How To Approach A Friend Who Has Eating Disorder

Have you ever had a friend who often refused to eat despite being extremely hungry? Or maybe a friend who loves eating in large amounts at one go? Or even a friend who has a weird habit of eating inedibles such as chalk or paper secretly?! How should you help them? What conditions are they facing? Why are they behaving in such disturbing ways?

1st Step: Be prepared

Eating disorders are mental health conditions with an obsession with their food or body shape. 1 in 20 people may be affected with eating disorders at some point in their lives. Both genders, male or female, may suffer from this condition. Eating disorders may be caused by factors such as genetics, brain biology, personality traits, and cultural ideas. You can learn more about the types of eating disorders and their common signs and symptoms in valid health websites such as healthline, wikihow, Myhealthportal Kementerian Kesihatan Malaysia, National Eating Disorder Association etc. 

There are 6 types of common eating disorders:

1. Anorexia Nervosa: People with anorexia nervosa tend to restrict food intake or show purging behaviors after eating in large amounts. They usually have an extreme fear of gaining weight, resulting in them becoming severely underweight.
2. Bulimia Nervosa: People with bulimia nervosa frequently secretly binge- eat excessive amounts of food with loss of control over eating, then purge. Examples of purging behaviors are misusing laxatives and enemas, self- induced vomiting, and excessive exercise. They are afraid to gain weight despite being at normal weight.
3. Binge Eating Disorder: Also known as compulsive overeating, people with binge eating disorder eat large amounts of food in short periods of time uncontrollably, even if they are not hungry or feel uncomfortable. Unlike other eating disorders, they do not purge.
4. Pica: An eating disorder in which a person will have cravings for things that are not usually considered food such as chalk, paper, soap, dirt, ice.
5. Rumination Disorder: An eating disorder in which people generally swallow food up again (regurgitate) the food they’ve recently swallowed. They will then rechew it, swallow it or spit it out.
6. Avoidant/restrictive food intake disorder (ARFID): Also known as “selective eating disorder”, people with ARFID are characterized as extreme picky eaters, causing them to undereat. They either have a lack of interest in food, or intense distaste for how certain food looks, smell or taste.

Here are some Warning signs and symptoms that may indicate eating disorders:

 (Warning! Do note that this table is not a checklist, but a general overview of types of behavior that may indicate a problem. Someone with an eating disorder may not have these signs and symptoms at once, and warning signs differ across eating disorders)

Eating disorders are mental health conditions which usually require treatment and counseling. If left untreated, it will be damaging to the body.

2nd Step: Support & Understanding

Eating disorders are also related to trauma or mental issues and require a great deal of support and understanding without being judgemental or accusatory.

1. Set aside time to talk to your friend in private without distractions or constraints.
2. Explain why you are concerned and speak from the “I” perspective such as “I noticed that you are eating less than usual and avoiding your friends during lunch. I am worried about you and care for your wellbeing.” Try to avoid blanket statements such as “You have a problem” or “You have an eating disorder”. Your goal is to express your concerns about your friend’s health, and to provide love, care, support to help them.
3. Be patient and supportive. Support your friend by actively listening to her thoughts and feelings about her eating disorder. Sit quietly, listen attentively, nodding your head and smiling to assure her that you are listening. However, there’s a chance that your friend may deny and become angry and defensive. Do not take it personally, and remain calm, focused and respectful if this happens. Remember, that this conversation likely feels threatening to someone with an eating disorder.

What to AVOID during the conversation:

• Avoid making assumptions, as you cannot tell someone has eating disorders or what symptoms they have based on what they look like.
• Avoid subjects of weight and looks. For instance “You look so skinny” or “You look great!” Instead, you can compliment them on their personality, skills, and nonbody traits!
• Avoid passing judgement or shaming your friends. Eventhough it may seem harmless, statements like “I can’t believe you think you are fat” or “Snap out of it, you seem sick” may be hurtful to them. Remember, that eating disorder is a daily struggle to them and not a lighthearted issue. Instead, you can express your feelings concerning your friend’s disorder and how it may be negatively affecting her health. You can explain to your friend by saying “I noticed that you are not eating with us anymore.”
• Avoid forcing them to eat and commenting on their food choices.  You may be tempted to say “Just eat, will you.” The sufferer may become frustrated, defensive, which may cause a discord in your relationship. Instead, you can offer to eat with them and ask them how you can be supportive around food.

3rd Step: Seek for Professional Help

Encourage your loved ones to seek for professional help such as a physician or therapist. Offer to help them find a physician or therapist specialized in eating disorders or encourage them to attend an appointment. Friends and family members may not be the right person to counsel or provide aid as mental health professionals.

As suggested by the National Eating Disorders, people are often unaware of the scope of their eating disorder, and a family member or friend’s insistence helps them understand the gravity of their condition to seek help. It was also reported from 78% of young adults that while waiting for treatment or delaying attending a specialist facility, their condition becomes significantly worse.

• Contact Helpline (Malaysia): International Psychology Centre: 603-2727 7434
• Support group: Online support groups, Others

Treatments for eating disorders include:

• Medical treatment
• Nutrition/ dietary management
• Physical and occupational therapies are also useful

Offering care and support to your friend with an eating disorder in the beginning stages can help make a difference for a better health and lifestyle. Don’t wait until the situation is so severe that your friend’s life is in danger.

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Reference:

1. Australian Government Department of Health. What are the main types of eating disorders? Available from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-w-whateat-toc~mental-pubs-w-whateat-typ
2. Wikihow. How to help a friend who has an eating disorder. Available from  https://www.wikihow.com/Help-a-Friend-Who-Has-an-Eating-Disorder
3. Help Guide. Helping Someone with an Eating Disorder. https://www.helpguide.org/articles/eating-disorders/helping-someone-with-an-eating-disorder.htm 
4. National Eating Disorder (NEDA). Warning signs and symptoms. Available from https://www.nationaleatingdisorders.org/warning-signs-and-symptoms
5. National Eating Disorder (NEDA). How to help a loved one. Available from https://www.nationaleatingdisorders.org/learn/help/caregivers

Written By

Ms. Rosamund Koo Wei Xin

Reviewed By

Doc2us Medical Board