If you have a friend or family member who you suspect struggles with disordered eating or disordered exercise, and you want to speak to them about seeking treatment, start with these foundations in mind:
Know that your talk with them may not seem to have an impact at the time.
Since many eating disorder behaviors are considered positive signs of discipline by individuals with them, they may disregard concern about them as threats to their hard earned efforts (to lose weight, omit food groups, over exercise, etc).
Other behaviors are highly secretive and shameful to individuals and require great sensitivity if brought up. It may be they deny having a problem, but another’s kindly spoken observations are helpful to break down denial and encourage seeking help.
Speak the truth, then let go of the results.
It takes courage to speak up, and an act of deep kindness. It is also important to let go of attachment to the results. We only grow when we become open to growing and no one else can decide when that will be. Your communication may add to the factors leading to someone’s decision to get help, but that is all.
How to Approach the Talk
Organize your thoughts
It helps to have an opening statement about wanting to talk, and being honest that you may be nervous or this talk might be difficult.
Have in mind sharing any similar struggles in your past, using a bit of self disclosure as a way of normalizing and de-shaming their potential struggles. Any type of emotional issue or addiction of your own may be worth acknowledging….
Some “Do’s” and “Don’ts”
DO speak with compassion. Keep in mind we all find maladaptive coping strategies that do seem to work initially. Most of us will find ourselves suffering from some form of emotional problem at some point in our lives, so come at it as a fellow human on a learning journey…
DO know that our culture has ‘disordered eating.’ In other words, everywhere we turn, weight, eating advice, exercise advice and body image are topics of conversation. It is no wonder both genders and people of all ages get drawn into what is a disproportionate emphasis on body image and “healthism.” As a result, many young people feel that their obsessive relationship to body image or eating is quite normal these days!
DO speak with respect for that individuals’ attempt at self- improvement, which may have gotten out of hand. Appreciating their initial effort to try to get healthy, or lose weight can help lessen defensiveness now that their behaviors may be out of control.
DON’T come across in an accusatory manner. It just backfires.
DON’T list the health risks of suspected eating disorder. People with ED’s don’t respond to health risks as concerning and more than telling an addict that their addiction isn’t healthy. It just creates more anxiety, which can drive the disorder deeper.
DON’T bring up other people and their concerns, like “your sister is worried about you too.” Keep the feedback from you and about your concerns.
DON’T refer the patient to nutritionists that are not dietitian specialists. Do not refer this person to health practitioners likely to make nutrition recommendations, as ANY nutrition advice at this point only furthers the disorder. Well- intentioned practitioners that make diet or exercise recommendations (be it a personal exercise coach, a holistic practitioner) adds more fuel to the growing list of “good” versus “bad” foods.
DON’T use patronizing statements like, “You are smarter than this”, “You know better” or anything implying shame in having a disorder.
DON’T talk too much or too long. Keep your statements short and to the point. Otherwise you lose that person’s attention and interest in what you are saying.
Who or Where to Refer to?
If the fear in getting treatment is related to a fear of gaining weight, the person may be more willing to see a dietitian specializing in eating disorders first. It may seem less threatening to have their diet or metabolism analyzed for nutrition or exercise physiology advice rather than consider going to a therapist.
Psychologically trained dietitians know how to work with restrictive eating, bulimia and emotional overeating and will refer that patient to a psychotherapist soon after getting a safe attachment with the client. A dietitian may be the place to start in people that don’t want to admit to a disorder.
Recommending someone to an individual provider might be a good place to start, but referring to an inpatient treatment center is also a possibility, either way, a treatment center would be able to assess the situation and determine the appropriate way to proceed based on the duration and persistence of the symptoms, the individual’s location, mental and physical state, etc.
Our staff at Ai Pono Hawaii would be happy to speak with you or your loved one in-depth about our treatment options and figure out a plan that makes sense for you.
Written by Francie White, MS, RD, Co-Founder of Central Coast Treatment Center; edited by Ai Pono Hawaii Staff Contributor