Nerissa Shaw is a psychotherapist specialising in eating disorders and the Clinical Lead at Somerset and Wessex Eating Disorders Association (SWEDA). SWEDA have 30 years of experience and 75% of their staff have lived experience of eating problems. They work alongside the NHS and other organisations with anyone affected by eating disorders. Alongside her Clinical Lead role, Nerissa designs therapeutic interventions and training programmes as well as working directly with clients. 

When someone you know is struggling with their relationship with food or with their weight or shape, it can be alarming and upsetting to watch them suffer. You may be unsure how best to help or may have found that previous attempts have not gone as well as you hoped. Alternatively, a friend or loved-one may have reached out to you for help, and you aren’t sure what sort of support to offer. This article offers some thoughts and advice to help you navigate this tricky role. 

What is an eating disorder?

An eating disorder is a mental illness characterised by disturbed eating behaviours and extreme levels of concern around body shape and size. It refers to illnesses such as Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder. It can also cover OSFED (Other Specified Feeding/ Eating Disorder) and sometimes ARFID (Avoidant/ Restrictive Food Intake Disorder) although ARFID is still not well understood or clearly defined and has some key differences to the other disorders. 

However, many more people struggle with disordered eating, a phrase that, in this context, refers to people who are struggling with symptoms of eating disorders but may not meet the criteria to be diagnosed with one. Having this ‘subclinical’ disordered eating does not mean that the problem is not worrying or deserving of treatment. In fact, the earlier we can intervene, the less likely it will be that the person goes on to develop a full-blown eating disorder. 

Some people can struggle for years with episodes of binging, restrictive eating, and behaviours designed to ‘compensate’ for eating such as self-induced vomiting, over-exercising or abusing medications, not to mention the anguish caused by obsessive and distressing thoughts and feelings about their weight or body shape. They may have periods where it gets worse or better that track periods of stress, difficult life events and better times but never develops into a full-blown ‘diagnosable’ eating disorder. 

How will I know if my loved-one has an eating disorder?

In short, you will not be able to tell just by looking at them. We might think about eating disorders as being characterised by women with skeletal frames who refuse to eat but people of all ages, genders, ethnic backgrounds and of all body shapes and sizes can have an eating disorder. 

You might notice:

• Rapid weight loss or gain or large fluctuations in weight.
• Anxiety or distress around food: avoidance of events involving food; refusing to eat in front of others; making excuses to avoid meals; being secretive about how much has been eaten. 
• Inflexibility around meals or types of food; refusal to eat things that others have prepared.
• Evidence of secret eating or food hoarding.
• Significant mood changes based on weighing or perception of body day-by-day. 
• A person being convinced that they are fat despite contrary evidence. 
• Obsessive exercising: distress when their exercise routine is disrupted, for example, through illness or injury or even going on holiday. 

How can I start a conversation with someone I am worried about?

Eating Disorders are often a coping mechanism, used to help someone manage distressing thoughts or feelings or feel in control in an unpredictable world. They are not all about food or a desire to be thin. It’s also important to remember that the person did not choose to develop an eating disorder; it is not their fault that they are ill. However, it is not your fault either so avoid self-blame. 

It is helpful to use a gentle, non-judgemental approach as someone with an eating disorder may feel shame about their situation. If not delicately handled, the person may react with anger or denial. 

• Plan what you want to say and think about how to structure it

• Be prepared to back off if the first conversation doesn’t go well but think about how you can try again. 

• Choose a private place and make sure you have plenty of time 

• Stick to things you have observed rather than guessing what might be going on. You can use phrases like ‘I have noticed that…’ or ‘I feel concerned about…’ rather than ‘You …’ statements. 

• Don’t use language that implies the person has control over their illness or that they can simply stop their behaviour if they choose. Trying to make them change by referring to the effect their behaviour has on you or others is likely to make things worse. 

• Encourage a trip to the GP; they can run some tests to rule out any immediate physical concerns

• Suggest a resource such as a specialist charity; this might be an easier first step for some than the doctor. 

What else should I think about?

Think about the language you use around people struggling with eating disorders; we live in a world where ‘diet culture’ is so entrenched that we don’t notice it much of the time. Referring to your own body or weight in a negative way, describing foods as ‘good’ or ‘bad’ or discussing diets and weight loss are unhelpful.

There is a medical risk associated with eating disorders, so this aspect needs to be considered. Regular blood tests and other monitoring will help manage any physical complications. 

Eating disorders are serious illnesses and require specialist help from someone with specific training; a well-meaning but inexperienced therapist could make things worse. If you are seeking private help, do some research and ask anyone you approach what experience they have with eating disorders. 
To seek help from SWEDA or talk to someone about an eating disorder, visit our website at www.swedauk.org, ring 01749 34 33 44 or email support@swedauk.org. We work with anyone in Somerset or Wessex (inc Bristol, Bath and surrounds) who is affected by eating disorders including young people. We also operate a helpline at 0300 330 5464. More details can be found here: https://www.swedauk.org/services/sweda-mindline-helpline