Helpful Strategies for Supporting Someone With an Eating Disorder

An eating disorder develops over time as a result of many factors. Naturally, recovery does not happen overnight. It requires overcoming powerful factors that have been maintaining the eating disorder, some of which may be external to the affected person. Changing eating disorder behaviours is therefore often a slow, non-linear process. Looking at the “stages of change” model can be helpful in developing your understanding of where the person you’re supporting is in terms of their readiness for behaviour change, what to expect, and how you can be supportive during this time. Setbacks can be frustrating and exhausting and they can be used as learning opportunities. With this perspective, it is easier to reframe them as a normal part of behaviour change and to maintain hope about the upward spiral many folks experience in the process of their recovery.

Knowledge of these stages allows caregivers to identify whether their expectations of recovery matches their loved one's. For example, often, caregivers are ready for action and implementing changes from the beginning of treatment; meanwhile, their loved one may not even recognize there is a problem yet, let alone be mentally prepared for changes. In this scenario, the caregiver is at the “action” phase, while the person they’re supporting is in “precontemplation”. When you know where the person you’re supporting is within the “stages of change” model, you can respond more compassionately when conflict and setbacks occur.

“Leave me alone!”

Precontemplation is the stage when an individual is not ready to acknowledge that a problem exists. They may respond to concerns and suggestions with hostility and defensiveness. After enough prodding, someone in this stage may be talked into finding out a little more about it when people in their life are telling them they have a problem. This may include trying to become aware of why they have not identified that a problem is present, and becoming more informed about the behaviour others are telling them to change. 

People often enter treatment in this phase, and they may stay here for some time. While treatment providers understand this, it can be helpful to provide continued encouragement and communicate that you support them getting help. Because resistance is high in this stage, depending on your role in their life, you may have to be more direct and hands-on in supporting them in making changes.

As a support person, the precontemplation stage can be both scary and frustrating. Try to stay calm when engaging with the individual and remember that people can and do recover from eating disorders. Talking to the individual about the negative effects the disorder will have on things that matter to them can help them see the bigger picture of what is going on for them and, in turn, lead them to consider positive aspects of change. 

“I know I have an eating disorder, but I’m not sure I’m ready to change.”

During this stage, the individual is willing to admit that they have a problem and is now more open to receiving help. However, the fear of change may remain very strong. They can begin to see the benefits of making a change, but are not ready to let go of the eating disorder and the purpose it serves in their life. For some people, the eating disorder is thought of as a friend and something that keeps the individual safe. These conflicting thoughts and feelings can be confusing and perpetuate the fear of change. 

As a supporter, you could help them recognize the function of their eating disorder and how it does not serve them the way it used to (i.e. how it may be more harmful than helpful now). If the individual considers the eating disorder a friend, it may be worth gently challenging them to consider how good a friend it actually is if it is causing them physical/mental distress. Encourage them to share their thoughts and feelings about the eating disorder, and let them know you hear what they are saying. It’s important to let them feel in control of their decision for pursuing change, as imposing your beliefs on why they need to change can lead to further resistance. Listen for opportunities to reinforce their openness to taking a recovery-oriented step; if they mention a reason to make a change, reflect it back to them.

“I’m getting ready to make small changes.”  

During the preparation stage, the person you’re supporting is ready to change, but perhaps uncertain about how to do it. They might look for you for support and encouragement regarding next steps.

A task that you could take on is collaborating with them on a plan for how they are going to make those changes. This could include establishing specific coping skills such as appropriate boundary setting and assertiveness, effective ways of dealing with negative eating disorder thoughts and emotions, and ways to tend to their personal needs. You can also help them identify potential barriers to change and additional supports that they might need (e.g. connecting with a peer support group and/or professional for guidance; working with friends/family to ensure pets and/or children will be looked after if they enter treatment; generating a list of people to call during times of crisis). Reassure the individual that you will support them through this process and that they aren’t alone. 

“I want to stop dieting/bingeing/vomiting/over-exercising/etc.”  

The person you’re supporting is ready to implement their plan and confront the eating disorder behaviour head on. They may be engaged in treatment and working hard to change their behaviours, willing to face fears in order for change to occur. 

They will likely find the changes difficult and experience distressing thoughts or feelings. Continue to offer reassurance when they become conflicted about what to do (e.g. staying with treatment or not) and encourage them to communicate their thoughts and feelings to their treatment provider(s) and work through them together.  

“I’m trying to keep up the changes I’ve made.”

