Understanding and Supporting Loved Ones with Eating Disorders During the Festive Season
It’s estimated that at least 52% of people with an eating disorder diagnosis have a history of trauma and supporting someone who is struggling with food is not a simple or easy task. In todays guest blog, writer and arts professional Fiona Moon shares her tips on navigating Christmas and holidays where food plays a central role, in a compassionate way. Fiona is a writer and arts facilitator/producer based in Hampshire, who has lived experience of Complex PTSD and eating disorders.
“The festive season can be a difficult time for many reasons, but for those living with disordered eating or recovering from an eating disorder, they can bring a whole host of extra stressors, concerns and triggers. The focus on shared food and meals, the pressure to be merry or wear certain clothes, and the company of people who they don’t see regularly can make the season feel overwhelming to say the least.
With the link between PTSD, C-PTSD and eating disorders well documented by both PTSD UK and numerous other studies, and approximately 1.25 million people in the UK living with an eating disorder, it feels more vital than ever to increase awareness and support not just for the person with the eating disorder, but their friends and family too.
When someone is dealing with an eating disorder, we can sometimes get so worried about saying the wrong thing and making it worse, that we feel it’s safer not to say anything at all. What’s more, there can be an assumption that any eating disorder is easy to spot based on appearance. In fact, only approx. 6% of people with eating disorders are medically underweight, which means that people may be struggling with disordered eating and others may not be aware of it. Below are some things to consider if you’re supporting or hosting a loved one with an eating disorder this Christmas.
Do not comment on appearance
As a society, we’re very guilty of making (often well intentioned) appearance related comments by way of saying hello. Particularly if a person has been medically underweight, it can be really tempting to make a comment about changes in their body, sometimes out of sheer relief, or by way of acknowledging their recovery journey. As a rule, try to avoid making any comments on appearance (even ones that you perceive to be positive). Eating disorders are very compelling, pervasive diseases, and even telling someone they look ‘well’ can trigger complex feelings of shame, fear and self-hatred, as their brain could translate this to ‘you look fat.’
Bodies will also often recover quicker than minds, so it’s also remiss to assume that if someone ‘looks normal’ they must be ‘recovered.’ When greeting someone, focus instead on telling them how nice it is to see them, or how pleased you are they’re there. If you really must make an appearance related comment, stick to something neutral such as ‘you look festive.’
Take an interest beyond their eating disorder
The sheer turmoil of an eating disorder means that life can often become very small. Aside from any medical treatment, constant obsessions around food can leave very little room for anything else, and can result in a real loss of identity outside of the illness. If you know of anything else going on in their life – such as a recent life milestone, achievement or interesting hobby, engage them in conversation about that. This can be a great reminder that they exist outside of their eating disorder, and that they are still the person you know and love.
Limit exposure to weight/food/diet talk
In a season where excess can be rife, it’s easy to slip into chats about how much you’ve eaten/fatness and your ambitions to join a gym and drop a stone in the new year. Again, this might even be something we think is helpful for the person to hear, by way of ‘normalising’ their feelings about themselves and food, or unintentionally reassuring them that their Christmas dinner was nothing compared to yours. Again, this can lead to encouragement of unhealthy behaviours, or just make the person feel unnecessarily pressured to join in or make similar goals.
Even if you aren’t directly talking to or about the person with the eating disorder, comments about TV celebrities, other people not present, or general negative attitudes towards/emphasis on size, weight, shape and food can increase anxiety and upset, and leave the person concerned wondering what’s being thought or said about them by others.
Give them advance information if that’s helpful
Sending a text in advance of any gathering giving as much detail as you can will likely help the person feel prepared and take measured decisions about their care. Include things like when and what you’ll be eating, and try to avoid any last minute changes. If going out to eat, ask them if they have a preference on location or type of food, or send them a menu in advance. Rules in the UK now mean that many restaurants have to list calorie content by law, however most should be able to provide calorie-free menus on request. These are all normal things you can easily incorporate in a group plan, so even if you only suspect someone attending may be struggling, you can still give support without drawing attention.
Offer choice and autonomy
Is there a way that you can approach the event that gives the person more choice over how, when and what they eat? A change in traditions can be refreshing, so if you’ve always been a 3-course roast kind of family, could you switch it up and try something new? Informal arrangements like a buffet, tapas or bring a dish party could help the person feel like they have more choice and that there’s less focus on the ‘eating’ element of the event. Alternatively, you could plan different elements to the celebration, such as a meal, drinks and nibbles, and a movie, so people could still join for the bits that work for them, and they don’t feel excluded from the festivities.
