapist but are ready to recover, you can offer to help find one or attend appointments with them.

Getting effective treatment as soon as possible dramatically increases a person’s chances for recovery, NEDA says.

Here are some resources:

• National Eating Disorders Association: People in the US can use NEDA’s helpline.
• National Alliance for Eating Disorders: Use the search tool for US treatment centers or specialists.
• Mind: This mental health organization lists resources in the UK.
• Eating Disorder Hope: This organization has information on international resources.

Don’t simply believe your loved one will see a professional — ensure the person follows through.

4. Remind them why they want to get well

Whether your loved one wants to travel, make friends, have children or pursue a career, they might have goals that have been thwarted by an eating disorder.

Reminding the person of that future can help with focus on long-term recovery, rather than the short-term perceived benefits of the disordered behavior, NEDA says. Help them reconnect with their values and who they want to be.

5. Avoid body and food judgment

You should also avoid saying things that can be triggering — such as comments like “Wow, you’re getting two brownies?” or “I feel so fat right now.”

“Somebody with an eating disorder is in competition with everybody else’s body,” Hendelman said. “The voice in somebody’s eating disordered brain is, ‘You can’t compete with this person, you’ve got a bigger body, you’re bad, you should be on the diet that this person is on.'”

6. Maintain a multifaceted relationship

If all you talk about with your loved one is the eating disorder, that person might push you away, Hendelman warned.

Generally, an eating disorder is just the tip of the iceberg in terms of what’s going on with the person — underneath could be problems such as depression, anxiety, trauma or insecurities.

“Understand that that loved one is in pain,” Hendelman said. “The food and eating is the way that they are numbing the pain, tolerating anxiety or getting through the day.”

Sometimes just doing fun, relaxing activities together can do two things: alleviate whatever the person’s experiencing, and show you’re there but not smothering.

Overall, supporting someone with an eating disorder requires patience, education, understanding, compassion and gentleness. But be firm, and “don’t wait until the situation is so severe that your friend’s life is in danger,” NEDA says.

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