If the individual has sustained the Action stage for approximately 6+ months, they are in the Maintenance stage. They are actively practicing new adaptive behaviours and new ways of thinking, bringing what they learned in treatment or from other resources into everyday life and learning to form an identity separate from the eating disorder. In doing so, they are living life in a more meaningful way. In this stage, ideally, they have a solid relapse prevention plan.

It could be helpful to discuss how you can continue supporting them in learning to live their life away from the eating disorder. Remind them that although setbacks may happen, people can and do recover from eating disorders – and regardless of where they are in their journey, you are proud of them for challenging the eating disorder. 

“I’m noticing the disordered thoughts/feelings are getting louder again/more prevalent in my daily life again.”

Recovery is not a linear process. It is normal and expected to encounter setbacks. A slip-up or smaller setback is often referred to as a lapse, while a bigger setback regarding thoughts or behaviours tend to be referred to as a relapse. While very difficult for the support person to witness and frustrating for the person affected to experience, setbacks can be learning opportunities that push an individual forward in strengthening recovery. 

They might feel like they are going in circles, but when we look at it sideways, it is an upward spiral – meaning they are not at the same place as where they started. Recovery is still possible. Sometimes people need to go through this cycle multiple times before they are able to maintain recovery. Offering this perspective and reminder can help in normalizing this upsetting process. Accepting this as a part of the recovery experience can strengthen their ability to practice self-compassion and remain hopeful and motivated for change. 

“The eating disorder no longer interferes with my life.”  

Recovery looks and feels different for everyone. For some, it is an ongoing process of healing. Some get to a point of being recovered that they define as a state in which they occasionally experience eating disorder symptoms but feel like they can live a full and satisfying life. Many people recover to the point where they no longer struggle with disordered thoughts, feelings, and behaviours related to food and their body – widely considered to be fully recovered. 

Regardless of how the person you’re supporting conceptualizes recovery, celebrate their resilience and continued hard work. Throughout the recovery process, it’s important to recognize and accept your limitations, seek your own support, and take “time-outs” from the helping role; this will help you avoid emotional burnout.

Mealtimes can be riddled with conflict and intense emotions for both those affected with an eating disorder and those supporting them. Here are some strategies that can help make things more comfortable. Remember that different tactics will work for different people at different times. 

Meal planning

• Ideally, someone who struggles with meal planning would be working with a dietitian or nutritionist and receiving guidance in meeting their nutrition requirements. If the person you are supporting is engaging in nutrition therapy, they may need help implementing their nutrition plan.

• Planning ahead can help reduce anxiety, minimize negotiation during the meal, and ensure adequate nutrition. If you are eating together, discuss who will be involved, what you are going to eat, what time you will eat, and where the meal will take place. 
  • Check that you have everything you need for the planned meal to avoid any last-minute changes, which could increase anxiety. 
  • As taking away food choices often provokes distress due to the loss of control over their intake, presenting them with two meal options can help prevent outbursts of emotion before mealtimes. This can allow the person you’re supporting to feel that they still have some autonomy to choose what they eat, but their options have been thoughtfully considered to ensure they will get adequate nutrition. If they try to negotiate as the meal is being prepared or served, reinforcing that they chose the food in question can help reduce the distress that is driving their attempt to get out of eating it.

• You can provide grocery shopping support by working with them to decide what to purchase and making a list, accompanying them to the store, and helping locate items on their list. 
  • Ensure the person you’re supporting has an additional safety plan in case they feel overwhelmed. For example, you might continue to shop for them if they need to step out of the store and use their coping skills.

• Encourage the person you’re supporting to join community-based support groups focused on nutrition if available, as these provide opportunities for psychoeducation and can help build confidence around food and reduce isolation.

• Online grocery shopping may be an option if the person you’re supporting finds the abundance of food options in-store overwhelming. 

• As multipacks or bulk portions of food can be challenging, especially if it is a food that the person tends to restrict or binge on, buying single servings could be more manageable.

Supported eating

• Create a positive atmosphere that focuses on the social aspect of meals.

• Keep the conversation neutral during mealtimes. Avoid sensitive topics such as diets, exercise, appearance, or how treatment is going.
  • Even topics like school, work, relationships, or hobbies can be stressful for some people. Know what subjects are comfortable for the person you’re supporting. 

• Ask the person you’re supporting what would help at mealtimes. Intentional distraction is a common strategy – for example, watching TV, listening to a podcast, playing board games, doing puzzles, colouring, being engaged in a conversation, etc. 

