How to help a friend with an eating disorder

Here are some ways you can help.

Spotting the signs of anorexia

Not sure if there's a problem? These are some of the early signals that a friend may have an eating disorder:

• Behaving differently when it comes to food, such as avoiding going out for meals or eating in front of you.

• Being obsessive about food, including cutting out lots of different food groups or planning ‘healthy’ meals meticulously.

• Having a distorted view of their body size.

• Losing a lot of weight.

• Disappearing to the toilet after meals.

• Being tired or irritable a lot of the time.

• Exercising obsessively.

Bringing the subject up

Once you think your friend may have an eating disorder, you need to know how to discuss it with them so you can offer support and encouragement to get help:

• Think about what you want say beforehand and how you will say it. Don't blame, shame or get angry - focus instead on how they are feeling.

• Choose the right time. Pick somewhere private and comfortable, and ideally not when food is around.

• Try to explain why you're concerned and that you want to help. But be prepared for anger or flat denial at first. You can reassure them that eating disorders are not rare, so they shouldn't feel embarrassed in any way.

• Gently encourage them to seek help from their GP who can refer them to a specialist. Offer to go to any appointments with them. In many ways, getting your friend to seek specialist help is the most important way you can help. You can also offer to be there if they want to tell other friends, partners or family.

• If they completely deny there's a problem in this initial conversation, don't feel disheartened. You've still opened a door, which is a great first step.

If you're really concerned and they refuse to speak to a doctor, you can speak to their doctor about your concerns. Their doctor won't be able to disclose anything to you about them without their consent. But they can take note of your concerns, and bear it in mind at their next consultation. Do be aware, though, that finding out you've gone behind their back could put a strain on your relationship - working together is always best if possible.

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Listen, don't analyse

It might be tempting to try to understand what's behind your friend's eating disorder, but probing and diagnosing can have the opposite effect; instead of opening up, your friend might shy away from discussing it. Instead, stay calm and reassure them you're there to listen whenever they want to talk. Let them speak without criticising.

Pick conversation subjects carefully

Eating disorders aren't really about food; they're about feelings, so don't talk about diets and weight loss. Avoid commenting on how they look, as someone with an eating disorder will often misinterpret compliments around weight and appearance in a negative way. Focus on how they're feeling and coping instead.

Let them do the talking

If they want to chat about their treatment, that's fine. Your friend's life may have changed significantly, with a lot of hospital and doctors' appointments. Understanding this will help you appreciate exactly what recovery entails and how difficult it can be. Most people in treatment value having someone to talk to who isn't family or a doctor - but know your limits. Being concerned and trying to help are part of a good friendship, but don't take it on yourself to fix things. Treatment is best left to the specialists.

Be thoughtful

You may have noticed your friend has changed. They might not want to go out anymore, but keep trying to include them, just as you normally would. Even if they don't join in, they'll appreciate being asked. You can also try to build up their self-esteem by telling them you think they're great and how much you appreciate their friendship.

Plan something fun to do

Suggest meeting up and doing something together - it's a good distraction from their illness and will give you both something to enjoy. Consider non-food-related activities like a walk in the park or going to the theatre, comedy club or cinema. If they do want to eat out, letting them pick the restaurant is a good idea. Don't be tempted to congratulate them on how much they eat, but focus on the conversation. If they don't feel up to going out at all, offer to spend some time at their house watching TV or just catching up.

Let them know you're there

Above all, remember dealing with an eating disorder is extremely difficult and probably the hardest thing your friend will ever have to do. When you're in recovery it can often feel very lonely, so one of the most important things you can do throughout the process is tell your friend that you love and care about them.

Talk about all the ways in which you need them and their support too, as this will help keep balance in the relationship. And remember to reassure them you're in it for the long haul and will always be their friend whatever happens.