by McKenna Ganz (she/her), EDF Program Administrator
When people reach out to The Eating Disorder Foundation, they usually start with me, whether it’s by phone, by e-mail, or at our office here in Denver. They come in looking for support for themselves in a period of personal crisis, or out of concern for a loved one, and often don’t even know where to start.
As a loved one of someone who is struggling, you may be wondering how to talk to your friend or family member. As someone struggling, you may be looking for ways to get support outside of your treatment team or trying to help your family understand how to support you.
One of my ways of looking at this is to understand the nature of the eating disorder. It’s not just about food – eating disorders thrive in Shame, Silence, and Isolation. Confronting these three elements gives us simple ways to give or receive support in non-clinical settings, such as among friends, family members, or community programs.
Shame
Shame can manifest in many ways when someone struggles with an eating disorder.
Overall, our society is very shame-oriented when it comes to food and bodies. Messages we receive from social media, family members, and even the grocery store constantly bombard us with shame about what and how we eat, or about the size and shape of our bodies.
Weight stigma poses a significant threat to psychological and physical health. It has been documented as a significant risk factor for depression, low self-esteem, and body dissatisfaction. Avoid “fat talk” around your loved one who is in recovery. In fact, body shape or size should generally not be considered acceptable topics of conversation at all.
If you or your loved one participate in high-risk vocations – activities or careers that emphasize size as a predictor of success, such as wrestling, ice skating, the military, etc. – you may need to keep an extra eye out for shaming language.
Acknowledge differences and diversity in body types, shapes, and sizes without judgment. Avoid derogatory terms for specific body parts. Never encourage someone struggling or in recovery from an eating disorder to attempt to change their body size.
Diet culture manifests very quietly through everyday social and cultural pressure – it’s amazing how many shaming comments and conversations occur around the dinner table.
Avoid assigning moral value to food choices, demonizing certain food groups, or making comments on what someone else is eating. There is no “good” vs “bad” or “clean” vs “junk” when it comes to food. Avoid referencing health, nutrition, or fitness behaviors that may not be evidence-based, such as trendy diets and fitness routines. Avoid shaming “picky eating” – an individual’s “safe foods” may be their best way of nourishing early in the recovery process; for neurodivergent individuals with avoidant and restrictive eating patterns, forcing them to eat foods that are uncomfortable for them outside a professional-led setting can even cause harm. You can, of course, encourage exploration, flexibility, and diversity in your loved one’s diet – but don’t shame them for what they are comfortable with. Avoiding food shaming can be especially important when someone is in weight restoration, following a clinician-led food plan, or exploring strategies like intuitive eating. In recovery, we have to let go of the rigid food rules and nourish ourselves with positive strategies that work differently for each of us.
Use caution when scrolling. Just 30 minutes on social media may expose individuals to harmful trends such as photoshop, filters & facetune, “what I eat in the day” videos, “before and after” pictures, “follow my fitness routine for X results,” influencers sharing false nutrition and fitness advice, advertisements and sponsorship of “weight loss” injections, supplements or vitamins, and more. You have the power to filter media messages that you receive. Filter out trigger words, customize your ad settings, block harmful accounts, and follow body positive content. Teens who reduced their social media use by 50% for just a few weeks saw significant improvement in how they felt about both their body image (Thai et al., 2023).
Weight is not the only marker of health. It is not the conclusive measure of a person’s well being, their life, or their worth. Having ‘excess’ weight is not a moral failing. Having a mental or physical illness is not a moral failing either.
Understand that health, wellness and fitness are defined differently and look differently for everyone. Make it clear that some health information may not be appropriate for everyone, and that wellness looks different for each individual.
Individuals may also experience shame around eating disorders and mental health in general. Eating disorders affect millions of people worldwide, yet the stigma surrounding them often leads to feelings of deep shame and isolation. You may hear things like “I’m just weird with food.” Shame can prevent individuals from seeking help and can exacerbate the struggles they face. Assure your loved ones that dealing with mental health challenges is not uncommon or abnormal, and that these are just as important to address as physical illness. Reassure them that having an eating disorder is not embarrassing or unworthy.