• With restrictive eating disorders, it’s common for physical discomfort (e.g. stomach pain and feeling full very quickly) to occur with eating regularly again. Follow the advice of their treatment provider(s), and be ready to support them through this discomfort, providing encouragement to continue eating regularly and using strategies to ease some of their discomfort. 

Post-meal

• Plan structured activities with the person you’re supporting after meals, such as games, homework, watching TV, spending time in nature, playing with a pet/sibling, doing laundry, etc. 
  • If the person you’re supporting doesn’t have anyone to accompany them after a meal, ensure they have intentionally planned an activity that they can do on their own. It may be helpful to try and be as far away from potential trigger zones (e.g. washroom or kitchen) as possible. 
  • Doing a solo activity with a companion virtually (via video or phone call) can also be supportive. 

• Evening meals are often the most difficult for people who binge eat. If the person you’re supporting struggles with binge eating, ask what you can do to help them manage during evening and night times.

It is common for people with  eating disorders to withdraw from social activities. Taking steps to stop them from isolating themself and to make them feel included helps promote recovery. 

• Continue inviting them to group gatherings and activities. Try not to sound aggressive. Frequently bringing up events they missed can lead to defensiveness and/or resentment as the person you’re supporting may believe you are blaming them for not being a good friend. Examples: 
  • “We miss spending time with you”
  • “You make things fun with your ___ (e.g. laughter, new perspective, knowledge, etc.)”
  • “It’ll be nice to try something new together – if we don’t like it, we can just leave early”

• Try to plan activities and social events that don’t revolve around food or exercise. Examples:
  • Board games
  • Escape room
  • Art-based activities (e.g., painting, pottery, embroidery, screen printing, etc.)
  • Live music, poetry readings, or theatre
  • Volunteering at a local nonprofit (e.g. animal shelter, food bank, etc.)
  • Museums, aquarium, amusement parks
  • Gardening 

• Have conversations unrelated to the eating disorder and treatment. Highlighting other interests and aspects in their life can be a helpful reminder and affirmation that the eating disorder experience is not their whole identity. 

• Help them find new hobbies or return to old ones they used to enjoy. If sports and/or exercising was a big part of their life prior to developing an eating disorder, they may need professional guidance to safely resume regular physical activity.

Eating disorders can make people behave in ways that seem out of character. They might respond emotionally or aggressively to others’ concern and attempts to help, especially when they feel challenged or pushed into a corner. Here are some tips that may help prevent further escalation of the situation.

• Give yourself and the person you’re supporting space by physically walking away and waiting until everyone involved has calmed down before resuming the conversation. Have a plan in place to ensure that they and anyone else present can stay safe. This might include having a set of coping strategies on hand or a safety plan ready to be implemented if risk of harm to someone arises.
  • “I’m going to take some time out. You’re upset. I’m upset. Let’s come to this when we're both feeling a bit calmer. I’m going to listen to some music for half an hour.”
  • “I’m tired now and you seem upset. Let’s take some time out and come back to this later on.”

• While it’s reasonable to feel frustrated or hurt when faced with anger, try to avoid responding with anger yourself. 
  • If you do end up angry at them and expressing it, try not to feel too guilty about it. When things have calmed down, set aside time to explain how you were feeling and invite them to do the same. Learning about the other’s perspective can help prevent miscommunication and conflict in the future.

• Use reflective listening to show you’re actively paying attention and trying to gain a better understanding of how they’re feeling and what you can do to support them. Combine this with open-ended questions to minimize assumptions and encourage them to share their thoughts.
  • They say, “Just leave me alone! There’s no way out. You’re just making this worse.”
  • You may respond, “It sounds to me like you’re feeling alone and trapped in this” (reflection) and “I want to understand you better. What does 'making this worse' mean?” (open-ended question)

• When things are calm, don’t be afraid to have conversations about boundaries. As much as the person you’re supporting is unwell and struggling, it doesn’t give them the right to hurt others. It is fair to talk about what is acceptable and what isn’t in the context of your relationship. Discuss ways to potentially avoid a similar conflict from reoccurring and coping strategies they could use when feeling heated. 

• Remember to take care of yourself. Model self-compassion to the person you’re supporting. Explain that you love them and don’t blame them for the way they reacted, and let them know that you’re going to spend some time tending to your own needs.

• Work together with other people in their life, both loved ones and the professionals supporting them, to ensure that you are united in how to approach difficult situations. This sends a consistent message to the individual and makes it easier for them to safely adapt their response to conflict and heightened social interactions. 
  • It can help to connect with caregiver peer support groups. Benefits include learning from others who are in similar situations; dedicated space to work through your own challenges as a support person; and reduced isolation, a feeling that is normal for both the person directly affected with an eating disorder and the people caring for them.

