The signs are all there.
She’s undeniably thinner than she used to be, gaunt even, and is armed with excuses to skip out on brunch – and all the other food-centric events you once enjoyed together. He obsesses over calories and fat grams and weighs himself at least once a day.
You can’t know for sure, but it certainly seems like your friend is struggling with an eating disorder. And now, during National Eating Disorders Week, it may be time to say something. “There are such high mortality rates for individuals with eating disorders that I think it’s our responsibility,” says Cirecie West-Olatunji, president of the American Counseling Association. “It’s our moral and civil responsibility to respond to anything we see.”
In the United States, 20 million women and 10 million men will suffer from a clinically significant eating disorder at some point in their life, according to the National Eating Disorders Association. And the earlier he or she seeks treatment, the greater the likelihood of physical and emotional recovery. Here’s what to keep in mind as you broach this sensitive subject with a friend:
Don’t make a rash decision. You can’t tell just by looking at someone whether he or she has an eating disorder. It’s important to consider “what you’re judging it on, and what’s making you concerned,” says Lynn Grefe, NEDA’s president and CEO. Signs to watch for include: Avoiding friends and family; wearing baggy clothes to hide the body; displaying new or different behaviors around food; significant weight loss or gain; and maintaining a rigid exercise routine – despite weather, fatigue, illness or injury. You might also see someone purging, using laxatives or constantly talking about their weight.
Set a time. Set aside a time to talk in a private place – don’t spring your concerns on your friend when you are, for example, in a group setting. If a number of people are firing questions or accusations at someone, the situation will feel confrontational and be unproductive. Go in willing to remain patient, supportive and calm.
Do your homework. Learn as much as you can about eating disorders – there are lots of organizations, websites, hotlines and books that can help. The more you know about conditions like anorexia and bulimia, the better you’ll understand what your friend is going through and be able to help in a meaningful way. If your friend is open to it, share what you’ve learned, but don’t preach.
Tell the truth. And make sure it’s not accusatory or judgmental. “Put your hand out and say, ‘I’m a bit concerned. I’ve noticed some differences in your behavior and attitudes,'” Grefe says. “The key is making it clear that you’re there to help, not to accuse. So it’s not ‘Oh my gosh, look at all the weight you’ve lost.’ That’s the wrong approach.” Likewise, stay away from “you” statements like “you’re acting irresponsibly.” Focus on “I” sentences – “I’m concerned about you because you’re refusing to eat breakfast or lunch,” for example. That will help you avoid placing shame, blame or guilt on your friend.
Remember it’s not your job to fix him or her. Your only job is to be there. “As helpless as that makes you feel, it is no more helpless than they feel every moment they live inside this struggle,” says Emily Sandoz, author of “Living with Your Body and Other Things You Hate." “And if you aren't willing to just be there or just listen or just offer whatever help they are willing to ask for, it's probably better to hang back and show them compassion in other ways.” Speaking of which…
Know when to back away. Most people will be defensive when you confront them about an eating disorder. Many will deny any problem. Don’t push the issue. “Just say, ‘Look, I don’t know, I don’t diagnose eating disorders. But I’m here to help you,’” Grefe says. Don’t get angry, and don’t get into an argument – that approach will only backfire.
Avoid giving simple solutions. Eating disorders don’t develop overnight, and recovery doesn’t happen quickly. “Telling somebody just to eat doesn’t help,” Grefe says. “That’s not going to solve anything. Eating disorders come out of the brain – it ends up being about food, but it doesn’t start there.” Explain to your friend that, if she does have an eating disorder, it’s no one’s fault. Indeed, eating disorders arise from a variety of factors, including psychological (low self-esteem), interpersonal (troubling relationships), social (cultural pressure to be thin) and biological (genetics).
Go to an adult or medical professional. If you’re still concerned after talking to your friend about his or her health and safety, consider going to that person’s parent – or husband or wife. But don’t do so in an accusatory way, like saying, “Your daughter has an eating disorder.” Grefe suggests framing it as: “I’m concerned about Kelly, and I have reason to believe she might have an eating disorder. Here’s why. I’d be happy to help you look for resources and help.” You could also consult your doctor or, say, the school nurse or guidance counselor.
Don’t enable the situation. West-Olatunji feels strongly about the importance of tackling the issue head-on. When we don’t talk about it, she says, “we’re enabling them – we join them in their secrets.” As she describes it, we need to consider the outcome of our decisions. “We don’t want to bury someone and then feel guilty because we saw the signs, but out of social niceties, we didn’t say anything – we didn’t want to offend them or for them to be angry at us.” Perhaps losing a friendship, she says, is better than losing a friend to an eating disorder.
Do it with kindness. What would you say to a friend with breast
cancer? You’d offer to help drive her to appointments or search for the best
doctor with her or sit with her as she navigated tricky medical lingo. Do the
same with a friend who’s struggling with an eating disorder. “Offer to be a
part of the solution,” Grefe says. “Don’t be part of the problem.”