10 Things to Never Say to a Friend With an Eating Disorder

You don't have to know exactly how it feels in order to learn what's appropriate to say.
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You don't have to know exactly how it feels in order to learn what's appropriate to say.
eating disorder

Art Credit: Regina Leah

With National Eating Disorders Awareness Week upon us, I’ve been thinking a lot about my own recovery process. I’ve been in recovery from anorexia nervosa for the past six years. While I’m in a much healthier place mentally and physically than I was when first diagnosed, there’s still not a day that goes by that I don’t have to be conscious of how easily I can fall backward.

I’m healthy, confident, and strong now, but my attitude can quickly shift if I am not careful. We live in a culture that’s somewhat obsessed with food, healthy living, and the female body. Even though my friends and family know that I’ve struggled with an eating disorder, they still don’t always know the right things to say.

You see, an eating disorder is not a lifestyle choice but a true mental illness. According to the National Eating Disorders Association,

“Eating disorders—such as anorexia, bulimia, binge eating, and eating disorder not otherwise specified (EDNOS)—include extreme emotions, attitudes, and behaviors surrounding weight and food issues.”

An eating disorder is not a phase, but a serious emotional and physical condition that can be life-threatening. Eating disorders can wreak mental and emotional havoc, starting with an unhealthy preoccupation with food and weight, to a distorted view of self-worth and reality, to an immense sense of shame. The fact is, the psychological components of this mental illness are complex and can be hard for those without eating disorders to understand.

The good news is, when it comes to knowing someone with an eating disorder, you don't have to know exactly how it feels in order to learn what's appropriate to say.

There are still many stigmas and stereotypes that surround eating disorders, but these illnesses are serious and complex and should be treated as such.

The first step in recovery is for a person with an eating disorder to admit he or she has a problem and wants to get help. If they can overcome denial, that’s a big step in moving forward.As many as 24 million Americans—men, women, young, old, and every ethnicity—have eating disorders. If one of these people is a friend of yours and has reached out to you, putting a little extra care in the words you choose can go a long way. Just as you wouldn’t tell your friend struggling with infertility, “boy, I hate being pregnant!,” you also wouldn’t tell yourfriend who has bulimia, “sometimes I wish I could just throw up to lose these last five pounds.”

Here are 10 things people have said to me on my journey to recovery that would have better been left unsaid.

01. “You look healthy to me!”

If your friend is in the throes of an eating disorder, healthy may be equated with fat. Hearing you look healthy when you’ve previously been told you look thin, slender, skinny, and so on, can set off a red flag in a mind clouded by an eating disorder. Let’s be clear: Healthy constitutes a wide range of states, but when you know your friend has an eating disorder, it is generally a good rule to avoid making comments about the way she looks. Even when it comes from a place of love and care, remarks about appearance can sound distorted in her head.

02. “Wow, you really can eat!”

Just as when telling a friend with an eating disorder that they look healthy, telling them that they eat really well or eat a lot is far from effective. She may internally question what you mean by this statement. Did I eat too much? Is the amount I am eating bad? Are you saying it’s better when I don’t eat like I am right now? If she’s still in the throes of an eating disorder, her thought process can quickly spiral out of control.

03. “You would look so much better if you filled out a bit.”

When at my unhealthiest, I’ve heard this statement, as well as “You look sick,” “You look scary,” and my personal favorite, “You look like a child.” Did these comments help me see how very distorted my body image was and light a spark under my butt to really want to recover? Yes. But they also made me feel more ashamed, more self-conscious, and more unattractive than ever before. And that’s not helpful at all.

04. “You’re lucky; I wish I was told I needed to gain weight.”

If your friend has anorexia and knows she needs to gain weight, you can and should encourage her in that. Telling her how “lucky” she is, though, is not the way to do it. To her, gaining weight is an uphill battle.