While many comments may be well intended and come from a place of caring, the eating disorder can skew the way in which the person you're supporting interprets what is said to them. It’s understandable if you feel uncertain of what to say in fear of further perpetuating the eating disorder. Here are some examples of helpful language.

Example 1

Just eat normally.

What may be heard: “You’re not trying hard enough”; “It’s not hard to eat / stop eating”; “You are greedy”; “Binge eating isn’t a problem”; “You are making this up”; “You want attention”; “You are the problem”; “You are a burden”.

Alternative: Eating disorders are complex mental illnesses. It’s not helpful to diminish one’s experience by offering a simple and reductionary solution – this can amplify feelings of shame. Demonstrate your understanding of eating disorders by validating their concerns and showing support.

• “Struggling or asking for support is nothing to be ashamed of; no one chooses to have an eating disorder and this isn’t your fault.”
• “I can see it’s really tough for you and I know you’re trying. I’m here to support you.”

Example 2

You look well.

What may be heard: “You look fat”; “You’re healthy now so things are easy for you”. 

Alternative: Affected individuals often take comments that relate to looking “healthier” or “better” to mean they have gained weight, which can heighten disordered thoughts and feelings. Give non-appearance-based compliments or focus on an item/accessory they own. It’s also nice to ask how they are, rather than making a statement rooted in appearance-based assumptions. 

• “Your energy is wonderful today”
• “I like your skateboard – really cool deck art”
• “How have you been feeling lately?”
  
  

Example 3

Wow, you've lost weight!

What may be heard: “You look better now that you're thinner”; “It's not okay to have a bigger body”. 

Alternative: Commenting on weight loss, even if intended as a compliment, conveys a bias against larger bodies and can heighten disordered thoughts and feelings. Give non-appearance-based compliments or ask how they are doing, rather than making a statement rooted in appearance based assumptions. 

• “It's so nice to get to spend time with you”
• "I've missed you! How have you been?"

Example 4

I wish I had your willpower / control / self-discipline / your body.

What may be heard: “It’s good to be obsessive with food, weight, and shape”; “You are in control of the eating disorder”; “The eating disorder is a blessing”; “You need to keep doing the disordered behaviours”.

Alternative: Because disordered behaviours are often used as coping mechanisms, it is extremely difficult to fight  the intense thoughts, feelings, and experiences that drive someone to engage in disordered eating and to change their habits. Don’t make statements that imply the eating disorder is the person’s choice. Avoid commenting on ways you want to change your weight and shape. If you want to talk about body image, food, or exercise, make sure you are not putting pressure on them to feel a certain way about their body, and that you’re emphasizing all the ways food and movement can fulfill our lives, rather than connecting it to physical appearance.

• “It’s not weird to feel differently about our bodies depending on the day, time, and situation in our lives.”
• “It’s unrealistic to go from hating how you feel in your body to loving it. It’s okay to aim for feeling neutral or like you can go about your day without it affecting your social, mental, and physical well-being.”
• “This food reminds me of [this positive memory]”
• “I like the social connection and excitement of a competition when we _____ (e.g. play/watch basketball, dance, swim, etc.)”
• “Slow movement like relaxing stretches help me decompress.”
  
  

Example 5

Get well soon.

What may be heard: “It’s easy to overcome this”; “You aren’t trying hard enough”; “You’re a burden”; “Hurry up and get better”. 

Alternative: Reassure them that you will support them  throughout this process even when it is difficult. Validate their strength, patience, and bravery for challenging the eating disorder.

• “It’s normal to feel frustrated if you’re not yet where you want to be physically and mentally. Recovery and healing is a process and it takes time. You’re still doing well.”
• “I’m so proud of you for doing your best to stand up to the eating disorder – no matter how big or small you feel those victories and clapbacks are.”
  
  

Example 6

I know exactly how you feel – I can easily finish a box of cookies.

What may be heard: “It’s not a ‘real’ problem because everyone eats this way”; “It’s normal to binge eat”; “You don’t deserve support”.

Alternative: While everyone overeats on occasion and may engage in emotional eating at times, these behaviours are concerning when accompanied by frequent feelings of guilt and shame or a feeling of being out of control with one’s relationship with food, or when eating is one’s sole coping mechanism. While it’s good to validate and demonstrate understanding, do not trivialize or over-simplify what the person is going through and assume you completely understand their feelings and situation. 

• “I hear how distressing this is for you and that you feel out of control. Do you want to tell me more about it?”