It took me a long time to realize that my best friend had an eating disorder. In the high school cafeteria, our table was always busy joking or studying, and it never even occurred to me to notice how much she was eating. Later, when we were home on break from college, I’d suggest going for a meal out. She would counter with heading to Whole Foods and picking up free samples throughout the store. I thought it was a fun game that fit into our budget as broke college students. It didn’t occur to me that the singular popcorn kernels, the blueberries, or olives on toothpicks were all she would eat that day.

It was only after a vacation we took together that I realized the extent of the situation since we were together for every meal that week. At every meal, she offered to split a dish and I ended up eating the whole thing. Was it me? Was I being a pig? I tried to match my eating habits to hers and my blood sugar plummeted. This wasn’t normal. I remember thinking: Why hadn’t I noticed this earlier?

I remember returning home and gathering our mutual friends in a coffee shop. “I think she might have an eating disorder,” I said in a hushed voice. My friends stared at me. “Obviously,” one said. “But what can we do?”

The path to supporting a friend with an eating disorder is difficult to navigate because every person, including their needs and their preferences, is unique. 

Having an eating disorder is a painful, sometimes deadly mental illness. But as I’ve learned over a decade, it also creates a radiating wave of pain through the friends and family who love that person. All those years ago, I thought maybe an intervention or confrontation could heal my friend. I was so wrong – an eating disorder is not something that can be cured by a loving friend yelling in your face, “You’re sick! Don’t you realize it! Let me help you!”. There is no simple fix, and that’s the first lesson.

The path to supporting a friend with an eating disorder is difficult to navigate because every person, including their needs and their preferences, is unique. There are some common threads to be aware of, though.

1. Realize that eating disorders aren’t about food.

Watching someone you love seemingly waste away is heart-wrenching. I remember passing my friend in a locker room once. She was turned away from me, and her back ribs jutted out as she bent over. “Oh my god,” I thought. “That poor person.” Then she turned around and I was shocked to see it was my friend.

It’s tempting to cling to an “easy” solution, like “just eat more!” But that won’t work because eating disorders are not about food. They are about control. 

The Temper spoke to Dr. Jaime Coffino, Ph.D., MPH, a clinical psychologist who researches eating disorders, and is currently a postdoctoral fellow at both the NYU Grossman School of Medicine and New York Anxiety Treatment. “People who experience a loss of control in various domains of their life (e.g., work, home, relationships, etc.) may engage in restrictive or compensatory eating behaviors as a coping strategy to deal with negative emotions,” Coffino says. “This perception of control overeating and weight can cause behaviors that spiral into the development of an eating disorder.”

This is to say that your friend might feel a lack of control in their life, and controlling their food intake or their body appearance is their way of clawing back control. There might be external stressors that trigger an eating disorder, and this probably has absolutely nothing to do with food itself.

2. Speaking out is important — but it matters how you do it.

With the perspective of control as the cause of eating disorders, you can see why telling or asking someone with an eating disorder to “please eat more” does not address the root of their issue. In fact, asking your friend to eat more will just draw more attention to the disordered behavior and place the blame on them. 

Remember: It’s not their fault. An eating disorder is a mental illness, and it is something external to your friend. The disorder is not your friend themselves. It is painful to see a loved one suffer but remember they are not making these choices willfully; they are sick.

Letting your friend know that you’ve noticed their patterns, that you’re worried about them, and that you care for them is all really important. Eating disorders can be deadly, so it is also important to speak out to keep your friend safe although you shouldn’t put the entire responsibility for their safety on your shoulders or you risk damaging your own mental health.

Speaking out is important for all those reasons but it will only be effective if you approach the conversation in a sensitive and educated way. It’s important to choose a good time to speak one-on-one and not overwhelm your friend like it’s a confrontation. Talking about your own feelings and concerns, and not focusing the conversation just on food intake, will also take some of the pressure or feelings of accusation off your friend. It has always helped me to rehearse the conversations, or write down points, before I speak to my friend.