Eating disorders are often misunderstood by those outside the affected community. Many view them as a choice or a sign of weakness, rather than as complex mental health conditions. This is why telling someone to “just eat” is unhelpful – it’s not just about the food, and the patterns of an eating disorder can be so deeply ingrained that it requires a great deal of hard work and professional help to change the disordered behavior. Never accuse someone struggling with an eating disorder of being vain or attention-seeking. Never make them feel guilty for being “unable to control themselves” or “lacking willpower.” Never shame someone for slipping in their eating disorder behaviors or for taking “too long” to recover. Individuals may relapse or need to go back to treatment – encourage them to seek the resources they need and reassure them that they have not “failed” in recovery.
An important thing to remember is that eating disorders are what is called a “maladaptive coping mechanism” – they often develop to soothe powerful emotions or to cope with trauma, gender dysphoria, life transitions, and more. Because the disorder serves a purpose, the brain seeks to protect itself and hold on to ingrained patterns. Recovery is a difficult process that can leave people feeling vulnerable or unsteady, and it can take time. Be patient and compassionate, with yourself or with others.
Because of weight stigma and diet culture, and because of stereotypes and even idolization of some eating disorders, people with eating disorders such as binge eating disorder or EDNOS/OSFED can feel shame for having the “wrong” eating disorder. They may also feel profound distress, shame, and guilt around certain behaviors such as bingeing. Avoid treating certain disordered behaviors as “worse” than others. Eating disorders can manifest in many different ways, and may also shift over time, but all are potentially life-threatening illnesses deserving of treatment and support.
You would be AMAZED at how often I hear folks tell me they didn’t think they were “sick enough” to get help. A local doctor heard that phrase so often she wrote a book titled “Sick Enough.” People may express this feeling if they experience their eating disorder differently from the stereotype often shown in media. Did you know that only 6% of those struggling with eating disorders are underweight (Flament et al., 2015)? Avoid referencing your loved one’s weight as the primary reason for your concern about eating disorders; conversely, you should also avoid assumptions that someone is “fine” or not valid in their struggle based on their body size. You cannot tell if someone is struggling based on their weight or appearance.
Disordered eating and body image also exist on a spectrum; someone may not receive a clinical diagnosis but may still need support. If food or body image causes distress or impacts one’s life, we consider that a good reason to seek out support. I want to stress that there is NO threshold at which someone is worthy of seeking out help.
Lastly, here at EDF, we often notice patterns among our community members. Often, people who struggle with eating disorders tend to be perfectionists, rejection-sensitive, or people pleasers, and experience cycles of self-blame where they feel like they are falling short. Notice when your expectations for yourself are unrealistic or harsh, and set boundaries on how far you are willing to go to be “perfect” when it harms your well-being. Notice when the hesitation to get help stems from a fear of burdening others. Offer your loved one validation and recognition for their positive traits other than appearance, their skills and passions, and for the value they bring to you and others.
Silence
Let’s talk! Eating disorders can be exacerbated by the shaming ways we talk about food, bodies, and mental health – but also by what we DON’T say.
Many people simply don’t know about eating disorders, how to recognize them, or how to get help. As many as 22% of worldwide youth experience disordered eating, but we simply don’t talk about it in our families, at our schools, or in our media (López-Gil et al., 2023). Increasing awareness about eating disorders can help dispel myths and reduce stigma. Consider encouraging your loved one’s school or employer to host presentations or resource fairs. Education can foster empathy and understanding, allowing those affected to feel less alone and more validated in their experiences. If you have a loved one with an eating disorder, it’s especially important to educate yourself. You don’t know what you don’t know! Reading books (see recommendations), watching workshops, and attending support groups can help you understand what your loved one is going through and avoid misperceptions of what they need from us.
