Helping A Friend Who May Have An Eating Disorder

Learn how to recognize a problem

Concerns about diet, weight and body size are common among college students.  In our culture, thinness is a symbol of beauty, success, happiness and control, while body fat or weight gain is seen as a sign of laziness, unattractiveness, lack of will power, or failure.  It is not unusual for someone to think that if he or she were a certain weight, size, or shape, life would be better. As a result, dieting and “fitness” have become for many an obsession.  The difference between dieting and having an eating disorder involves the degree of a person’s preoccupation with food, the amount of anxiety and distress related to eating and weight , the lengths one will go to control weight and food consumption, and the degree to which weight and food contribute to self esteem and self worth.  Socially accepted dieting practices, such as fad diets, cleanses, and fasts can actually be unhealthy preoccupations with body image and weight. 

Many individuals with nutritionally unbalanced eating practices may not have a diagnosable eating disorder. However, unhealthy eating and exercise patterns are reason for concern, as they can develop into serious problems that may impact an individual’s health, self esteem and daily functioning.

Here are some questions that might suggest your friend has an eating disorder[1].  If he or she answers two or more of the following questions positively, he/she should see a healthcare professional for an evaluation.

  • Do you make yourself Sick because you feel uncomfortably full?
  • Do you worry that you have lost Control over how much you eat?
  • Have you recently lost more than 14 pounds in a 3-month period?
  • Do you believe yourself to be Fat when others say you are too thin?
  • Would you say that Food dominates your life?

Talk to Your Friend

If you are concerned about a friend’s eating or exercise behaviors, it’s time to talk to him or her about it.  Don’t wait until your friend’s behaviors become out of control, deeply entrenched or dangerous. 

Approach your friend individually.  Don’t ambush or surprise with a large intervention.  Even if a number of individuals in your friend group, team, or residence hall are concerned, pick someone to have a one-on-one.  This will decrease the likelihood that he or she will become defensive as a result of feeling ganged up on or gossiped about.  Set up a time to talk with your friend that is convenient and comfortable for both of you.  Finals week may not be a good time to begin this conversation, but anytime is better than avoiding the issue if you are concerned.  Pick a time and place where you won’t be interrupted or distracted.  Suggest that you both turn your cell phones off, or agree not to text or answer the phone while you talk.

It’s ok to think about what you want to say beforehand.  Consider writing it down first or practicing with another friend.

Share Your Concerns

Be open and straightforward, but avoid statements that are judgmental, shaming, or place blame.  Statements like, “You just need to eat,” “You’re ruining our friendship,” or, “How can you make yourself throw up?,” are counterproductive.  Instead, give specific examples of why you are concerned about your friend’s eating or exercise behaviors.  Some more effective approaches can be, “I’ve heard you vomiting in the bathroom and it scares me,” “Lately you’ve stopped coming to the dining hall with us, saying you’ve already eaten,” “I’m concerned with how much time you spend at the gym,” “I’ve noticed the more stressed you get, the less you eat.”

Accept Your Limits

Disordered eating behaviors are often a way for someone to feel in control, deal with their feelings, or cope with stress.  It is not realistic to expect your friend to give up these behaviors right away, or just because you talked about it.  People with anorexia, bulimia, or binge eating need professional help.  Let your friend know you think he or she should speak with a professional.  Offer to help your friend make an appointment at UHCS, or help them find a doctor, therapist or treatment facility.

Remember, you cannot force your friend to want treatment or to change his or her behavior. Trying to force your friend to eat or following him or her into the bathroom so that they cannot purge is not effective.  It may make your friend feel you are trying to control them, and make him or her less likely to turn to you for help in the future.  If your friend refuses to acknowledge the problem or seek help, it does not mean you have to deal with your worries alone.  We urge you to meet with a counselor at UHCS yourself to discuss your concerns and address how the eating disorder is affecting your life.

Express and show your on-going support

Because denial, shame, and issues of control are so prevalent for someone with an eating disorder, it can take repeated, nonjudgmental conversations for a person to feel safe enough to admit and talk about their problem.  Be patient and let your friend know you want him or her to be happy and healthy.

Encourage your friend to talk about how he or she is feeling, rather than dealing with emotions through unhealthy behaviors.  Help your friend find other areas where they can feel proud of themselves besides weight, by complimenting him or her on strengths, talents, and achievements. 

Be a role model for your friend by maintaining your own healthy eating and exercise behaviors.  Avoid conversations focused on calorie intake, fad diets, or how much time it will take to “work off” the ice cream you just ate.  Your friend is likely paying attention to how you talk about yourself and your body, and can benefit from your example of positive body image and self-acceptance.

[1] John F Morgan, Fiona Reid, and J Hubert Lacey, “The SCOFF Questionnaire - a New Screening Tool for Eating Disorders,” West J Med. 2000 March; 172(3): 164–165.

Resources for Eating Disorders Support