Supporting someone with an eating disorder

Many people with eating disorders look healthy but can be seriously ill. People in larger bodies are at high risk too, and are often missed. Weight alone never tells the whole story.

Eating disorders come from a mix of genes and environment. Families do not cause them, and they can be the person’s and the care team’s best allies in treatment.

Letting go of eating disorder behaviours can feel very frightening. Someone may deny there is a problem or push your help away, even while struggling. Staying present, rather than pushing hard, keeps the door open.

Eating disorders can harm the heart, bones and other organs, and they carry a higher risk of suicide. But they can be treated successfully, and early detection and treatment are important for recovery.

Many people say they are fine, or get upset. Try not to argue or pile on evidence. Stay calm, say you care, and let them know you will keep being there.

You might say

• “Okay. I hear you. I’ll always be here if you want to talk.”
• “I’m not trying to catch you out. I just love you.”
• “Can we check in again next week?”

Feeling challenged can bring up fear and shame, which may come out as anger. Try not to take it personally, and avoid arguing back. You can pause and try again another day.

Keep inviting them to things, even if they say no. They will still like being asked. Tell them what you appreciate about them, beyond their body, to support their self-esteem.

Encourage them to see a doctor or nurse, and offer to go with them. Getting help is often one of the hardest steps. A primary care provider can check their health and refer them on.

Recovery goes better when the people around someone stay united, with each other and with the care team. Mixed messages give the eating disorder room to divide and argue.

Ways to stay united

• Agree together on how to handle hard moments
• Back each other up, even if you’d have done it a little differently
• Discuss disagreements away from the person
• Keep in touch with the care team’s advice

Eating disorders can take over so much of life that everyone forgets the person underneath. Keep noticing and naming their qualities. Make time for things you enjoy together that have nothing to do with food.

You might say

• “I know that’s the eating disorder talking, and I’m not giving up on you.”
• “I’m angry at the illness, never at you.”
• “I can see how hard you’re fighting.”

To avoid conflict, families sometimes go along with the eating disorder’s rules. That might mean cooking only “safe” foods, allowing endless checking, or ignoring missed meals. This is called accommodating, and it can keep the illness going.

Fear can make us hover, take over and treat the person as fragile. Too much protection can leave them feeling less capable and more watched.

Feeling frustrated is completely human. But criticism, sarcasm and angry outbursts can increase shame and make recovery harder. Try to criticise the illness, never the person.

Carer programs teach families how to respond calmly and supportively. A review of 13 studies found these programs reduced carers’ distress and burden, and reduced critical or overinvolved responses. The changes lasted over time.

Comments about weight or shape, including “You look healthy now”, can be heard very differently by someone with an eating disorder. Praise who they are and what they do instead.

Try instead

• “I love spending time with you.”
• “You were so kind to your brother today.”
• “I’m proud of how hard you’re working.”

Talking about your own diet, calories or “being good” can feed eating disorder thoughts. Try to keep food neutral at home, and keep table talk light and about other things.

Mealtimes can be the hardest part of the day. Follow the care team’s plan if there is one, keep the mood calm, and avoid commenting on what or how much they eat. Staying together for a while after meals can help.

Social media can be full of diet and body messages. You could gently offer to help them clean up their feed, and do the same with your own.

Research suggests family-based treatment can improve outcomes. In these approaches, the care team supports parents to play a central role in helping their child recover.

What helps

• Act early, and talk to your child’s doctor about any worries
• Keep connection and fun alive beyond food
• Stay united with other caregivers
• Tell your child you are on their side

Adults make their own decisions about care, which can be very hard to watch. Keep encouraging help, offer to go with them to appointments, and keep the relationship warm.

It is easy to slide into watching every meal, which can strain a relationship. Ask your partner, and their care team, what kind of support helps. Keep making time for closeness that has nothing to do with food.

You don’t need to manage their eating. Keep inviting them, listen without judging, and remind them they are valued. Plan time together that isn’t centred on food.

Ask the team what your role should be, especially around meals. Families can play a key role in supporting treatment.

Slipping back can happen, and stress can make eating difficulties return. A setback is a reason to reach out to the care team, not a sign that recovery is impossible.

Full recovery from an eating disorder is possible. When the person you love can’t believe that yet, you can quietly hold that hope for them.

Signs of immediate danger

• Chest pain or a racing, pounding heart
• Confusion, or a sudden change in alertness or speech
• Difficulty breathing
• Fainting, or feeling faint or very lightheaded
• Not able to eat or drink for over 24 hours
• Seizures
• Swollen ankles or legs
• Vomiting that won’t stop, or blood in vomit
• Talking about suicide or behaving very strangely

Signs to report

• Eating or drinking even less
• More purging or over-exercising
• Mood getting lower
• More self-harm or suicidal thoughts

People with eating disorders face a higher risk of suicide. If you are worried, ask them directly if they are thinking about suicide, stay close, and help them connect with support.

Talking with others who have been there can ease loneliness and give practical ideas. ANAD offers free online support groups that are open to anyone.

Programs for carers, from workshops to guided self-help, have been shown to reduce carers’ distress and burden. Ask the care team what is available.

Look after you

• Get counselling for yourself if you need it
• Keep up your own meals, sleep and movement
• Keep some time that is just yours
• Share the load with other family or friends
• Talk to someone you trust about how you feel

Brothers and sisters may have big feelings too, like worry, sadness or feeling left out. Give them time of their own, and space to talk about how they feel.

If someone’s life is in danger, call 911. For emotional support any time, call or text 988, or text HOME to 741741.

A primary care provider can check physical health and refer to a mental health professional. FindTreatment.gov, run by SAMHSA, can help you find services near you.

ANAD (anad.org) offers free online support groups, a recovery mentorship program, and help finding treatment.

Find A Helpline (findahelpline.com) lists free, confidential helplines by country, by phone, text or chat. The International Association for Suicide Prevention links to it. If someone is in danger, call your local emergency number.

In the app

• Binge eating disorder
• Eating disorders
• Healing your relationship with food
• Other eating problems
• Supporting someone you love
• When someone in your family is struggling