Here’s a sobering fact: 30 million people in the U.S. will suffer from a diagnosable eating disorder during their lifetime, while many more cases go unreported. It’s likely that you have a friend, family member, or colleague who’s suffered from anorexia, bulimia, binge eating disorder, or EDNOS (eating disorder not otherwise specified). But since there’s stigma surrounding mental illness in America, many choose to keep their struggle (and recovery process) under wraps.
If someone is open enough to tell you about their food issues, you don’t want to risk hurting them or triggering problematic thoughts by saying something inappropriate. Judith Mosesso, LMSW, primary therapist at the Renfrew Center in Old Greenwich, Connecticut, emphasizes that every patient is different—what makes one person uncomfortable may not bother another. But, as a rule of thumb, here are some topics and phrases to avoid.
|Why don’t you just eat healthy and exercise?|
This is similar to telling a person with depression to “snap out of it”—it’s not that easy for those with an eating disorder to start eating “normally.” This question treats anorexia or bulimia like a diet plan chosen by the sufferer to help them lose weight, and it also discounts the depths of these diseases. As Mosesso points out, “these are mental illnesses. There is something going on in the chemistry of the brain that makes them behave like that.”
Sufferers often have deep-rooted anxieties surrounding certain foods or meals. The goal of treatment is to get over their fears and compulsions but recovery is a slow process. “Telling someone to just ‘get over it’ minimizes their feelings and can make the person feel weak,” she says. This often comes from lack of education about eating disorders. “People don’t realize that someone can get really sick from it,” Mosesso says. “They are shocked to find out someone could be hospitalized for anorexia.”
|I wish I had your willpower|
“They see this person as being very disciplined for their ability to restrict food,” she says. In reality, the person doesn’t want to have an eating disorder but is compelled to restrict or binge and purge. “An E.D. patient uses their behaviors around food as a way to control their emotions,” Mosesso says. The kind of language in the above phrase can reinforce disordered eating by giving them power, says Mosesso. When everything around them may feel chaotic or they feel they can’t do anything right, someone with an eating disorder can point to their restrictions, which are often “the only place where they are seeing success in their lives.”
|You don’t look that skinny|
Throw out the antiquated idea that a “typical” eating disorder patient is an emaciated young woman. People of all shapes and sizes can have eating disorders; just because someone hasn’t dropped below a certain weight doesn’t mean they aren’t suffering from a crippling disease. “You aren’t validating what they are going through and that makes them feel worse,” says Mosseso. And you’re actually feeding into their disordered thinking: In the mind of an E.D. patient, it could be taken as you pointing out that they haven’t lost enough weight.
Unfortunately, some doctors still use Body Mass Index as part of the diagnostic criteria for anorexia, but this outdated system ignores body type and patterns of behavior that may be beneath the surface. In addition, “a person could be bulimic and not look like they have an eating disorder, because they traditionally have a healthier BMI,” Mosesso says, but that doesn’t mean they aren’t in trouble. “By focusing on someone’s physical appearance, you ignore who they are as a person, their feelings, and what they are going through psychologically and emotionally,” she says.
|Don’t you know how bad that is for you?|
It should come as no surprise that the answer is yes. On some level, people with eating disorders do know how bad it is for them. “They have both an eating disorder brain and their rational brain,” Mosesso says. Think of it like good cop/bad cop: the longer someone goes untreated, the louder the bad cop becomes. Soon, according to Mosesso, the E.D. brain overpowers the rational inner self, dominating all thoughts, feelings, and behaviors. So while a person may understand the negative impacts of their disease, they don’t see those things as reasons to give it up.
|But you’re all better now, right?|
“Someone in recovery can feel a lot of pressure to get back to ‘normal’ again,” says Mosesso. “You can’t just wipe all those feelings away like a chalkboard. Like with drug addictions, relapses happen; the key is not exacerbating the patient’s guilt for falling back into old habits.” Understanding that this will be a lifelong struggle can be one of the best ways to support your loved ones.
|Let’s grab dinner|
Eating is a social activity: it’s one of the easiest ways to reconnect with friends. But if that friend struggles with eating, you should avoid suggesting that you catch up over a meal at a restaurant, she says. Instead, try going to a museum or for a walk in a park. Your conversation will flow just as easily and they won’t feel added pressure to eat a certain way.
If you do share a meal, steer clear of stressful topics Eating is already stressful enough for recovering patients; so don’t add to it by discussing things that may increase anxiety for them. If you are eating at home together, focus on upbeat topics that aren’t related to food; cheerful conversation can sometimes serve as a good distraction from food-related anxiety. Mosesso says one patient’s family bought TableTopics ($25; amazon.com), a box filled with thought-provoking questions like “If you could master one instrument which would it be?” to prompt lighthearted discussion. If the person lets you know that they’re struggling during the meal, ask them what they need from you but avoid talking about their emotions too much, she says.
|I ate so much last night, I’m going to skip breakfast|
There’s a difference between having disordered eating behaviors and having an eating disorder. Normalized eating changes every day, as Mosesso describes: “someone who doesn’t have a history of an eating disorder can binge on Thanksgiving dinner one day and skip breakfast.” These aren’t healthy behaviors but it doesn’t lead that person down the slippery slope of daily restriction. Take the time to explore your own relationship with food, but understand that while you may be able to eat a sleeve of Oreos and skip your next meal without ruminating too long about it, just talking about that could trigger a relapse in someone in recovery.
What should you say?
“Ask how you can be supportive,” Mosesso suggests, “and be there for them to do or say whatever they need. Don’t be confrontational and don’t become the ‘food police’—monitoring everything they put in their mouths.” You avoid talking only about their eating disorder, which can diminish who they are as a person. Mosesso stresses, “Don’t define them by their disease, encourage their individual thoughts, feelings and beliefs outside of recovery.”
This article originally appeared on Health.com.