What many people don’t realize is that when someone is severely underweight or has been restricting their food intake, their body will go into what’s called starvation mode. Their metabolism slows down in order to save energy and conserve as many calories as possible. Once they begin the recovery process of eating normally again, their metabolism can go into hyperdrive. “Refeeding syndrome,” as it’s known, requires those suffering to eat multiple meals and snacks a day just to maintain weight. Gaining weight and getting the metabolism to regulate itself once again may require them to eat like an Olympic athlete. To put it in perspective, when I started treatment I was severely undernourished and consuming less than 1,000 calories per day. In order to gain a healthy weight of one to two pounds each week, I was eventually consuming 4,000 to 5,000 calories per day.

05. “If you just gain some weight, everything will be better.”

The mistake here is seeing the eating disorder as a problem to be quickly solved—and missing the complexities in the process. Weight is only one part of recovery from an eating disorder. Whether your friend has anorexia, bulimia, binge eating disorder, orthorexia, or an EDNOS, her weight is one component of healing. If she is underweight, then weight gain is absolutely essential. That’s a decision that the doctor—not you—will have to make. For some people with binge eating disorders, their doctor may recommend weight loss. Ultimately the recommendation is based on health, not a number on the scale.

So when your friend does gain (or lose) the necessary weight, they will still need to retrain their minds to see food and body image in a different light. Recovery is a continual process with ups and downs, weight losses and gains, good days and bad days. This is normal! Encouraging your friend in his or her recovery is helpful. But telling them that reaching an appropriate weight will solve all their problems is simply not true.

06. “Why can’t you just have a milkshake every day?”

Eating disorders are much more complex than the ability or inability to eat a milkshake, hamburger, or fries. If your friend does not have a dietician or a counselor, help her find one who specializes in eating disorders. But don’t try to take the place of a professional. She needs to trust and follow her medical team—and you need to trust her.

07. “Your meal plan doesn’t seem right.”

“How do you know your dietician isn’t trying to make you gain too much weight?” or “When you eat according to your meal plan, you’re not eating enough.” Whether your friend’s meal plan seems like too much or too little, that is between your friend and his or her dietician. So many various factors go into a meal plan; it should be customized exactly for your friend’s needs. The goal is for your friend to get to a place where they don’t need a meal plan anymore, where they can eat intuitively. But while in the delicate process of recovery, your friend will need to follow the meal plan provided by her medical professionals.

08. “I don’t have enough willpower to have an eating disorder.”

A person doesn’t choose to have an eating disorder. Those suffering probably made the choice at one point to start a diet—but they didn’t decide to start an eating disorder. Think of an eating disorder like a type of addiction that functions as a coping mechanism, similar to alcoholism, drugs, gambling, or even a shopping addiction. The eating disorder serves as a way to cope with some deeper-rooted issue in that person’s life.

09. “I definitely need to run an extra mile today after eating that bagel for breakfast.”

Is this ever really appropriate to say? One meal, one day won’t hurt your overall health when you’re taking care of yourself. Normal, intuitive eating means notclassifying it as either bad or good, and not telling yourself the only way you can eat a certain food is by exercising afterward.

10. “Sally could lose a few pounds.”

And at the same time, avoid making comments about your mutual friends’ bodies! So often we resort to weight, body, and food as topics of conversation, but there are so many better things we can discuss. When you remark that your mutual friend Sally needs to lose weight or that John is getting a beer belly, your friend who has an eating disorder will probably think, “Gee, if you’re saying these things about Sally and John, what are you saying about me?” The same goes for commenting on your own body and weight. Why not talk about your life instead?

Sadly I’ve been told all of these things before, and by people who know my story and are close to me. Maybe you’ve said some of these things before yourself. Maybe you have some friends who may or may not be suffering from an eating disorder. Whatever the case or intention, we can all benefit from being a little more careful with our words.

My hope is to bring this often misunderstood and stigmatized topic into the light. To start a conversation and to remove some of the shame. If you have a friend with an eating disorder, talk to her about her experience—and when you do, you can now avoid these 10 conversation fails. Oh, and of course, listen.