How to help someone with an eating disorder

It is estimated that over 28.8 million US adults will live with an eating disorder at some point in their lives. A person with an eating disorder may experience various symptoms, depending on their diagnosis and the types of eating behaviors or rituals they partake in. 

Although stigma and misunderstanding often occur when the discussion of eating disorders arises, disordered eating is not uncommon nor limited to one type of person. Instead, there are numerous types of eating disorders and numerous presentations. These conditions can also impact children and adolescents, with 5% of all teenage girls meeting the criteria for an eating disorder in the US.

What do eating disorders look like? 

There are many stereotypes and misconceptions about what an eating disorder can look like. However, no one body, gender, or identity represents what eating disorders look like. People of all genders can experience disordered eating, regardless of age, profession, or body size. 

Recognizing that eating disorders can affect people of all ages and backgrounds can be vital to treating and understanding these challenges. In addition, it can be valuable to recognize that eating disorders are mental illnesses, not the result of "laziness," difficulty working, or a desire to make personal changes. 

What are the symptoms of common eating disorders? 

Eating disorders are mental health conditions revolving around unhealthy eating habits and patterns. Although the two most commonly referenced eating disorders are bulimia nervosa and anorexia nervosa, there are other forms of eating disorders, as well. 

General signs of an eating disorder to look out for can include the following. Note that these signs are not exhaustive and may not occur for every eating disorder. Each eating disorder has different symptoms, patterns, and causes, so research these conditions further before assuming what a person might be experiencing. 

Dressing in layers 

Attempting to hide weight of any number through clothing can demonstrate a potential mental health concern. People with eating disorders often view their bodies critically and may feel uncomfortable or unsafe if the shape of their bodies is visible through their clothes. Dressing in layers may mitigate this fear or comments from others. 

Fixation on weight or food

Individuals with eating disorders often fixate on eating habits, exercise regimens, and weight. They may devote significant amounts of time toward the pursuit of ideal weight or physique, potentially tracking what they eat, the calories they eat, and their weight. 

Difficulty eating with others 

Individuals with eating disorders might feel shame or embarrassment when eating and may try to avoid eating in the presence of others. They might also do this to avoid showing others their food behaviors, such as binging, purging, or restricting. 

Food-based rituals and routines 

Some people with eating disorders feel better if they feel they are in control of their eating habits. This feeling may lead to the development of rituals or routines surrounding food, such as not allowing food items to touch, chewing in excess, eating certain food groups, or rigidly eating at specific times.

Withdrawal from others 

Individuals with eating disorders might also demonstrate declining mental health by pulling away from family and friends, increasing secretive behavior, and showcasing disinterest in enjoyable activities. These behaviors might be due to a decrease in energy. 

Sleep disturbances 

People with eating disorders may show symptoms of sleep disturbances. These disturbances can vary from an increased desire and need for sleep to an inability to get to sleep or stay asleep.

Weight fluctuations

Although weight loss can be a symptom of some eating disorders, weight gain can also occur. In those with restrictive behaviors, insufficient nutrients can cause the body's systems to struggle. They may experience an inflammatory response, which can cause bloating and swelling. 

Dull, waxy, or pale skin 

Skin can indicate difficulties with mental health. People with eating disorders might present with skin that is waxy, pale, or dull in appearance. This coloring might occur due to a lack of nutrients, exhaustion, or hormonal imbalances.

How to support someone with an eating disorder 

Although you may not be able to help someone "stop" the habits related to their eating disorder, these individuals may benefit from the help, love, and support of the people closest to them. 

Many family members and friends might feel uncertain about where to start when trying to help their loved one with an eating disorder. They may fear making the problem worse or supporting the person in a way that doesn't suit them. If you relate, below are a few guidelines to follow. 

Encourage them to seek professional support 

Family members and friends are not qualified to provide the same aid as mental health professionals. Still, they may be instrumental in helping people with eating disorders seek support. 

National statistics suggest people may be unaware of the scope of their disordered eating (anosognosia), and a family member's insistence might reveal the gravity of the condition to them. Although you cannot force someone to reach out for help, consider offering them a list of local resources and insist you offer support in setting them up with a professional if you can. 

Avoid weight as a conversational topic 

People might comment on their loved ones' bodies and weight from time to time as a form of "small talk." However, focusing on the weight of an individual with an eating disorder often causes harm. Instead of commenting on their weight, body, or health, consider asking them, "How are you feeling?" or complimenting a non-bodily aspect of them, such as their clothing choices, hair, or makeup. 

Offer to help them with meals 

People with eating disorders may experience shame, frustration, and fear surrounding mealtimes. It may be difficult to start eating meals with other people. Instead, having someone cook or prepare meals can ease the pressure. If an individual is living with avoidant and restrictive food intake disorder (ARFID), forgetting meals and struggling to value food are significant symptoms. If you know someone with ARFID, ask them how you can help them add more structure to their eating habits. 

Offer acts of service 

People with eating disorders might struggle to complete responsibilities during treatment and may appreciate support in cleaning their home, paying bills, or caring for their pets. Ask how you can help while they reach out for support and recover. 

Educate yourself on eating disorders 

Learning as much as possible about eating disorders may be an effective way to support loved ones. Actively trying to learn can demonstrate concern and a willingness to understand what someone might be struggling with. If it helps, you can ask the individual to let you know their input on the resources you're looking at to see if it aligns with their feelings. 

Have an intervention 

When someone you love is struggling with an eating disorder, it may be beneficial to lead an intervention to discuss your concerns with them. It may be more effective if you don't stage an intervention like in TV shows and movies. Instead of a formal event with everyone the person loves sitting around them, consider going up to the person individually and explaining why you are concerned while offering resources and emotional support. Try to schedule this conversation with them when they are available and emotionally well. 

You might also consider a professionally led intervention if you're struggling to get through to the individual about your concerns. In these cases, you might consider signing up for family therapy with the individual's consent. You can then attend therapy and discuss your concerns professionally with a neutral mediator. Therapists may be valuable because they are trained to remain impartial, patient, and empathetic. If the person with an eating disorder feels attacked or judged, the therapist can help them explore these feelings in a safe environment.

Counseling options for eating disorders 

Often, people with symptoms of an eating disorder benefit from ongoing support from a mental health professional. However, attending in-person therapy sessions could prove challenging due to anxiety about physical appearance or a lack of energy. 

In these cases, online therapy through a platform like BetterHelp can be effective. With internet-based counseling, individuals can meet with a mental health professional from home. This setting may also feel safer for those recovering from eating disorders, and they may be less hesitant to impart their challenges and emotions. 

The Covid-19 pandemic presented many opportunities for mental health researchers to investigate online therapy's effectiveness in treating eating disorders. One recent literature review found that internet-based counseling was a highly effective treatment method for adolescents with disordered eating. Fifteen out of 18 studies revealed a drop in symptom severity after online therapy, with results similar to in-person studies.