Eating with Disorders

When you eat with someone who has an eating disorder, the two of you are never alone.  A constellation of distorted thoughts, painful emotions, and habit-driven impulses joins you at the meal, wreaking havoc on your friend, daughter, brother, coworker, or partner.  Whether it’s a family member who consistently claims to have eaten just before meeting up with you or a classmate who carries his own mustard to the cafeteria and adds it to everything from lettuce to toast, most of us can call to mind a person whose behaviors around food and eating are concerning, but we’re often clueless about how to help while we’re sitting at the table across from our loved one – and their eating disorder.

Eating with patients in various treatment settings over the years has given me a unique perspective on the things that often occur at meals for individuals with eating disorders.  First, the emotions: fear, anxiety, disgust, and guilt, not to mention the anger and irritability that defends against them.  Whether they appear composed or distracted, those struggling with these illnesses are commonly bombarded by distressing thoughts like, “If I eat this, I’ll get fat” or, “I don’t deserve to eat.”  A range of unusual eating behaviors are often observable: cutting food into small pieces, excessively stirring or manipulating food, eating foods in a specific order. The non-disordered eater at the table can be easily overwhelmed by these and other aspects of the uninvited tablemate that is The Eating Disorder, and the mealtime experience can become tense and unpleasant.

Though little research is available to guide us on the best ways to support those with eating disorders at mealtimes, the following tips, based on my experiences of what works best for patients in treatment, may help:

• Provide support.  Ask the person how he or she is feeling and if there is anything you can do to help.  Remember that there is a battle raging inside the person you care about – try to ally yourself with the healthy side of that struggle (that is, with your loved one against their illness) without jumping into the battlefield as a second adversary.

• Gently offer your observations.  Don’t be afraid to call it as you see it, but also try not to be the “food police.”  There is a big difference between, “Why don’t you just eat normally?!?” and, “Your lunch looks a little small today – I’m worried you’re going be hungry again really soon.”  Sometimes it’s hard to figure out the most effective wording in the heat of the mealtime moment. Brainstorming different language and practicing it on others in anticipation of your next meal with your friend or loved one can help you feel prepared to communicate more effectively.  If you’re close to the person and he or she has been open with you about particular eating-related struggles and goals, this is an invitation to provide more specific comments (e.g., “I know you’re working on eating more carbs, so how can I best support you as you eat your roll?”).

• Walk the line between distraction and engagement.  Individuals with eating disorders may try to avoid thinking or talking about the fact that they’re eating, perhaps by chattering away about an unrelated topic or by rapidly asking questions to take the focus off of them.  In this case, gentle redirection can help (For example, “Gosh, I’m really taking away from your eating time here – how about if I talk for a bit so you can focus on finishing your food?”).  Others may become distracted by the meal or may “shut down” emotionally and seem unreachable.  Asking openly about what might be going on for them might break down the walls of mealtime isolation.

• Serve as a model of healthy eating and healthy communication.  It is common for individuals with eating disorders to compare themselves with those around them, particularly at mealtimes.  Before sitting down to a meal with someone you know or suspect has an eating disorder, do an honest self-assessment of your own eating idiosyncrasies and be prepared to respond to questions or comments in an honest, non-defensive manner.  In this way, you can model both healthy eating behaviors and healthy communication.

• Know when to ask for help.  You alone are not responsible for your friend or loved one’s wellbeing. Rather than take on the role of sole or primary caretaker of an individual with an eating disorder, encourage the person to use as many supports as possible and to seek professional help if the struggles persist.  Also, consider whether or not you might benefit from learning a bit more about these conditions and their treatment.  The National Eating Disorders Association is a great resource for patients and for family members and friends of those who suffer.

We still have a lot to learn about the role of eating in eating disorders and potential therapies that might help alleviate mealtime anxiety.  In the meantime, figuring out ways to support the person with the disorder while challenging the symptoms of the disorder (and remembering that they are not one and the same) can make the process of “eating with disorders” just a little easier.

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