Here is a real, sobering and disturbing fact: Over 30 million people in the United States will suffer or have suffered from an eating disorder. I, myself, have had a variety of diagnosed eating disorders since the age of 16.
But even more disturbing are the cases that go unreported. In America, there exists a detrimental stigma surrounding mental illness — and many choose to keep their sufferings and struggles hidden. That means it is likely that you have a close friend, relative or co-worker that has suffered from bulimia, anorexia, orthorexia, binge eating disorder or eating disorder not otherwise specified (EDNOS).
“Eating disorders are mental health conditions which are dangerous to physical and emotional health; they have high morbidity and share features with addictions, mood disorders, phobias, OCD and delusional disorders,” says Deanne Jade, director of the National Centre for Eating Disorders (NCFED).
If you have never suffered, it can be extremely complicated to understand. For those with an eating disorder, whether it has existed in the past or has sprung back up in the present, food is like a drug. Unlike other mental illnesses or addictions, however, food exists everywhere and is essential for living. It is impossible to separate oneself from it entirely because it is included in every day to day experience.
If someone is open enough or close enough to you to tell you about their food issues, you do not want to risk triggering them or hurting them by saying something inappropriate or off-handed. In fact, supporting someone with an eating disorder can be like dancing around a massive elephant in the room. Trying to find the right words to say can feel like you are stepping through a carefully crafted minefield — but it does not have to. Remember, this is a mental issue, and it takes open communication, relaxation and patience to understand.
From my experience with eating disorders, and the experiences of many others, here are the things you should never, ever say:
1. “But you don’t look sick.”
Anorexia Nervosa (an eating disorder characterized by weight loss or lack of appropriate weight gain in growing children; difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image) is the only eating disorder that holds a weight criterion, but that does not mean that every sufferer is stick-thin. The vast majority of people with eating disorders are not underweight. They may have been at one point, but it goes up and down. Anorexia, like all other eating disorders, is internal. Those internal thoughts show on the body. While you may think this is a compliment, you are just reinforcing the damaging message that many sufferers believe: Your problem is not valid and you look like an average size.
2. “Why don’t you eat healthily and exercise?”
Keep in mind that eating disorders are mental illnesses, not a simple diet plan or restrictive routine. By asking this question, you are treating it as such and discounting the depths of the disease. Jade says it is not that simple: “Eating disorders are characterized by excessive concerns about shape and weight, leading to some injurious weight-control behaviors.” These behaviors include lying, throwing away lunches and intense fear of eating or eating certain foods and eating foods in certain orders.
3. “I want to lose weight. How did you do it?”
If you are asking someone who is underweight because of dangerous, mentally draining and physically harmful actions, then you are reinforcing this person’s mentality that what they are doing is good and desirable. Our society has deep-rooted issues with body image and weight. We praise weight loss and continuously are after the latest and greatest ways to shed pounds quickly and easily. If a person is not eating or is throwing up their meals, this question can encourage disordered eating behaviors that you may not even know they have.
4. “You look sick/unhealthy/gross.”
These words may stem from concern and love, but the eating-disordered mind equates “sickly” and “unhealthy” with ‘admirably thin.’ It is best for those who suffer, and even those who don’t, to avoid reference to a person’s shape, weight or size. There are other ways to express concern: Ask how that person is doing or feeling, avoid overly simplistic solutions (like just stop), encourage them to see a professional and compliment them on traits unrelated to appearance.
5. “Have you considered going on a diet?”
Most people with eating disorders are competent and intelligent in all other areas of their lives, resulting in people thinking that a diet is a logical fix. It is tempting to ask why they are unable to nourish their bodies properly, but if someone is suffering from binge eating disorder, the idea of going on a diet seems illogical and beyond comprehension. They are not choosing to binge. Asking them why they will not stop themselves or pick something more manageable only increases the amount of guilt and shame they are already experiencing. These emotions can trigger future binges and starving episodes.
6. “I feel fat/gross/huge today. I should go on a diet!” Or, “I shouldn’t eat lunch.”
This kind of negative self-talk shouldn’t be thrown around due to its potentially negative consequences: “Fat talk” has been linked to more negative body image, low mood, and internalization of a thin ideal for women. And while being body-positive is helpful to everyone, saying these things to someone in recovery or those presently suffering can cause the focus of the day to immediately shift onto weight and food issues. Many sufferers are already hyper-aware of what people around them are eating and how they look to the outside world
7. “Should you be eating that?”
Eating disorders revolve around safe foods. Safe foods are those that the sufferer feels the most comfortable eating. Sometimes it is a healthy choice, like an apple, and other times it can be a greasy plate of fries. Whatever the food option, do not comment on what it is. The food the sufferer is eating could be the first thing they ate all week, or the first meal they have kept down in months. “Whether it is anorexia, bulimia or [other] atypical forms that elude diagnosis, treatment is the same. Correcting dietary chaos is one priority,” adds Jade. “The other priority is to deal with the deeper psychological deficits which give rise to the salience of appearance and the intensive, intrusive pre-occupation with food and weight which reflects it.”
8. “I’m so glad you ate! I never see you eat anything!”
Unless you are part of a family-based treatment plan, which is a manualized treatment delivered by trained professionals usually delivered in outpatient settings, avoid commenting on what a person suffering from an eating disorder has consumed that day. People with anorexia, bulimia and binge eating disorder are often fearful that those around them are judging or watching what they are eating, and commenting on what they have taken in only confirms this fear.
9. “Men don’t want someone who is skin and bones!”
Out of all of these comments, this is one of the most offensive. Eating disorders are deeply stemmed in how the sufferer feels about themselves and the uncontrollable world around them. Rarely are they genuinely concerned with what a random man on the street thinks about their body shape? An eating disorder is not caused by merely wanting to look suitable for someone else. No matter how small a person suffering is, it is unlikely that they see it that way. And if they do, I can assure you; they hate how it looks.
10. “Do you know how hard this is for me to deal with?”
Believe it or not, those who are suffering know how hard it is to deal with because they are dealing with it from the inside out. Sufferers hate having an eating disorder or having to depend on others and being looked at as ill. The never-ending guilt, deep self-hatred, nights of sobbing and emotional distress is hard for us to deal with as well. Placing blame on the sufferer will only cause more guilt, which starts the cycle all over again.
11. “Why is it taking so long for you to get over this?”
Seventy-seven percent of individuals with eating disorders report that the illness can last anywhere from one to 15 years or even longer in some cases. “Recovery from a severe and enduring eating problem is an existential struggle that may take a very long time to resolve if it ever will,” says Jade. “A therapist will only reach down to the pain inside the anorexia when the patient is ready, but when will that be? We must always love the sufferer, but we also have to live and help other members of the family to connect to what is good in life.” These patterns and habits and coping mechanisms took a long time to form and will take an even longer time to alter. Patience is key. Understanding is essential.
If you or someone you love is suffering from an eating disorder visit https://www.nationaleatingdisorders.org/ for guidance, recovery options, treatment centers and hotlines. Remember, show love, show your support and never judge what you do not understand.