How to support someone with an eating disorder

Eating disorders are serious illnesses that can have life-changing and even life-threatening health consequences. Nearly 1 in 10 Americans will have an eating disorder at some point in their lifetime. Support from loved ones can help them survive and overcome these dangerous conditions. If you're searching for answers on how to support someone with an eating disorder, here are a few ways you can help.

What is an eating disorder?

Eating disorders are mental health conditions that can cause preoccupation with food, body weight and/or appearance, leading to behaviors, thoughts and feelings about food and eating that threaten overall health. There are several kinds of eating disorders, including:

• Anorexia nervosa – Individuals with this illness severely restrict their food intake. Anorexia is a very serious health condition, associated with extreme weight loss in many cases, as well as a higher risk of death than any other mental health condition, including depression.
• Bulimia nervosa – People with bulimia use various tactics — including vomiting or taking laxatives (known as purging), or excessively exercising — to ‘get rid of’ or burn off calories. People with this illness have at least some episodes of binge eating (eating large quantities of food at one time) before engaging in purging behavior. Purging may also occur after eating small meals or snacks.
• Binge-eating disorder – This is the most common eating disorder. People with this condition eat large amounts of food in a short period of time, often alone or in secret because of shame, guilt and distress they feel about their eating. Binge-eating disorder involves bingeing without purging.

Many factors can contribute to whether a person develops an eating disorder. These include family history, ingrained eating behaviors (such as past dieting or restricted access to food), other mental health conditions (such as anxiety, depression or obsessive-compulsive disorder), stress and societal pressures.

Anyone can develop an eating disorder — regardless of age, gender, racial/ethnic background or body weight. While anorexia and bulimia are more common in women and girls (although they may still occur in men), binge-eating disorder affects almost as many men as women.

Treatment and support

If you're wondering how to support someone with an eating disorder, Dr. Gary Litovitz has guidance that can help. Dr. Litovitz is chief medical officer at Dominion Hospital and medical director of Reflections Eating Disorder Treatment Center at Dominion Hospital in Falls Church, Virginia – part of our larger HCA Healthcare network. Here, Dr. Litovitz offers suggestions for how friends and family can encourage someone on the path to recovery.

Encourage positive self-esteem and coping mechanisms

First, Dr. Litovitz says, focus on building positive self-esteem and a sense of self that is not based on appearance or becoming thin. “You want to avoid focusing on body weight or shape or thinness as a sign of success,” he explains. This is even true for those at a heavier weight than is healthy for them. “Don't talk about weight loss but about eating a healthy variety of foods within a context of health and proper nutrition."

Rather than thinking and talking about foods as good or bad, emphasize balance and moderation in food choices. This fosters trust and encourages the development of healthy habits.

Family members and friends should not praise weight loss, which can sometimes lead to or exacerbate eating disorders. Our society tends to glamorize weight loss and thinness, Dr. Litovitz says.

“People sometimes think of having an eating disorder as some kind of badge of honor,” he explains. “They don't realize the price paid or true impact on health and life goals.” He encourages people to share accurate information about how eating disorders like anorexia nervosa affect overall health and even risk of death.

Eating disorders can emerge in response to stressful or high-pressure situations, Dr. Litovitz adds. Encouraging healthy coping mechanisms can help prevent and treat eating disorders. For example, he encourages loved ones to normalize seeking help in difficult situations. This could include talking to a school counselor or mental health professional.

If someone says they want to handle their eating disorder or other mental health issues on their own, it's often a sign of stigma against or fear of mental health treatment, Dr. Litovitz says. Asking for help or seeking mental health care is “nothing to be ashamed of,” he adds. In fact, reaching out for help in times of stress is a sign of resilience and healthy coping strategies.

Know the signs

Loved ones should be aware of the signs of eating disorders, such as skipping meals, avoiding family meals and other social situations that involve eating, eating in secret or disappearing to the bathroom after meals. Weight loss may be another sign, but people of any weight can have an eating disorder.

If you notice any of the signs, Dr. Litovitz suggests talking to the person in a nonjudgmental way. “Expect denial," he says. “Eating disorders can be a source of shame and embarrassment.”

He explains that it's important to create a safe environment so the person feels comfortable talking about their illness. “Let them know how common eating disorders are and that you want to help address their struggles with eating and body image,” Dr. Litovitz says, urging “nonjudgmental listening that is not critical or threatening.”

Consider treatment options

Many people with eating disorders try to avoid treatment. However, the earlier someone gets into treatment, the greater their chances of recovery.

When looking at treatment options, Dr. Litovitz explains that there are multiple levels of care, including outpatient treatment, partial hospitalization, and hospital or residential programs. Treating eating disorders can be very different from other mental health conditions, so it's important for professionals to have specialized training beyond general psychiatry or psychology. Family members and partners should also expect to participate in treatment, Dr. Litovitz says.

A multidisciplinary team that includes a therapist, dietitian and physician — all with specialized eating disorder training — can best identify the approach for specific situations. Although eating disorders often occur alongside other mental health conditions — such as anxiety or depression — they should still receive care in an eating disorder clinic, Dr. Litovitz says. “Nutritional impairment can affect mental health, so it's important to treat that first,” he explains.

Treatment takes time and commitment on the part of the individual as well as family and friends, Dr. Litovitz says. It may take several tries before treatment leads to recovery. Recovery may look different for everyone — it could mean no longer engaging in disordered behavior as well as weight restoration for those whose bodies need it. However, Dr. Litovitz says, “treatment is the best path to a healthy future.”

Find information about mental health resources from our larger health network, HCA Healthcare.