If you are reading this, then chances are you're concerned about the eating habits, weight, or body image of someone you care about. Maybe it's a friend at school, a teammate, a roommate, your girlfriend, or possibly a relative like a sister, cousin, or even a parent.

We understand that this can be a very difficult and scary time for you as a friend or family member of someone struggling with an eating disorder. You may be feeling afraid, angry and helpless. These feelings are natural!

Let us assure you that you are doing a great thing by looking for more information. If you feel scared or worried about your friend or relative, then it is a very good idea to get some more information and figure out what to do next.

You are doing the right thing by learning more about eating disorders!

Of course, this brochure won't teach you everything you need to know about eating disorder or what to do in our specific situation, but it will give you some helpful background information and some suggestions on what to do, what to say, and where to go for help if you are worried about someone you care about.

At least 5-10 million girls and women* and 1 million boys and men in the United States are struggling with eating disorders. This means there are lots of people out there who understand what you are going through and are eager to help you and your friend!
*Because 90% of the people suffering from eating disorders in the U.S. are female, and 10% are male, this brochure will frequently refer to your friend as "she." But this information is important for everyone, guys and girls, and it should be helpful for any friend or relative!

The term "EATING DISORDER" may be used for three different conditions:

ANOREXIA: Self-starvation and refusal to eat or maintain weight at a healthy or normal level for her age, size, height, and activity level. Intense fear of being fat in spite of excessive weight loss.

BULIMIA: Cycles of binge eating and purging (eating large amounts of food, more than most people would eat in one meal in short periods of time, then getting rid of the food through vomiting, laxative use, or over-exercising).

BINGE EATING/COMPULSIVE OVEREATING: Eating large amounts of food in a short amount of time. Impulsive or continuous overeating.

Eating disorders are complex physical, emotional, and psychological conditions. an eating disorder is often a person's method of coping with or avoiding events or feelings in her life. It may be a way for a person to feel control or nothing at al. She may be trying to distract or numb herself from pain or fear.

Even if your friend doesn't fit on of the descriptions above, she may be wrapped up in DISORDERED EATING. Disordered eating means that your friend's attitudes about food, weight, and her body may be causing her to have very strict eating and exercise habits that jeopardize her health, happiness, and safety.

DISORDERED EATING may begin as a way to lose a few pounds or get in shape, but these behaviors can quickly get out of control, can become obsessions, and may even turn into a full-blown EATING DISORDER.

-Has your friend lost or gain a significant amount of weight recently?
-Does she avoid eating meals or snacks when you are together?
-Does she categorize food into "good foods" or "bad foods"?
-Does she calculate the number of fat grams and calories in eat bite?
-Does she talk or worry about her size and shape?
-Does she weigh herself often?
-Does she exercise because she feels like she has to, not because she wants to?

If you answered "yes" to some of these questions, your friend could be struggling with, or on her way to, an eating disorder.

Learn as much as you can about eating disorders. Read books, articles, and brochures.

Know the difference between facts and myths about nutrition and exercise. Knowing the facts will help you reason against any inaccurate ideas that your friend may be using as excuses to maintain her disordered eating patterns.

Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body image problems. Avoiding or ignoring it won't help!

Be caring, but be firm. Caring about your friend does not mean being manipulated by her. Your friend must be responsible for her actions and their consequences. Avoid making "rule" or expectations you cannot or will not uphold.

Tell someone. Share this brochure with them. It may seem very difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in their beginning stages probably offers your friend the best chance for working through them and becoming healthy. Don't wait until the situation is so severe that your friend's life is in danger. Consider telling her parents, a teacher, a doctor, a counselor, a nutritionist, or any trusted adult. She needs as much support and understanding from the people in her life as possible.

If you are worried about your friend's eating behaviors or attitudes, then it is appropriate for you to express your concerns in a loving, supportive way. It is important to handle these issues with honesty and respect. it is also important to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders.

Because your friend's health or even her life may be in danger, it is important not to keep this a secret for fear of making your friend angry or getting her in trouble with her parents, at school, with a coach, or anyone else. Other people in her life need to know so they can encourage her to acknowledge her problem and get help. If your friend is under 18, her parents need to know immediately.

In a calm and caring way, talk about specific things you see or feel. Share your memories of two or three specific times when you felt concerned, afraid, or uneasy becasue of her eating rituals. Talk about the feelings you experienced as a result of these events

Try to do this in a very supportive, non-confrontational way. Here are three suggestions:

1. Use "I" statements. (I'm concerned about you because you refuse to eat breakfast or lunch. It makes me afraid to hear you vomiting.)
2. Avoid accusational "You" statements. (You have to eat something! You must be crazy! You're out of control!)
3. Avoid giving simple solutions. (If you'd just stop everything would be fine!)

If your friend has become obsessed with eating, exercising, or her body, she probably needs professional help. She may be angry that you call her on her attitudes and behaviors, or she may deny that there's a problem. If she won't listen, you may need to tell someone who will listen, someone who can help.

Here are some ways you can help promote healthy body image and remind yourself and others that self-esteem should never be weighed in pounds on a scale:

-Consider and be aware of the ways your beliefs and attitudes about your body and others' bodies are influenced by our society and culture.
-Be a good role model in your attitudes about food, body image, and weight-related issues. Avoid making negative comments about your body or anyone else's. Remember that your comments impact other even when you may not intend them to.
-Take good care of yourself. This includes eating well, getting plenty of rest, enjoying a bit of exercise, and interacting with people you love and enjoy being with. (Maybe even talking to a counselor about your worries.)
-Talk to others about the natural differences in body types and the body's powerful attempts to maintain these various shapes and sizes.
-Learn about and tell family and friends about the dangers of dieting, the importance of eating a variety or foods, and enjoying a moderate exercise to feel healthy and strong. Avoid overemphasizing a person's beauty and shape.
-Do and say whatever you can to support and encourage the self-esteem and self-respect of your friends, family, classmates, teammates, and roommates - in personal, social, athletic, and intellectual endeavors. Provide males and females with the same opportunities and encouragement!

Although you should not feel completely responsible for changing your friend's eating attitudes and behaviors, people struggling with anorexia, bulimia, or binge eating disorder do need professional help. It is recommended that treatment should include some combination of help from a nutritionist, a medical doctor, a counselor or psychiatrist, and possibly a support group.

Source: EDAP brochure, Copyright 1998