Emotional Health

In this article we will outline the ways in which you can help and support someone with an eating disorder.

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How to Help Someone with an Eating Disorder

This article has been medically approved by a Pharmacist.

If a friend or relative has an eating disorder, such as anorexia, bulimia or binge eating disorder, you will probably want to do everything you can to help them recover.

You might already know a lot about eating disorders, or you are just finding out more about them. Finding out more about eating disorders shows you care and helps you to understand how your loved one might be feeling.

Numerous services offer help with eating disorders, but there are also things that you can do to support someone you care for. In this article, we share advice on how you can help someone with an eating disorder.

What is an eating disorder?

Eating disorders are serious mental illnesses that affect people of all ages, genders, ethnicities and backgrounds. People with eating disorders use disordered eating behaviour as a way to cope with challenging situations or feelings. This behaviour can include restricting the amount of food eaten, eating unusually large quantities of food at one time, getting rid of the food eaten through unhealthy means (e.g. purging, misusing laxatives, fasting, or excessive exercise), or a combination of these behaviours.

It�s important to remember that eating disorders are not all about food itself, but about feelings. The way someone handles food may make them feel more able to cope or may make them feel in control, though they may be unaware of why they are using unhealthy behaviours to deal with hard feelings. An eating disorder is never the fault of the person experiencing it, and anyone who has an eating disorder deserves to receive treatment quickly and compassionately to help them get better.

For more information visit the NHS eating disorder page.

Types of eating disorders

There are several different eating disorders that someone can be diagnosed with. Someone can move between diagnoses if their symptoms change, as there�s often a lot of overlap between different eating disorders.

The most common eating disorders are:

Anorexia nervosa � someone who is trying to control their weight by not eating enough food, exercising too much, or both
Bulimia � someone who binge eats, then makes themselves vomit or uses laxatives to purge the food from their body
Binge eating disorder (BED) � someone who consumes large portions of food until they feel uncomfortably full
Avoidant/restrictive food intake disorder (ARFID) - someone who avoids certain foods, limits how much they eat or does both
Other specified feeding or eating disorder (OSFED) � if the pattern of behaviour does not fit those above. OSFED is the most common diagnosis

Signs of eating disorders

It can be very difficult to identify whether a friend or loved one has developed an eating disorder. However, there are warning signs you can watch for. As eating disorders progress, the signs may become easier to notice.

Preoccupation with food

One of the common early signs of an eating disorder is a preoccupation with food and/or exercise. A person may spend more time talking about food, looking for recipes online, and cooking for others.

You may also notice:

Precise tracking of energy intake or steps
A sudden disinterest in certain food groups
An increased interest in different diets or healthy foods

As an eating disorder progresses, you may also pick up on certain food rituals and behaviours around mealtimes such as:

Eating foods in a certain order
Cutting food into tiny pieces
Having very specific portion sizes
Only using certain crockery and cutlery
Excessively chewing

When someone has an eating disorder, they will often continue to add more rules and rituals as time goes on.

Changes in mood

When a person is struggling with an eating disorder, this can impact their mood. They may become irritable and angry more quickly than usual, and they may also seem sad and reserved.

These mood changes can happen for several reasons. If the person is restricting the amount of food that they eat, nutritional deficiencies may mean they have less control over their emotional regulation. They may also become more irritable or angry when the conversation turns to their food intake and exercise, as they are likely to feel criticised.

A regimented exercise routine

A person struggling with an eating disorder may often have a disordered relationship with exercise too. If you are concerned that someone is showing the early signs of an eating disorder, you may have started to become aware of the following:

Their exercise routines are often very strict and inflexible
They display distress if their routine is disrupted or if they can�t train
Exercising takes precedence over other elements of their life including health, work and relationships
Despite evident tiredness and fatigue, they continue to exercise, even if they�re unwell
Exercise is used to work off calories, lose weight, or offset an eating binge

An obsession with tracking

A person who is developing an unhealthy relationship with food is likely to keep close track of their food and fitness. This tracking will be strict and regimented, where they monitor some or all of the following:

The number of calories consumed and burned
The number of steps taken
Changes in body weight and body measurements

Over time, tracking food and fitness can prevent people from being able to listen to signals from their bodies. Rather than focusing on what their body wants and needs, they come to rely on rules and restrictions summarised in tracking apps and devices to determine how they should eat, drink and exercise.

Deception

When someone has an eating disorder, they will often start to lie to other people about their eating and their exercise in an attempt to maintain control.

Some comments and behaviours that you may notice include:

They say more often they have already eaten
They are too full and will eat later
They feel ill more often or have a stomach-ache
They want to eat elsewhere, such as in their room
They say they don�t like the food that has been prepared
They have a slower eating pace

This deception is something that typically worsens over time, as the person attempts to hide what is going on from other people.

Low body confidence

You may notice that the person is unhappy with how they look. They may communicate this to close family and friends and will believe other people see them in the distorted way in which they see themselves.

Signs to look out for include:

Extreme preoccupation with body or weight (e.g. constant weigh-ins, spending lots of time in front of the mirror body checking and criticising their body)
Significant weight loss, rapid weight gain, or constantly fluctuating weight
Frequent comments about feeling fat or overweight, or about fear of gaining weight
Wearing baggy clothes or multiple layers in an attempt to hide weight

Tips for supporting someone with an eating disorder

Getting professional help from a doctor, practice nurse, or a school or college nurse will give your loved one the best chance of getting better. But this can be one of the most difficult steps for someone living with an eating disorder, so try to encourage them to seek help or offer to go along with them.

