"Is she diabetic? When’s the last time you ate?"
"What did you have?"
"A granola bar."
"Have you had anything else to eat today?"
She shook her head. Someone was calling 911. I went downstairs to try to find her phone in her backpack. In the front pocket I found a folded piece of paper with a scribbled list of foods that looked like a daily record.
At this point I was kind of in shock. I took deep breaths to stop myself from freaking out. Oh no oh no oh no! The same thing had happened to me once. I'd fainted, and fell into the bathtub. No one called 911 then. I didn’t really know much about my friend at all, except that she was still in high school and also did gymnastics, and I know both of those can create a lot of pressure to look a certain way. She seemed healthy on the outside. I wanted to do something, but I didn’t really know what.
Someone brought up a box of fancy Japanese candy and offered some to her. All I could do was stand there and watch. I packed up my stuff, and when I got outside I found my instructor standing next to the ambulance.
“I’m really glad you’re taking her to the hospital,” I said. "I’m concerned she might have an eating disorder, if she hasn’t eaten all day… Ahh I just want to give her a big hug!"
It’s not always obvious if someone is struggling with an eating disorder, and that’s the scariest thing. They could be underweight, overweight, or a normal weight and still have unhealthy thoughts, behaviors, and anxieties about food. People with eating disorders usually make a huge effort to act as normal as possible around others, but sometimes despite all the secrecy, you can still tell something’s up.
Some telltale clues include:
- having cold hands all the time
- withdrawing socially from friends
- skipping meals, and avoiding eating in front of others
- cutting food into tiny pieces or pushing it around on a plate without eating it
- baking treats or cooking elaborate meals for others and not eating any themselves
- constantly making excuses not to eat
- restricting diet to just a few foods
- wearing many layers of clothing even when it’s warm
- suddenly being really interested in cooking, ingredients, food preparation, sustainable agriculture, etc.
- collecting pictures of food, recipe books, food magazines, etc.
- exercising for extreme amounts of time
- complaining of tiredness all the time
- collecting secret stashes of food
If you have a friend who you suspect has an eating disorder, don’t just stand by and expect it to go away! The sooner they address the problem, the better their chances of a full recovery. I know it’s so easy to feel kind of helpless, or to pretend there isn’t a problem - especially when that’s what your friend is likely doing. So what can you do to help?
- Tell them you’re concerned - It’s important to plant the idea in their head that everything might not be ok, and to let them know that you just want them to be happy and healthy. Cite specific occasions when you were concerned about them as evidence, and use “I” statements to avoid sounding accusatory. Also, be prepared for denial. I remember a few times people confronted me like this and it freaked me out, but always led to some serious reflection.
- If they deny anything is wrong, don’t argue - Someone with an eating disorder will likely feel terrified that you’ve found them out. They might resent you for wanting to control what they look like, or even think you’re jealous of them for being skinnier/healthier/fitter than you. Try to avoid an argument, but restate your concerns so they know you haven’t changed your mind.
- Encourage them to get help - Suggest that your friend make an appointment with a counselor, nutritionist, medical doctor, or other professional who can help them out or just make sure they’re truly ok. Know you can’t force them, but they might be more likely to take this step if it’s just to make sure they’re getting the nutrients they need on a restricted diet, or to help them cope with stress, or for some other related concern that’s not an eating disorder. Say it would make YOU feel better. You can also refer them to online resources such as Something Fishy, or this article (which also has links to more online resources).
- Say something to someone else - Depending on the situation, it might make sense to tell someone else about your concerns, who has more authority over your friend than you. This could be a parent, teacher, coach, employer, etc. - someone with a greater chance of getting them professional help. I know for me with my friend, it was definitely a huge relief to have said something.
- Offer friendship and support - You can’t force your friend to change - they ultimately have to decide to recover on their own - but you can be a supportive friend at a time when it feels like they’re alone in the world and no-one understands them. Spend time doing fun, non-food-related actives together, and make yourself available as a supportive and non-judgmental listener if they ever want to talk.
- Offer compliments - Acknowledge your friend’s accomplishments and personality to take the focus off of appearance as much as possible. Remind them that beauty has much more to do with confidence and health and happiness, than about body shape or other inherited physical traits we really have no control over.
- Be a good role model - Everyone is influenced by the people they spend time around, so try to set a good example of healthy eating habits, positive body image and self esteem. Avoid judging yourself or others based on shape or weight, and focus on goals that show there are more important things in your life than diet or physical appearance.
- Don’t expect them to "just snap out of it” - No one makes an instant recovery. Ultimately, eating disorders are not just about the food, they’re usually coping mechanisms for deeper emotional issues. Although malnutrition exacerbates these problems, it takes more than just eating more or eating less to be healthy again.
There's such a wide spectrum of disordered eating habits, and dieting is so common in our culture that it's easy to wonder, "Am I/is my friend really sick enough?" Is it a diet or an eating disorder? When is it enough of a problem to do something about it? What I would say is don't be a bystander. It can't hurt to express your concern and point your friend toward someone who can make a better decision about whether they need help, sooner rather than later!