Supporting friends and family with eating disorders

Many individuals recovering from eating disorders, and families assisting their children and teens through recovery, receive little support and outreach during this difficult process. People tend to shy away from those with eating disorders and other mental illnesses because there isn’t a solid understanding of what the illnesses are and how seriously they can impact health. Also, with near constant media focus on dieting, restricting and endless exercise being good, many people are led to believe that disordered eating and eating disorders are nothing to worry about at all. This lack of understanding leaves individuals and their families isolated at a time when they have a need for support from family and friends.

When friends or family are ill, we reach out…right?

It’s human nature to provide care and support when our friends or family members are ill or struggling. These times can vary from coping with the death of a loved one or dealing with a personal health crisis, to caring for a sick child. Once we’re aware, we reach out to offer our help, make a meal, “check-in,” and just listen. Yet, when it comes to mental illnesses, like an eating disorder, that same care and support is often missing.

Why do we view mental health differently than physical health?

Society tends to view mental illness differently than physical illness. Why? I can think of a few contributors to the misperception around mental illness:

  • Physical illness is visible or provable with images and tests, but you can’t prove mental illness, giving it the perception that it’s less real.
  • Most physical illnesses seem less in our control – they are something that happen to us, while mental illnesses seem like they are in our control, they are our mind after all, so they must be a decision we’re making.

The estimated mortality rate for breast cancer is about 10%, while anorexia has a similar estimated mortality rate. This statistic is a useful indicator of just how serious the eating disorder is for those working towards recovery, and their loved ones. Also, similar to cancer and other “physical health diseases,” those with eating disorders suffer from long term health complications to vital organs and the skeletal system, and they require an often lengthy, intensive, costly and draining treatment process.

What it’s like to be in recovery from an eating disorder

Adolescents

The treatment process for children or teens with an eating disorder can be swift and intense depending on the severity of the disorder, weight loss*, health complications, and accompanying mental health issues. There may be a hospital stay to stabilize the child physically, followed by full or part-time residential care to continue monitoring the physical health of the child while establishing a treatment plan. There is also out-patient treatment, where the child is physically monitored and mentally supported by a team typically comprised of a primary care physician or GP, a psychologist or psychiatrist, or both, and a registered dietitian.

Family based treatment (FBT) is the gold standard for the treatment adolescents, because it allows the child to be supported with care by a medical treatment team as well as trained family members, giving nearly constant support and reinforcement in the out-patient recovery process. In addition to attending all appointments as a family, FBT puts parents on the front line of confronting their child’s eating disorder at home – preparing and planning all meals, and visually ensuring that they are eaten; assisting with at-home therapy needed to get through each meal and each day; and, monitoring for any form of restriction. This is a highly emotional, demanding, and stressful process, and can sometimes create tension between everyone in the family.

The daily reality for families experiencing any form of treatment is that their child is away from them for most or part of the time, and they are often putting other activities on hold and taking time-off or a leave of absence from work to keep up with a demanding routine of appointments. During this time parents likely fear that their child will not only miss school, but also miss other opportunities for sports and clubs, camps, work, common social interaction, and potentially delayed graduation. But the even greater challenge is knowing that while a child is in the midst of an eating disorder, the disorder is determining their every move. Their brain function, heart function and other organs suffer, and there is a very real and constant fear that the often-accompanying anxiety and depression will lead to self-harm. The whole family’s focus is – and has to be – on the child, despite siblings, jobs, and other demands on the family.

Adults

Adults with eating disorders face another set of challenging circumstances, as it often takes a full-blown health scare or hospitalization from an eating disorder complication for an adult to be able and willing to take time out from work, family and an overall busy life to focus on treatment and recovery. Most adults tackle this on an out-patient basis, typically without the aid of family training and support. Recovery is then usually aided by a treatment team of a primary care physician or GP, a psychologist, psychiatrist or both, and a registered dietitian (if you have the financial ability or health insurance to cover the costs). The difficult element here is that the adult is relying on their own personal motivation in between these appointments to stay committed to their goals and take care of themselves.

Adult recovery is especially challenging as it tends to be isolated and lonely. You face physical and mental changes with an hour or two of support each week. You are likely scared at the prospect of recovery and what that it entails, and concerned about others knowing about your illness for fear of being judged or criticized. Finding an in-person or online support group, using a diary or another form of writing to express yourself, reaching out for religious support if available, or just finding a good friend or family member that can listen and be supportive is not only helpful, but critical. Adults need to feel heard and supported through recovery as much as a child or teen.

About weight and diet

We are all constantly confronted (in schools and homes, on TV and electronic devices, in stores and malls, and sadly, even the doctor’s office) by a world that is fat-phobic, setting the expectation that all bodies in their natural state are “thin.” Media and advertising have generated a billion dollar diet industry based on fear, and everyone, everywhere, is talking about what and when they do and don’t eat. This is very challenging for anyone with an eating disorder. One of the best things that you can do for your family or friends experiencing an eating disorder is to not talk about diets, weight, specific amounts of exercise – or anything that would prompt them to compare themselves physically, what they’ve eaten, and how much they’ve exercised against you or anyone else.

Also, if you are not a registered dietitian, don’t give nutrition advice…you’re not qualified! Whatever works for you in a particular moment of time, may not work for someone else. Every body is different – all bodies have different chemistry, work differently and react differently – and only an experienced dietitian should give diet advice after considering a person’s physical and mental health, and personal circumstances.

*Eating disorder weight loss does not always mean the typical media image of the emaciated teen. Eating disorders and their severity are often wrongly judged by the body’s appearance alone. Not all bodies, and in fact many, don’t react to restriction in the same way. Someone who looks thin, normal, or overweight, can be struggling with a severe eating disorder, and they are on the same physically and mentally destructive path as the person that is emaciated.

Always hold on to hope

Recovery is possible, especially with a solid support network.

For information on what to look for if you are worried about someone with disordered eating or an eating disorder, visit this page by the National Eating Disorder Association (NEDA): https://www.nationaleatingdisorders.org/warning-signs-and-symptoms.

More information about what eating disorders are can be found here: