What to do:
Learn as much as you can about eating disorders. Read books, articles, and brochures. Surf the Internet.
Know the differences between facts and myths about weight, nutrition and exercise. Knowing the facts will help you reason against any inaccurate ideas that your friend may be using as excuses to maintain her disordered eating patterns.
Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body-image problems. Avoiding it or ignoring it won't help.
Be caring, but be firm. Caring about your friend does not mean being manipulated by her or him. Your friend must be responsible for her or his actions and their consequences. Avoid making "rules," promises or expectations that you cannot or will not uphold. For example, "I promise not to tell anyone," or, "If you do this one more time, I'll never talk to you again."
It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body-image or eating problems in their beginning stages probably offers your friend the best chance for working through these issues and becoming healthy again. Don't wait until the situation is so severe that your friend's life is in danger. If you have already spoken with your friend and still feel that more steps need to be taken to address these issues, consider telling her or his parents, a teacher, a doctor, a counselor, a nutritionist or any trusted adult. People with eating disorders need as much support and understanding as possible from the people in their lives.
Address your concerns and approach your friend.
There can be as many approaches as there are individuals, but in thinking about how you will talk to your friend, it may help if you develop a plan.
Instead of focusing on the number of calories she or he is eating or the number of pounds gained or lost, or meals not eaten, you may find it helpful to use the following approach (suggested by Levine & Hill, 1991) to think about their behavior, and to help you address your concerns with your friend.
- Inefficiency-Is your friend suffering from physical and psychological lapses in strength, energy and concentration?
- Misery-Is your friend clearly suffering? Is she angry, depressed, anxious, obsessed or sad?
- Alienation-Is your friend's constant concern with and thoughts about eating, weight, exercise and body image cutting her off from you and her family and friends, and even from herself?
- Disturbance-Is your friend's behavior scary, upsetting or generally disturbing to you, to her and to others?
What to say, step by step:
Set a time to talk. Set aside a time for a private, respectful meeting with your friend to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be someplace away from other distractions.
Communicate your concerns. Point out a few behavioral instances that indicate to you that you should be concerned about your friend's health, happiness and safety. Explain that you think these things may indicate that there could be a problem that needs professional attention. It is more effective to give them reasons for your concern rather than asking, "Is everything okay?" or "Is there something you want to tell me?". A direct approach usually works best and you can't be brushed off as easily: "I am worried because I heard you throwing up after dinner."
Ask your friend to explore these concerns with a counselor, doctor, nutritionist or any health professional she or he feels comfortable enough to see. If you feel comfortable doing so, offer to accompany your friend on her or his first visit.
Avoid conflicts or a battle of the wills with your friend. If she/he refuses to acknowledge that there is a problem or any reason for you to be concerned, restate your feelings and the reasons for them. Leave yourself open and available as a supportive listener.
Avoid placing shame, blame or guilt on your friend for her/his actions or attitudes. Do not use accusatory "you" statements, such as "You just need to eat" or "You are acting irresponsibly."
Express your continued support for your friend. Let your friend know that you care about her/him and that you want her/him to be healthy and happy with herself/himself.
After talking with your friend, if you are still concerned for her or his safety and health, find a trusted adult or medical professional to talk to. This is probably a challenging and difficult time for both of you. It could be helpful for you, as well as for your friend, to discuss your concerns and seek assistance and support for yourself from a professional.
Follow through, and don't give up. People with eating disorders are very good at sidestepping the issue when confronted, and will convince you that nothing is wrong. It is natural to want to believe that, but don't give up on your concerns. Your friend may also admit to you that yes, she had a problem, but she's better now, or it's under control. Don't be satisfied with that answer.