Eating disorders are serious mental health conditions that affect a significant portion of the U.S. population.
An estimated 9 percent of Americans, or 28.8 million people, will have an eating disorder in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). Anorexia nervosa, one of many types of eating disorders, has one of the highest mortality rates of any mental health condition, ANAD states.
Considering the seriousness of these conditions, it’s understandable for anyone to want to help a loved one who has an eating disorder. But with negative body talk (negative communication about one’s own body), persistent myths, and stereotypes about eating disorders being so common in society, it can be hard to know the right things to say to help.
Here are five phrases to avoid saying to someone with an eating disorder, and what to say instead to help them feel supported.
1. ‘You Don’t Look Thin Enough to Have an Eating Disorder’
Eating disorders were historically thought to only affect “skinny, white, affluent girls” (also known as the SWAG stereotype, according to research). While people with these characteristics can certainly develop eating disorders, they’re not the only ones who can.
“You can have a [so-called] ‘normal’ body mass index (BMI) or be at a higher BMI, and still be malnourished and be at incredible medical risk, not to mention the emotional and mental anguish that can come with an eating disorder,” says Cherie Miller, a licensed professional counselor and the clinical director of the Nourished Soul Center for Healing in Southlake, Texas, who treats people with eating disorders and has also personally experienced an eating disorder.
The truth is that eating disorders can affect anyone at any weight or body size, and people in larger bodies have the highest risk of developing an eating disorder at some point in life, according to ANAD. Fewer than 6 percent of people with eating disorders are medically diagnosed as “underweight,” notes ANAD.
There’s no way to know for sure whether someone has an eating disorder simply by looking at them, and casting doubt on one’s experiences because of their body size only causes further harm, Miller adds.
Try instead “I hear you, and I believe you. If there are specific ways I can support you, please let me know.”
RELATED: Why Aren’t We Paying More Attention to Eating Disorders in People With Larger Bodies?
2. ‘You Look So Beautiful Today. Have You Lost Weight?’
Any comment about someone else’s body has the potential to be harmful, even if it’s intended as a compliment, explains Jennifer Gaudiani, MD, a certified eating disorder specialist and the founder and medical director of the Gaudiani Clinic, an eating disorder treatment center in Denver.
For some with eating disorders, phrases like these equate beauty with thinness and may inadvertently add to their anxieties about their body. This can perpetuate an unattainable goal to always want to be more and more thin in order to be perceived as beautiful, says Dr. Gaudiani, who is also a member of the editorial board of the International Journal of Eating Disorders and the Academy for Eating Disorders Medical Care Standards Committee.
“Whether someone intends it that way or not, it has become a wolf in sheep’s clothing for commentary on weight loss, most typically,” she notes.
Try instead “It’s so wonderful to see you,” or “I’m so happy to be with you.”
3. ‘Have You Tried [Insert Diet Here]?’
Sometimes, people who are not experts in food or nutrition suggest fad diets to people living with eating disorders. While this may be well-intended, any advice around food is usually unwarranted and can cause further pain, says Heidi Schauster, RDN, a registered dietitian-nutritionist with Nourishing Words Nutrition Therapy and Somatic Experiencing (SE) in Boston, who has specialized in disordered eating for nearly 30 years and personally experienced an eating disorder when she was younger.
“Advice around what to eat or not eat was generally not helpful at the time,” says Schauster.
Right now, many high-protein, low-carb diets such as keto or paleo are quite popular, and Schauster has found that some of her clients were previously advised to try them as a way to control symptoms like binge eating, for example.
“But the reality is that most of the time, the issue underneath the eating pattern is not being addressed,” Schauster says. Since eating disorders are mental health conditions, addressing the psychological factors contributing to an individual’s eating disorder symptoms is a key part of recovery.
Try instead “I trust you to choose for your body.” If you are concerned about someone on a specific diet, and have a close personal relationship with them, you may consider saying, “But you know, I’m going to be concerned, given what you’ve been through, when I hear that you’ve chosen a restrictive diet,” says Gaudiani.
4. ‘Ugh, I Feel So Fat Today!’
Engaging in negative self-talk about your body can inadvertently make some people with eating disorders feel more self-conscious about their own bodies, says Gaudiani. By equating “feeling fat” to “feeling ugly” or being unhappy with one’s body, others may internalize those cues, she warns.
“For example, even if the parent would never dream of making a comment [about weight] to their child, or adult child, their child loves and respects their parents. And if the parent has a history of making disparaging comments about their own bodies, their kid feels that too,” explains Gaudiani.
“Such comments about one’s body are often toxic. Everyone would do better if they just left it out of their lexicon completely,” she adds.
Try instead “I feel anxious about my appearance today and need to check in with my body.”
5. ‘Real Men Don’t Have Eating Disorders’
As many as 25 percent of people with eating disorders are men, according to ANAD. Despite this, many within the public, as well as some health professionals, incorrectly view eating disorders as a uniquely female condition because of persistent stereotypes, per research published in BMJ Open. As a result, many men and boys may not recognize their behaviors as potential symptoms of an eating disorder.
These stereotypes, as well as the lack of gender-appropriate information and resources about eating disorders for men, can prevent many men from understanding their experiences and seeking help, and can make their conditions harder to treat, suggests the aforementioned research in BMJ Open.
“They’re really underrepresented in treatment, and men are less likely to seek help, I think because of stereotypes, as well as some cultural conditioning, that men are supposed to be tough and not need to ask for help,” says Miller.
Try instead “I understand that the stigma about men having eating disorders poses an extra barrier for you in seeking help. I would be happy to help you find resources to get the help that you need.”