3. Encourage your friend to seek help.

As I learned from the first time I ever approached my best friend about her eating disorder, being met with denial, anger, and defensiveness is very common. I remember feeling angry at her response, and so frustrated and desperate that she was unwilling to acknowledge what I so clearly saw before me.

According to Coffino, this is very common. “It is important to be patient and supportive during your conversation because you may be met with resistance,” she explains. Coffino’s research shows how help-seeking behaviors might be impacted by a person’s gender or race or ethnicity, so this is another important factor to consider when broaching the topic with your friend. I personally found these conversations very difficult, but Coffino’s advice is to share “genuine concern” for your friend’s wellbeing and maintain an “open and vulnerable” conversation as best you can.

What I’ve learned over time is that what was painful for me was 100 times more painful for her. She was meticulously covering up her disordered eating patterns yet hadn’t even acknowledged what was happening to herself. To her, I was a threat to the only strand of control she had left.

Over time, I’ve learned about the Stages of Change a concept used in many settings, but particularly relevant to eating disorders. There are five stages of change:

  • Pre-contemplation
  • Contemplation
  • Preparation and determination
  • Action
  • Maintenance

What stage of change your friend is currently in will determine how they react to you speaking out, and also the appropriate ways for you to encourage your friend to seek help.

What I’ve learned over time is that what was painful for me was 100 times more painful for her. 

When I first spoke to my friend, and she was defensive and in denial about having an eating disorder, she was in the pre-contemplation stage. Asking someone in this stage to seek help will not be effective because that person does not acknowledge that they have a problem that needs helping. However, as I found, it’s still important to gently and respectfully speak out because this might plant the seed of change that they need.

If your loved one is in the pre-contemplation stage, but you are seriously worried for their life, you can speak to their family, a school counselor if you are in school or university, or a mental health professional. If your friend is over 18, it is difficult to “force” them into life-saving treatment, but there are still actions you can take. Know, however, that ultimately change is something a person has to desire in themselves in order for treatment to be effective. Forcing treatment on an unwilling person is not necessarily the answer.

4. Staying supportive through your friend’s recovery.

Along the latter stages of change, it is important to encourage your friend to seek help through therapy, recovery retreats, doctor’s visits, or eating disorder support groups, and support them as they do so.

But as I found, it is also really important to know that ultimately it is up to your friend to make these changes. All you can do is love and support them, but placing the blame or sole responsibility for their health on your own shoulders is both inaccurate and harmful.

Coffino’s advice is to be direct when asking your friend what type of support they need. “Let them know you are available to listen to them,” she explains. Additionally, Coffino says that “when engaging in conversations, avoid commenting on their weight or shape, or using triggering language such as ‘it’s okay, just eat’.” 

If your friend has chosen to seek help, this is something you should encourage and let them know how proud you are of them. You can continue to support them by:

  • Not focusing conversations or activities around food
  • Not talking about bodies or body image
  • Don’t comment on their weight whether it’s a loss or gain
  • Ask about their reasons for change and support these
  • Do activities together that boost self-esteem 
  • Don’t force them to eat or blame them for their behavior
  • Listen to them when they are ready to talk, but don’t force an intervention
  • Ask open-ended questions and let them guide to conversations when they’re ready

5. Remember it’s not your fault.

As I know personally, it is heartbreaking to watch a friend suffer. I regretted and blamed myself for years because I did not recognize my friend’s eating disorder sooner. “I could’ve changed everything, I could have helped her, she wouldn’t be in this situation now,” I used to tell myself.

I know it’s hard, but if you are also experiencing these thought patterns, it’s important to shift your perspective. It is not your fault that your friend is still sick, and it is not even your responsibility to “fix” them. An eating disorder is often a lifelong mental illness that your friend will learn to recover from, but still battle daily. There is no simple fix, and it certainly isn’t up to you. All you can do is support your friend, and be there for them when they need you.

I learned these tips through trial and error, supporting my best friend through over a decade of her eating disorder. If someone in your own life has an eating disorder, my heart goes out to both you and them. Hopefully, with this advice in mind, you will feel prepared to both support your friend, and uphold your own mental health.