When we do talk about eating disorders, it can sometimes be influenced by stereotypes and false assumptions about who can have eating disorders. For those of us in certain demographics, we may not talk enough about the prevalence of eating disorders in our communities. Despite stereotypes, the truth is that minority groups are equally – and sometimes more – at risk, but simply do not have access to care, whether due to lack of visibility, increased stigma, or because of prohibitive costs and limited access to treatment. Unfortunately, BIPOC are significantly less likely to have been asked by a doctor about eating disorder symptoms (Acle et al., 2021).
Reading or sharing recovery stories can be helpful. For example, a recent study showed that Taylor Swift’s openness about her own body image and disordered eating struggles positively influenced fans’ attitudes and behaviors around eating and body image. Be open that many people experience disordered eating, body image, and mental health struggles – and also that recovery is possible.
It’s not just eating disorders that we’re too silent about. We don’t talk about mental health in general and need to encourage more openness about how we’re doing and when we need help. If we can share “you know, I struggled today,” the people around us may be more comfortable letting us know when they need our support. Open dialogues about mental health, self-esteem, and more can create more supportive environments for everyone. Try not to be dismissive of someone’s feelings or tell them ‘it’s not so bad’ – be open and listen when they tell you how they’re feeling.
If you are thinking about talking to your loved one for the first time about your concerns, I know that it can be really scary! Talking about struggles with food and body image for the first time can be the most difficult part, for them and for you. Be a trusting person to host this conversation. Understand that the person may not yet want to get well and takes comfort in control and feels safe in the rituals of the disorder. Many people are afraid to bring up this topic because they fear their loved one will not react well. They may become defensive, angry, or deny that anything is wrong. It’s possible – and it’s also okay. Your role as a non-clinical support person isn’t to fix things. Your job is to let your loved one know that you care about them, you are there for them, and you are ready to listen without shame or judgment.
What can make this even scarier for many families is the high risk of suicide among individuals with eating disorders. If you see warning signs, two of the first steps in evidence-based suicide prevention are ASK and BE THERE. “Are you thinking about suicide?” It’s not an easy question to ask, but it can help start a conversation. Studies show that asking people if they are suicidal does not increase suicidal behavior or thoughts. Listening without judgment is key to learning what the person is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce suicidal thoughts (National Institute of Mental Health, 2024).
Isolation
While these disorders impact individuals in various ways, one common thread is the sense of loneliness that can accompany them. This is one of the many reasons why eating disorders saw such a spike during the COVID-19 pandemic.
Did you know that over 14% of Colorado high school students don’t feel that they have anyone to talk to about their mental health (Healthy Kids Colorado Survey, 2023)? It’s important for everyone – not just those struggling with eating disorders – to build a robust support system. A support system can include friends, parents, siblings, neighbors, teachers, chat rooms, support groups, gaming groups, sports teams, coaches, mentors, sponsors, therapists, doctors, and more. Be creative – there are people in your life who care about you and want to help.
Eating disorders often thrive in secrecy. Many individuals hide their eating disorders due to fear of judgment or misunderstanding. This secrecy can lead to profound feelings of isolation. Individuals may feel compelled to hide their behaviors and struggles, leading to self-imposed isolation. You may notice an individual pulling out of their usual social activities, shared meals, events, special occasions, or hobbies. On an everyday basis, you may notice them eating secretly or in private. When approaching this type of isolation, it’s important not to push or pressure someone to change their habits, or to shame them. It’s also important to not make it all about the food. Don’t force someone to eat in front of you; rather, invite them to spend time with you, to join you for activities they enjoy, and to feel noticed and appreciated.
When someone feels they cannot share their struggles, shame can grow unchecked, reinforcing the belief that they are alone in their fight. Many of our community members report needing a sense of community of those who “get it.” Don’t be offended if your loved one doesn’t think you understand what they’re going through. Instead, help them find peers who do, such as support groups, mentors, memoirs and recovery stories, professionals who are themselves in recovery, and more. EDF is a great place to send folks for this – our in-person and virtual groups and mentorship program have demonstrated considerable impact on individuals working toward recovery, maintaining their personal mental health, and building an ongoing community that is vital to healing.
