Eating Disorders
Dangerous Secrets
How to help a friend with an eating disorder
Cheryl's story
Tips for reaching out to a friend in distress
Warning signs of eating disorders
Did You Know?
How to get help
When Cheryl's hair started falling out, Linda knew she had to speak up. She knew about Cheryl's “habits” for a long time,
but she had promised not to tell anyone. Finally, worried for her friend's physical and emotional health, Linda encouraged
Cheryl to seek help. When that failed, she told Cheryl's parents. Doctors confirmed what Linda had feared: Cheryl had anorexia
— an eating disorder characterized by significant weight loss from self–induced starvation.
Now — two years later — Cheryl's in recovery and grateful that her friend cared enough to reach out. “I was so angry with
Linda at first. Then I felt mostly relief,” Cheryl said. “I'd been carrying this obsession around with me for so long, it
was like a huge burden had been lifted off me. The truth is I wasn't in control. Anorexia controlled me. Linda made the right
choice, and I’m glad she did.”
Why are we afraid to speak up when someone we care about seems obsessed with dieting, weight or body image? For some of us,
it’s a matter of shared obsessions — people seek out others who think like they do, or maybe we don’t want to offend a friend
and lose an important relationship. It may be easier to dismiss symptoms as personality quirks, and remain detached from such
potentially scary problems. And sometimes, even though we suspect a friend has an eating disorder, we simply don’t know how
to approach them about it. What people don’t realize is that speaking up can make a big difference.
“There are so many instances when friends, family members or other concerned people are instrumental in getting someone they
care about into treatment,” said Julia Rafsky, JD, Director of the Eating Disorders Program at Belmont Center for Comprehensive
Treatment. “Many people [with eating disorders] are so ashamed of the problem that they can’t come forward on their own. Getting
feedback and information from people who care about them can help them seek the treatment they need.”
And the best chance for recovery for people with eating disorders such as anorexia is getting professional help that includes
coordinated care from nutritionists, medical doctors and counselors or psychiatrists. Behavioral health experts specializing
in treating eating disorders offer these tips for reaching out to a friend in distress:
Speak up. In a loving, honest and respectful way, talk with your friend. Share your concerns privately, in a place free from distractions,
and without others present. Some behavioral health professionals suggest using the “IMAD” approach, focusing your discussion
on the inefficiency, misery, alienation and disturbance that an eating disorder causes in your friend’s life. Inefficiency
means suffering from physical or psychological lapses in strength, energy and concentration. When talking of misery, consider
whether your friend is angry, depressed, anxious, obsessed or sad. Is your friend’s fixation on weight, exercise and body
image alienating him or her from family and friends? And finally, is your friend doing things that are frightening, upsetting
or disturbing?
Focus on results. Don't make remarks about appearance, weight, food or calories. Keep your discussion centered around the results of your friend’s
eating disorder. Use “I” statements such as “I’ve noticed you seem unhappy (tired, angry, lonely) lately. … I feel we’re not
as close. … I’m worried about you. … I want you to be healthy and happy with yourself.” Avoid using “you” statements, such
as ”You just need to learn how to eat. … You look terrible. … You’re hurting yourself and the people who love you.”
Encourage. When you talk to your friend, explain how your friend’s behaviors have made you concerned. Suggest that your friend seek
help from a doctor, therapist, or nutritionist as soon as possible. You may even offer to go with your friend. “Going with
a loved one to an initial appointment is a great way to support them in getting help,” said Dr. Rafsky.
Tell someone. If you’re still concerned for your friend’s safety and health after discussing your concerns with your friend, talk to a
trusted adult or medical professional. Don’t wait until the problem becomes so severe that your friend’s life is in danger
and don’t try to solve your friend's problems on your own. Consider telling your friend’s parents, a teacher or another person
who can provide support and intervention.
Avoid power struggles. Don't try to force a change in eating habits. Don't bargain. And don’t allow yourself to be manipulated or dominated. If
your friend denies there’s a problem, state your feelings and the concerns behind them again and offer to listen.
Take care of yourself. While offering support is important, it may not always have the desired impact. Your friend may not seek help or change her
behavior, despite your expression of concern. So, don’t blame yourself. And be sure to secure support for yourself when you
need it. “Ultimately, people are responsible for their own recovery and no one else can do it for them,” Dr. Rafsky explained.
Read about it. Your friend’s issues aren’t truly about weight and food — these are merely symptoms of underlying problems. Learn about eating
disorders and get the facts about weight, nutrition and exercise. The more you understand about these issues, the better situated
you'll be to help a friend in need.
The bottom line is this: while saying something can cost you a friendship, doing nothing may cost you a friend. “Friend and
families need to realize that people with eating disorders feel out of control and overwhelmed. It can be a big relief to
have someone else notice how much they’re suffering and take a leadership role in intervening,” Dr. Lensky explained.
Cheryl and Linda are still dear friends. “I was so afraid of Cheryl dying or harming herself physically that it blocked out
whatever fear I had of her being angry with me,” Linda says. “I’m just so glad Cheryl’s well and still part of my life.”
Warning Signs
Learn some of the warning signs of an eating disorder. If someone close to you exhibits any of these behaviors, he or she
may be struggling with an eating disorder.
- Recently gained or lost a lot of weight
- Avoids eating meals or snacks when you are together
- Categorizes foods into “good foods” and “bad foods”
- Calculates the number of fat grams and calories in each bite
- Talks or worries about body size or shape
- Weighs self constantly
- Exercises because they “have to,” not because they want to
Did You Know?
The National Eating Disorders Association ( www.nationaleatingdisorders.org) offers these sobering statistics:
- Conservative estimates indicate that some five to 10 million American women and girls, and 1 million boys and men struggle
with eating disorders including anorexia, bulimia, binge eating disorder or borderline conditions. That's triple the number
of people living with AIDS in the United States.
- Almost half of American elementary school kids between first and third grades want to be thinner.
- Four out of five fifth graders are afraid of being fat.
- Americans spend more than $40 billion each year on dieting and diet products.
Call for Help
For more information about treatment for eating disorders, call Belmont Behavioral Health at 215-877-2000.
