If you want to know how to help someone with an eating disorder, start with a calm, private conversation about what you have noticed, then encourage a professional evaluation. Keep comments off food, weight and appearance, learn the warning signs, and look after your own health so you can stay steady for the long run.
If your loved one has fainted, has chest pain or cannot keep food or fluids down, go to an emergency room or call 911. If they talk about suicide, call or text 988.
What is an eating disorder?
An eating disorder is a mental health condition in which eating, weight and body image take over a person's thoughts and daily life. The National Institute of Mental Health (NIMH) describes eating disorders as serious illnesses that can affect people of any age, gender or body size.
NIMH names three common types, though other types exist:
- Anorexia nervosa: severe food restriction and an intense fear of gaining weight
- Bulimia nervosa: episodes of bingeing followed by purging or other ways of making up for the food
- Binge-eating disorder: repeated binges without the regular purging seen in bulimia
Body weight does not tell you whether someone has an eating disorder. A person in a larger body can be restricting food in a dangerous way, so take your concern seriously even if your loved one looks healthy to you.
What are the first signs of an eating disorder?
The signs of an eating disorder are reasons to start a caring conversation, and only a professional can make a diagnosis. You may notice several of these:
- Skipping meals, eating very small amounts or cutting out whole food groups
- Constant talk about food and weight, calories or body shape
- Eating in secret, or food going missing
- Going to the bathroom right after meals
- Exercising even when sick, injured or exhausted
- Avoiding meals with family and friends
- Weight changes, dizziness, feeling cold or tired, or stomach problems
- Mood changes, such as anxiety, irritability or low mood around meals
Eating disorders often occur alongside anxiety, depression or substance use. A person may use food restriction or bingeing as a coping mechanism for feelings that seem out of their control.
How do you start a conversation about an eating disorder?
Pick a private, unhurried time that is not during or right after a meal. Talk about specific things you have seen and how you feel, and keep the focus on your loved one rather than on food.
- Start with care: "I love you, and I've been worried about you lately."
- Name what you have noticed: "You've been skipping dinner, and you seem stressed around meals."
- Listen more than you talk, and let silences happen.
- Offer help with the next step, such as booking a doctor's appointment or sitting with them on a call.
- End without an ultimatum, and plan to check in again.
You do not need to be an expert to help. Listening without trying to fix everything is often the most useful thing a family member can do.
How do I start a conversation with an adult child?
Talk with an adult child as an equal, and ask before you give advice. Say what you have noticed, offer practical help, such as paying for an evaluation or driving them to an appointment, and respect that the decision to start treatment is theirs.
What should you avoid saying to someone with an eating disorder?
What to avoid saying to someone with an eating disorder comes down to one rule: do not comment on food, weight or appearance. Even compliments can feed the illness, because they keep the focus on the body.
- Avoid "You look healthy" or "You've gained weight," even when you mean it kindly.
- Skip "Just eat" or "Why can't you stop?" because the illness does not work that way.
- Avoid calling foods "good" or "bad," or talking about your own diet.
- Don't compare their body or eating with anyone else's.
- Leave out threats, blame and arguments about what is on the plate.
Try phrases like "What would help right now?", "I'm here whenever you want to talk" and "You don't have to handle this alone" instead.
What if they deny the problem or get angry?
Denial and resistance to treatment are common parts of an eating disorder, and they are not a sign you handled it badly. Stay calm, avoid arguing about the facts, and tell them you will bring it up again because you care.
It may take several conversations before your loved one agrees to see someone. Keep your tone steady, keep offering the same help, and encourage them to seek an evaluation from a doctor or therapist as a first step.
Can people be forced to get help for an eating disorder?
Adults usually cannot be made to start treatment, though emergency care can step in when someone is in immediate danger. Parents or guardians can usually arrange treatment for a child under 18, and a clinician can explain the options for your situation.
How are eating disorders treated?
Eating disorders are treated with a mix of therapy, nutrition support and medical care, based on an assessment of both mental and physical health. The level of care depends on how medically stable the person is and how much structure they need around meals.
At Enhance Health Group, eating disorder treatment takes place in PHP, which takes up most of the day, and IOP, which leaves more room for school or work. Virtual treatment is also available for people who are medically stable at home. A plan can include these parts:
- Individual therapy with a licensed therapist on the person's relationship with food and the thoughts behind it
- Nutrition guidance from a registered dietitian who works with the therapist on the same plan
- Groups led by a licensed therapist for skills around meals, urges and body image
- Cognitive behavioral therapy and dialectical behavior therapy
- Family therapy, when your loved one wants family involved
- Medication prescribed by a licensed psychiatrist, when it is part of the plan, such as for anxiety or depression
Can someone recover without professional treatment?
Some people improve with support, but eating disorders can affect the heart, blood and hydration in ways that are hard to see from outside. Professional help is the safest place to start, because a doctor can check physical health and a therapist can treat the thoughts behind the behavior.
How can you support someone during eating disorder treatment?
Supporting someone with an eating disorder during treatment means following the plan their team sets instead of making your own rules. Ask the care team, with your loved one's permission, what your role at home should be.
Should I monitor what my loved one eats at home?
Supporting without enabling or monitoring food is the balance to aim for. Enabling means covering for skipped meals or purging, while monitoring means watching every bite, and both can damage trust. In family therapy, the team can explain what support at meals should look like in your home.
How can I support someone during family meals?
Keep family meals calm and regular, and talk about topics other than food and weight. Serve the meals the treatment plan calls for, and avoid commenting on portions or what is left on the plate.
How can I help someone with binge-eating disorder?
Avoid shaming comments, food policing and diet talk, which can make binges more likely. Encourage regular meals and professional treatment, and let your loved one know that binge-eating disorder is a real condition with real treatment options.
Should I visit them in the hospital?
Ask your loved one and their care team what would help. A short visit can be a comfort, and it helps to keep the talk on everyday life rather than food, weight or treatment.
Will they be cured when they come home?
Recovery from an eating disorder usually continues after a program ends. Ongoing therapy and nutrition support are common, and setbacks can happen, so ask the care team what support at home should look like.
When to seek emergency medical help
Some warning signs mean medical care comes before anything else. Go to an emergency room or call 911 if your loved one faints, has chest pain, has a racing or skipping heartbeat, cannot keep food or fluids down, or is too weak to get to a session. Fast weight loss also needs a medical check soon.
How do you take care of yourself while supporting someone?
Caregiver self-care and support groups help you stay steady through a long recovery. Keep your own sleep, meals and time with friends, and set limits on how much of your day the illness takes up.
Family and friends of someone struggling with an eating disorder often feel scared, guilty or angry, and those feelings are normal. A therapist of your own, or a support group for families of people with eating disorders, gives you a place to say them out loud. If your loved one relapses after treatment, contact their care team and remind yourself that setbacks are part of recovery for many people.
How does insurance verification work for eating disorder treatment?
Call admissions or send the form with your loved one's insurance details. The team checks benefits with the insurer and explains the deductible and copay, though benefits vary by plan and verification is not a guarantee of coverage.
Talk with Enhance admissions
If you are worried about someone, you can call before they are ready to call themselves. Call Enhance Health Group admissions at (714) 862-1907 to describe what you are seeing, ask about treatment options and learn what the next step could be.
