How to talk to a friend with an eating disorder

Last Friday Nikki Grahame, the reality TV star who rose to fame as a Big Brother contestant, died after an ongoing battle with anorexia. She was just 38 years old.

What struck me was the heartbreaking reaction from her friends. Some had set up a crowdfunding page on GoFundMe to help pay for her treatment while others opened up about how bad they felt for not visiting Nikki in her final weeks.

Michelle Heaton, the former Liberty X singer, admitted that she was “scared” to visit Nikki during her final weeks in an Instagram post. She said she was scared of saying the wrong thing, or something “triggering” that would make Nikki worse. “I was a coward and I'm sorry,” she wrote, while former Emmerdale actress Gemma Oaten fought back tears in a video saying: “I wish I could have done more”.

Watching a friend or family member suffer from an eating disorder can be excruciatingly painful and it can be difficult to know what the “right” thing is to say. I know this first hand, having watched close friends and family obsess over calories, restrict their food, binge, disappear after dinner to make themselves sick or excessively exercise.

I’ve seen how this illness has controlled and taken over their lives. Some have been hospitalised, others have been admitted to specialist inpatient facilities. They’ve attended appointments with clinical psychologists, psychiatrists and dietitians. Several opted for therapy while a few were prescribed antidepressants. Even though the eating disorders varied from each friend, knowing how best to talk to them remained a challenge.

I worried I’d say the wrong thing, that it was none of my business or that I was coming across as nosy or insulting. I didn’t want to come across like I was oversimplifying a mental illness that is incredibly complicated.

But eating disorders thrive on secrecy and isolation, which is why experts believe they’ve taken hold in lockdown. Last month, Nikki’s mother Sue told The Telegraph that the lockdowns had “floored” her daughter, causing her “terminal loneliness”.

“Not knowing the right thing to say to someone with an eating disorder can be daunting and sometimes fear of saying something that may be accidentally upsetting can cause people to pull away and not say anything,” says Tom Quinn, Beat's director of external affairs. “It’s important not to do this – eating disorders can be very isolating and the person will need support. If you aren’t sure what to say, just being there to listen makes a big difference.”

If you are worried about a friend, and you’re not sure how to approach the conversation, here’s how you can support them…

Do not comment on their appearance

One of the worse things to say to someone struggling with an eating disorder is making a comment on their weight, or what they look like.

Even saying, “You look well” or “You look better than you did” can be unhelpful, because the person with an eating disorder might immediately think: “That means they've noticed my weight gain.”

“Comments on appearance that you mean to be complimentary can sometimes be interpreted negatively,” adds Quinn. “Compliments on things other than appearance can help the person feel valued and is less likely to cause these worries. Avoid talking about your own weight too, or diets and weight gain or loss.”

Instead of commenting on appearance, talk about behavioural changes. My friend, who’s had an eating disorder for 10 years and experienced various treatment settings, says she found it helpful when friends said something such as: “You seem happier – do you feel happier?”

Tell them you’re concerned, and that you care

If you don’t know where to start, just being there and listening can be helpful. Try sending a text saying: “I’m a bit worried about you at the moment – if you need someone to talk to, I will help as much as I can.” Let them know that they're not alone, and that they're loved and cared about.

“You may like to ask them how they’re feeling and what they’re thinking, and encourage them to share their feelings if they feel comfortable – try not to assume what they may be going through,” says Quinn. “They might tell you they want to be ‘left alone’, or that you can’t do anything to help, so here it can be helpful to remind them you can hear they’re upset and how difficult things are, and you’ll be there if they need you.”

Try not to be accusatory or get angry

“It can feel overwhelming to watch a loved one with an eating disorder and it’s important to remember that neither they or you are to blame,” says Quinn.

Try to avoid saying things that could feel critical, accusatory, or dismissive. Ask how they’re feeling, rather than questioning them about what or how much they’ve eaten, as this can offer them the space to talk about the feelings behind the eating disorder without making them feel their eating habits are being scrutinised.

Tell them you believe in them

One of the key things to remember about an individual with an eating disorder is that they fear judgement, criticism and rejection, says dietitian and eating disorder specialist Renee McGregor.

“One of the best things a friend can do is help to shine the light on all the amazing attributes the individual with an eating disorder brings; their sense of humour for example, or the impact they make but just never see,” she says. “While they may reject what is said, helping them to understand by saying, ‘I know you don’t feel this but my experience of you is that you are caring, loving and always show so much support for me’ as an example.

“The key is to help the individual appreciate that the negative narrative they have of themselves is not reality but an assumption based on their own view.”

Offer practical support

Can you go to the GP with them? Or an appointment? If they need professional help and you know they’re not getting it, it can be helpful to send them the number of a charity helpline, or have information on hand to share with them.

When I've been really concerned about a friend, and they haven’t wanted to talk to me, I’ve sent them a text saying something like, “I came across this charity that's really good – might be worth looking into. No pressure.”

My friend told me that when she was really poorly, she didn’t have the energy to look up where to get support or sometimes felt that she didn’t deserve it – by sending the address of a helpful website, like the charities Beat or Seed, it can act as permission for the person suffering with an eating disorder to seek the help they need.

Ask if they’d like you to continue to check in on them

Don’t wait too long before approaching them again, but equally don’t check in on them every five minutes – it’s about finding a balance. Ask if it would be helpful to have a weekly check in to see how they’re feeling. Remember that looks can often be deceiving – not everyone with an eating disorder looks ill or underweight – so by checking in, you’re showing that their thoughts and feelings are valid, and could actually help prevent them from getting to a point where they’re physically poorly. Eating disorders are mental illnesses, so it is someone’s thoughts, feelings and emotions that are involved. Weight-loss is just one of the symptoms.

If you need help with your or someone else's eating disorder:

• Get in touch with your GP, so you can be referred for specialist help

• Contact Beat, the UK’s eating disorder charity, on 0808 801 0677 or beateatingdisorders.org.uk

• Get in touch with eating disorder support service Seed on 01482 718130 or seedeatingdisorders.org.uk