How to Talk to an Adult who you Suspect has an Eating Disorder: Part II

Below is follow-up from our previous post on how to speak to an adult who you suspect might have an eating disorder. This post provides a detailed break-down with step-by-step suggestions to help you formulate your conversation.

1.) Open the conversation by asking if they have a moment to talk.

Example A) I have something I’d like to say which may be touchy to bring up. I’m a little nervous about saying this in a way that comes out right…

Example B) I’ve been thinking about you lately and I’d like to share some thoughts about some things I’m seeing…

2. ) Kindly speak about 2-3 observations that you have made regarding their behavior.

Be specific and objective. In other words don’t go directly to your interpretation of their behavior. Don’t say “I think you have an eating disorder..” rather:

Example A) I noticed you picking at your food the other night, and leaving most of it on your plate.

Example B) I noticed you got up from the table the last few night right after we ate and went into the bathroom. I began to wonder what might be going on…

Example C) Lately you’ve been getting up before dawn to go running. This is new for you, and then I noticed you going back to the gym in the evenings…

Example D) I noticed that there has been food missing from the cupboards, and it made me wonder what might be happening.

Important: In the above statements they are direct observations, but they are framed as what was noticed directly versus what you imagine or heard.

3.) After stating the observations with concern and kindness, frame your observations as evoking curiosity in you about what may be signs of a larger problem.

Name the disorder or problem as best you can and state that your intention in this sharing is to ask the person to consider getting treatment.

Example A) What I saw made me curious to consider that perhaps you are struggling with bulimia and if so, I want to support you to get help.

Example B) I know personally what it is like being so afraid of gaining weight that I became obsessive about portions and over exercise. I know now that I should have sought help because there is excellent treatment available.

4.) Find a way of joining with the person through statements that offer understand that well-intentioned health habits can become problematic.

You could use self-disclosure here to normalize having a potential eating disorder.

5.) Check in as to what it is like hearing the observations and concerns that you stated.

This invites them to share, and a chance for you to reflect back what it is they are saying. This “active listening” technique will help them feel understood by you, and whether or not they take action right away or not, it contributes to a positive experience toward being honest in the long run.

The individual may get defensive here, and this is an outlet for them to do so. Most people will react, and try to justify their behavior, saying they are fine and you don’t need to worry. If you are prepared for that very likely outcome, it helps! If they insist they are fine and there is nothing wrong. The goal is to leave the door open so if/when they are ready to talk about having a problem, you might be someone they could come to.

6.) Be specific about treatment options you have researched or have in mind.

Example A) I brought this up so that you know I care and that I’d be happy to help you consider treatment options. One option is just to see a dietitian that works with people who have focused weight concerns. She could see if you are fundamentally healthy and she knows how to keep weight off in very specific ways, once it has been lost. (Again many eating disorders start with a fear of gaining weight.)

Example B) I found a therapist (or program) right here in town that evaluates people for disordered eating. It is free and I heard they are friendly yet experienced in more subtle forms of eating/body image problems.

7.) Thank them for listening and for considering what you have had to say, and offer support should they want to have a future conversation.

Written by Francie White, MS, RD, Co-Founder of Central Coast Treatment Center; edited by Ai Pono Hawaii Staff Contributor