Food For Thought (part 2): Supporting someone who is struggling with an eating disorder

It can be really difficult seeing a loved one struggle with an eating disorder, and/or disordered eating/exercise patterns, and it’s often very tough to fathom how to help in the best way possible both for compassionate and accountable support. You are not alone– we are here to help provide generalized psychoeducation that can be helpful for families and support people of those struggling with an eating disorder (ED).

First and foremost, it is recommended to have a multidisciplinary “treatment team” since eating disorders can severely impact mental/emotional, physical/medical, and nutritional functioning. These 3 professional support systems to have on board should all specialize in eating disorder treatment and the recovery process thereof: 1) mental health support with a licensed therapist, 2) registered dietitian/nutritionist, and 3) primary care physician/doctor. Not all professionals in these areas have specific training or knowledge of the eating disorder treatment/recovery process, so it is important to ask them about their training/experience with eating disorder work due to the high potential for them to inadvertently cause more harm in the recovery process without proper experience/training. A helpful tip to ask them about is if they are HAES informed providers– HAES stands for Health At Every Size, which is a philosophy that many eating disorder treatment providers utilize, and can be a helpful resource for you to understand as a support person too if desired.

Below are some encouragements to ponder. Ask your person what they need to see how you can be the best support person you can be. Not all people relate to every bullet point listed below, but it can be very helpful to have an open dialogue around what they themselves need from you. Discussion around this might be difficult for some people, but you being receptive and open can assist with this process.

● Having your own positive and flexible relationship with food that does not “moralize” food. For example: not talking about things that are “good” or “bad” for you since all foods are good and have nutritional value; and not engaging in only eating (or talking about) diet/health foods such as low-carb substitutes, Weight Watchers, and Keto diet, as these all have restrictive tendencies that cause disordered eating patterns.

● Not talking about numbers, such as weight, calories, clothing sizes, etc as much as possible as this can cause fixation, anxiety, comparison, depression, etc.

● Not commenting on bodies (yours, others, etc) such as size, shape, weight restoration/weight gain as much as possible as this too can cause fixation, anxiety, comparison, depression, etc. Sometimes even compliments on bodies can reinforce the eating disorder, such as hearing “you look great, have you lost weight” places value on their appearance and thus fuels the idea that “by restricting/over exercising/etc, I am getting the results I want” even if it is maladaptive and unhealthy. Example: rather than saying “you look good today” maybe instead saying something like “you seem happy today.”

● Trying to not act as a “professional” but be yourself as a partner/parent/friend/etc. For example, refer them back to their professional team if needed rather than trying to give advice that might be harmful (such as do not recommend diet changes or exercise as home remedies for depression, anxiety, etc as these are discouraged since they can lead to relapse and can be very dismissive of the matters actual at hand)

● Being mindful about discussion of exercise/fitbits/etc as some eating disorders tend to use exercise as a form of compensation to alter the body which is very unhealthy and gives into the distorted body image disturbance that fuels the eating disorder.

● Asking open questions of “how can I support you right now” if you happen to notice potential struggle (not assuming there is struggle, yet offering assistance if there is seeming to be a need)

● Not making judgemental comments/remarks/facial expressions regarding what/how much they are eating as they are likely already struggling internally with this. They need support from you, and comments such as “just eat the food” can feel dismissive especially since there is more to it than “not eating.”

● Recognizing there is underlying difficulties that the eating disorder co-exists with such as depression, trauma, anxiety, suicidal ideation, etc to be mindful and aware of. Mental health struggles may not be visible at times, but they still exist and are very real and can impede on everyday functioning.

● There can sometimes be difficult feelings that arise with letting go of the eating disorder that has served as a maladaptive form of coping for a long time as they replace the eating disorder with healthy forms of coping. Continuing to encourage healthy coping, though not being dismissive of potential feelings that may arise. Maladaptive and unhealthy ED behaviors to be aware of can include but are not limited to: restricting food intake, binge eating which is consuming large amount of food in short amount of time, binge-restrict cycles, purging with self-induced vomiting or use of laxatives, cutting out food groups/rigid food rules, not completing what’s plated, cutting food into small bites, excessive exercise, caffeine use and/or water loading which is drinking excessive amounts of water or caffeine that both suppress appetite, hiding/throwing away/giving away/hoarding food, counting calories, eating in isolation. 

● Understanding underlying negative “inner critic” thoughts that lead to ED behaviors, and referring them to coping and challenging skills to use from what they have learned in therapy/treatment

● Check in with yourself to make sure you aren’t accidentally projecting your own feelings onto them, such as fear, anger, disgust, etc.

● Using “curious questions” rather than “finger pointing questions,” such as instead of saying “Why aren’t you eating your food/following your meal plan?” (as this can come across as attacking and can lead to defensiveness) and instead reframing it to something like, “Hey I’m curious if there is anything that might help you out right now with finishing your meal—shall we take our bites together, or practice some mindfulness?” Asking open questions can help them communicate what they need out of their own volition rather than feeling like someone is trying to be “food police” or “fixing them”, and offering some helpful ideas might be beneficial for them to choose from.

These are just a few tips to get you started on how you can be the best support person you can be for your loved one. This is just a start– it’s not every answer in the book. There’s always more to learn and it takes time, and that’s okay. I encourage you to give yourself credit that even taking this step in reading through this blog is a step in the right direction. Both you and your loved one are capable of healing in this journey :)