Once you’ve given your loved one space to talk about what’s going on and listened nonjudgmentally, the next steps in frameworks like Mental Health First Aid include “give reassurance and information,” “encourage appropriate professional help,” and “encourage self-help and other support strategies.” You are an important part of your loved one’s support system, but it’s important to recognize how far you can help and where other resources are more appropriate.
If you’re having trouble helping someone reach out to other resources, listen to them to find out what barriers there are to accessing clinical care. If you yourself are struggling to move forward in the next step in your recovery, try writing down a list of concrete things your loved one can do to help.
Are they having trouble navigating their insurance? Sit down with them as they talk to their insurance company and take notes for them. Are they unsure what level of clinical support they even need? Project Heal’s Clinical Assessment program is a good place to start, or you can see if your local treatment center offers free phone assessments. Are they nervous to make that first phone call? Schedule a time to sit down with them while they make that call. Are they overwhelmed finding a therapist? Write down a list with websites and phone numbers ready to go. Are they putting off their first support group? Pull up the sign-up form on a computer and have it ready for them. It’s important to remember that you should only be there as a support for the person in recovery to take the concrete steps toward getting help – don’t just do it for them.
When encouraging someone to get further help, such as a treatment program, emphasize the seriousness of the topic but maintain a hopeful tone. Eating disorders are serious issues and recovery can be difficult, but it is possible if the individual gets the appropriate support.
As a caregiver or support person, make sure you aren’t doing this in isolation either. Supporting someone struggling with an eating disorder is hard and can bring up a lot for you emotionally, including your own body image or food concerns. You can get support for yourself, such as a support group or mentor.
And, if you find yourself really struggling to find answers beyond this “Shame, Silence, Isolation” framework, that may be a clue that it’s a question for more specialized & professional services, like a dietitian, therapist, or treatment program for your loved one. It’s important to have support systems in place to help people on their journeys to recovery, but you can’t expect yourself to know all the answers or “fix” your loved one.
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I’m sure there is PLENTY I’ve left out here, but hopefully I’ve left you with a good system of identifying simple areas for support. By remembering these three key components of eating disorders, we have a simple, easy framework for non-clinical support. If you’re feeling lost or unsure about the next steps, you can think of ways to confront just one of these in your life or your loved one’s life.
References
Acle, A., Cook, B. J., Siegfried, N., & Beasley, T. (2021). Cultural Considerations in the Treatment of Eating Disorders among Racial/Ethnic Minorities: A Systematic Review. Journal of Cross-Cultural Psychology, 52(5), 468–488. https://doi.org/10.1177/00220221211017664
Flament, M. F., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H. N. T., Birmingham, M., & Goldfield, G. (2015). Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 403-411.e2. https://doi.org/10.1016/j.jaac.2015.01.020
Healthy Kids Colorado Survey. (2023). Healthy Kids Colorado Survey Dashboard | Department of Public Health & Environment. Cdphe.colorado.gov. https://cdphe.colorado.gov/healthy-kids-colorado-survey-dashboard
López-Gil, J. F., García-Hermoso, A., Smith, L., Firth, J., Trott, M., Mesas, A. E., Jiménez-López, E., Gutiérrez-Espinoza, H., Tárraga-López, P. J., & Victoria-Montesinos, D. (2023). Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics, 177(4). https://doi.org/10.1001/jamapediatrics.2022.5848
National Institute of Mental Health. (2024). 5 Action Steps to Help Someone Having Thoughts of Suicide. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/publications/5-action-steps-to-help-someone-having-thoughts-of-suicide#:~:text=Studies%20show%20that%20asking%20people
Thai, H., Davis, C. G., Mahboob, W., Perry, S., Adams, A., & Goldfield, G. S. (2023). Reducing Social Media Use Improves Appearance and Weight Esteem in Youth With Emotional Distress. Apa.org. https://www.apa.org/pubs/journals/releases/ppm-ppm0000460.pdf