Consider a distraction
Linked to the point above, if you do decide to go for a sit-down meal, it can be helpful if there is another element to the activity that can distract from the food (Christmas crackers are great for this). Could you consider a tabletop game, conversation prompts, or even dinner in front of a Christmas film. This can help make a person feel more at ease with eating in a group.
Don’t make a big deal about low much (or how little) they eat
This one is super important, and should just be the norm for all of your guests. Again, it can be tempting to make a big deal of praising a person who has been restricting if they finish a meal by way of showing support, but in most cases, this will likely make the person feel very uncomfortable that their eating habits have been thrust into the spotlight. Similarly, if you notice someone eating more than usual for them, now is not the time to express surprise, relief, encouragement or crack a joke about it. A massive element of eating disorders is extreme shame around food and weight, and many people go to great lengths to keep their eating disorders hidden. If you happen to notice that they’ve dealt with the event particularly well, you can always praise their approach (not what they ate) privately to them afterwards.
Be sensitive to their coping routines / Let them participate on their terms
Eating disorders are sneaky in that the rules are constantly shifting. So a person may have felt fine to agree to something in advance, but on the day those feelings could be very different. There are also a whole host of other symptoms that a person may be managing, including fatigue, nausea, anxiety and physical pain, so they may need to do things to help keep themselves safe and well, such as take some time away, bring their own food or cutlery, have a plan in place to help them cope. It might be that it’s just not something they’re ready to do yet. Try not to take any of this personally, and let them know there’s no pressure to participate in a certain way, and they are safe to do what they need to do.
It’s more than just food
If you are hosting, it can be really helpful to think about the wider environment they’re coming in to and being sensitive to that. For example, removing scales or glossy magazines from your bathroom, or ensuring food packaging with calorie information isn’t left out on the side for them to see. If gift giving, avoiding anything food, exercise or clothing related can also be helpful.
Ask how best to support them
For me, this is the most important one. Whilst the suggestions above are all well and good, every person with disordered eating is going to have different needs and preferences, and what works for one may trigger another.
Eating disorders are complex and can be scary and confusing to friends and family, meaning that we might start treating the person differently without even realising it. Try to remember that, underneath the illness, this is still the full person you love, and try to treat them as normally as possible. If you feel close enough, simply asking them beforehand how best you can support them can make them feel seen and loved, and lessens the chance of any unintentional upset or triggering situations. Everyone’s needs will be different – some might prefer very practical help, like you serving up their food, for others, it could just be a gentle check in, or not mentioning it at all.
Helpful as these suggestions might be, if you’re supporting someone and others aren’t aware, or you aren’t sure if a loved one is struggling, that can be much harder. I’d suggest talking about any fears, concerns and plans beforehand, and ask how they’d feel best supported during the event in a way that doesn’t drawn attention and that works for them. If you’re worried and trying to determine whether someone has an issue and decide to chat to them, keep things factual and focus on the changes in behaviour you’ve observed. Though it’s hard, try wherever you can to be calm and gentle in your approach, and not resort to guilt or blame. Their eating disorder is not anyone’s fault, and pressure or hostility will likely make them feel worse. Reminding them that you care and are here for them will help them feel less isolated and cut off in their disease. There are also several professional services if they need further support. Don’t forget yourself in the equation too – we all know the phrase ‘you can’t pour from an empty cup’ – it’s not selfish for you to put time aside for your own mental health and wellbeing.
Lastly, I want to offer the notion of hopefulness. Eating disorders are great at convincing people that change isn’t possible, and this just simply isn’t true. As I finish writing, I’m sitting on my sofa snacking on some pretzels, which a year or two ago would have been unthinkable. With support, hard work and the right treatment, a life free of an eating disorder is attainable – though it’s rarely linear and will look different for everyone, every single person without exception, deserves to eat, and deserves to recover. “
Fiona is a writer and arts facilitator/producer based in Hampshire, who has lived experience of Complex PTSD and eating disorders. She is passionate about access to arts and culture, telling stories, and empowering others to tell theirs. She writes about mental health, wellbeing, nature and creativity, and spends her weekends exploring in her self-converted camper, Vanmoose.
This blog isn’t intended as medical advice and you should always seek help from a medical professional if you are concerned about yourself or a loved one. Support and information about eating disorders is available from charities and organisations such as Beat or Mind. In emergencies, you can contact your local crisis team.
Beat Eating Disorder Charity https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/how-many-people-eating-disorder-uk/ Accessed 04.12.23
National Association of Anorexia and Associated Disorders https://anad.org/eating-disorders-statistics/ Accessed 04.12.23
Photo by RDNE Stock project
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