You can support them in other ways, including:

Learn about eating disorders

The more you know, the better prepared you�ll be to help your loved one, avoid setbacks, and cope with challenges. The eating disorder charity Beat also has information on what to do if you're worried about a friend or family member.

Listen without judgment

Give your time, listen to them and try not to give advice or criticise � this can be tough when you don�t agree with what they say about themselves and what they eat. Try to remember, you don�t have to know all the answers. Just making sure they know you're there for them is what's important. This is especially true when it feels like they are rejecting your friendship.

Show patience

Recovery from an eating disorder takes time and persistence, so it�s crucial to show your loved one patience and compassion. Try to avoid placing pressure on them with unrealistic goals or demands to see progress. Don�t shame, argue, manipulate, or bargain them into new eating habits. Instead, give them hope and encouragement, praise each small step towards health, and stay positive through their tough days or setbacks.

Take care of yourself

Try not to become so preoccupied with your loved one�s eating disorder that you neglect your own needs. Make sure you have support, so you have the tools to help them. Whether that support comes from a good friend, a support group, or a therapist, it�s important to have an outlet to talk about your feelings and emotionally recharge. It�s also important to schedule time into your day for relaxing and doing things you enjoy.

Try to include them

A person with an eating disorder may not want to go out or join in with activities, but keep trying to talk to them and ask them along, as normal. Even if they do not join in, they will still like to be asked. It will make them feel valued as a person.

Try to build up their self-esteem

A person with an eating disorder may struggle with low self-esteem. You could try and build it up by telling them what a great person they are and how much you appreciate having them in your life.

Help them seek support

While it can feel scary, the act of opening up to family and friends can be invaluable. Support groups, both online and offline, can help anyone struggling with an eating disorder to link up with other people with lived experience of what they�re facing. Secrecy and shame around eating disorders only preserve and reinforce them. If you�re supporting someone with an eating disorder, remain encouraging, offer your support and remember to attend to your own needs too.

Put them in touch with an expert

When someone is living with an eating disorder, the support of a professional team can make a big difference. If you�re supporting someone, encourage them to share their symptoms with a GP so they can monitor their overall health.

A psychologist can address the cognitive and emotional patterns underlying and maintain disordered eating, while a dietician can help establish a meal plan tailored to their needs.

Validate their feelings

Being heard is so important. You could try to help them externalise their illness. You could start by asking questions like �How is the eating disorder making you feel?� and ask them to share what they�re experiencing (so long as they�re comfortable doing so). These simple steps can reduce any stigma concerns, help them feel less alone and provide encouragement to seek further help.

Be mindful

Be mindful of potential eating disorder triggers. Try to avoid any discussions about food, eating, or weight. Be aware of your perspective or negative statements you may make regarding your own body or food. Try to eat �normally� in front of someone with an eating disorder as it can help them normalise their relationship with food.

Eating disorder treatments

It�s completely possible to recover from an eating disorder, but it may take time and recovery will be different for everyone. If someone is referred to an eating disorder specialist, they'll be responsible for their care.

Treatment for an eating disorder can include:

Online self-help programme

In some cases, support may be offered through an online self-help programme.

This might be offered initially if:

there is a diagnosis of bulimia
there is a diagnosis of a binge eating disorder
the symptoms of the eating problem are similar to either of the above.

There may also be short support sessions alongside the programme. These may be face-to-face or over the phone.

If the programme is hard to complete or is perceived as being unhelpful, the GP should be contacted for more support.

Nutrition advice

During treatment, there will be advice on how to eat healthily and what a good diet looks like. However, this advice alone will not help someone recover from an eating disorder, so they will need to have talking therapy as well as dietary advice.

Cognitive behavioural therapy (CBT)

CBT involves talking to a therapist, who will help to explore emotions and thoughts that could be contributing to an eating disorder. It may be offered for anorexia, bulimia, or binge eating disorder.

For binge eating disorders, group CBT sessions are usually offered at first.

You can access talking treatments through the NHS. GPs should be able to make a referral.

Medication

There are no specific medicines to treat eating disorders. However, there are medicines to help with underlying factors such as depression or anxiety. For example, someone may be offered antidepressants to help manage these feelings.

A doctor will decide whether to offer medication alongside other treatment options such as talking therapy. The individual can agree with their doctor what is the right treatment for them.

Read more about the different treatments for:

Treatment for other specified feeding or eating disorders (OSFED) will depend on the pattern of symptoms.

Useful resources

It can be difficult to know what to do if you're worried that someone has an eating disorder.

They may not realise they have an eating disorder. They may also deny it or be secretive and defensive about their eating or their weight.

You might want to let them know you're worried about them and encourage them to see a GP. You could offer to go along with them as support.

The eating disorder charity Beat also has information on:

Beat, also provide useful information about eating disorders, as well as a helpline and chatrooms where you can talk to someone about how you are feeling and get help.

Get support for yourself

It's important the whole support network understands the situation and has support themselves.

The following organisations offer advice online:

You can also ask your GP about support groups for parents/carers looking after someone with an eating disorder.

Find services for people with eating disorders.