Lindsey Ricciardi, PHD, CEDS-C
Lindsey Ricciardi is a psychologist and founder of the Eating Disorder Institute of Las Vegas
Eating disorder recovery is hard as hell, and, without realizing it, you could be making it a whole lot harder. There is a good chance you know someone who is living with an eating disorder. Odds are they won’t look like what you expect because of the stereotypes about who develops an eating disorder. You cannot tell if someone has an eating disorder by looking at them. Eating disorders are first and foremost serious psychiatric illnesses. They impact people of all ages, sizes, genders, races/ethnicities, sexual orientations, religions, cultures, abilities, and socio-economic statuses.1 As an eating disorder progresses, the thoughts turn to behaviors, and these behaviors begin to wreak havoc on ALL the body’s physiological systems. Medical consequences of eating disorders occur in individuals of ALL body sizes. The mortality risk for individuals with an eating disorder is among the highest of all the psychiatric illnesses.2 Individuals who have an eating disorder are significantly more likely to attempt, and die by, suicide compared to the general population.2 Unfortunately, our culture is quite toxic, shaming and ill-informed when it comes to messages about nutrition, weight, and our bodies. Of course, these toxic messages are rampant in mainstream and social media, as these lead to financial benefit for the diet, fashion and “wellness” industries. It appears few places are immune: Doctor’s offices, health classes, athletic departments, fitting rooms, gyms, grocery stores, grandma’s house. Heck, even our own dinner tables are often, unknowingly, laden with anti-healing, harmful rhetoric. When someone you care about is living with an eating disorder, they need your healthy support more than ever! Here are five ways that you can be a more informed, effective and supportive ally.
1. Be mindful of how you talk about food
Eating disorders are complex and multifactorial. We know that they are caused by a complex interaction between biology, genetics, significant life events, and culture, or in sum, a “perfect storm” of risk factors. While the onset and presentation may be different, most eating disorders are fueled by extreme, rigid beliefs, and dysfunctional thoughts and ritualized coping behaviors around food. An essential component of recovery is relearning to eat a variety of foods in all contexts, and to eat sufficiently to meet the body’s needs. Intense fear and self-judgment are obstacles in recovery. So, why does this matter to you? Moralizing foods as good or bad, healthy or junk, exacerbates guilt, stress, shame, and obsessive preoccupation around eating these foods. Your loved one will be more prone to restrict, binge or purge when you moralize foods, as it reinforces the debilitating eating disorder voice they already battle. Our world profits heavily from diet culture – a set of beliefs that values thinness, weight and shape above health & well-being. Diet culture places importance on restrictive eating habits and labels foods as “good” or “bad.” Diet culture has been passed down generationally and is imbedded into all aspects of our lives. Comments like, “I’m being so bad,” or “This is going to make me fat,” are rooted in diet culture and anti-fatness. To learn more about diet culture, its origins, and its dangers, check out Anti-Diet by Christy Harrison.3 The good news is that this all works the other way, too. If you listen to your body and honor it’s nutritional needs, and you can enjoy all kinds of foods without guilt, shame, or fear, or critical commentary, there is a good chance you can be a safe and helpful support to someone in eating disorder recovery.
2. Stop judging the size, shape and appearance of bodies – your own or others
(Not just the negative judgments, but the “positive” ones too!)
Comments such as “You lost weight, you look great” may be well intended, but are actually harmful. They reinforce our culture’s preference for smaller bodies, a concept known as the “thin ideal. The thin ideal promotes the ideology that thinner people are healthier, “better,” and morally superior. Comments that convey a preference for thinner bodies also fuel weight-stigma and harmful weight-based discrimination. The reality is that anti-fatness is a social justice issue deeply rooted in racism, sexism, ableism and capitalism,3,4 not health. If thinness and dieting were truly about health, we would have well established research demonstrating that dieting makes healthier people in the long run. We do not. Eating disorder recovery involves accepting one’s biologically appropriate weight and shape and rejecting these harmful cultural messages about what it means to live in a body that does not fit media ideals.
I recently attended a yoga class and the instructor loudly proclaimed to one of the students walking in, “Wow, it’s been a while. You look great! You look really fit, what have you been doing?” This woman was in a thin, white, stereotypical yoga body. The comment threw me off the whole class and screwed up my Zen. I couldn’t help but wonder how the men and women in larger, softer, older, bodies may have felt after hearing the instructor state their obvious preference for a thin, “fit” looking, white, young female body. Did this heighten body shame and insecurity in the room? Did it make the experience of others less intuitive and embodied and more self-conscious? I also kept thinking about my clients with eating disorders and how they feel when receiving feedback about their bodies. These “positive” comments mess with their minds and make recovery way more challenging. I thought about the woman who received the feedback and wondered if perhaps she took it as “You weren’t looking so fit the last time I saw you” and “I like you and your body more when you have less body fat” or perhaps it just made her uncomfortable? I had to wonder, is she eating enough? Is she OK? By sharing this example of something that happens all the time, in so many settings, I hope you can see how body comments, even the positive ones, when focused on weight, shape and appearance, can be harmful. They can be harmful to the person receiving the comment, the people who overhear it, and to society at large by reinforcing the thin ideal and weight-based stigma and discrimination. To be blunt, commenting on people’s bodies, shape or weight is none of your dang business. Stop it. Please.
3. Don’t promote or encourage restrictive diets and intentional weight loss
For the sake of the millions of people who are struggling to nourish and accept their bodies just as they are today, please stop promoting intentional weight loss. Regardless of the intervention, nearly ALL dieters will regain any weight lost and experience a reversal of any short-term medical benefits of weight loss.5,6,7 People who diet for weight loss are NOT healthier in the long run, will gain more weight over time than non-dieters, and are more likely to develop eating disorders5,6,7. The risks and stress of dieting far outweigh any short-term benefits. We must challenge our culture’s brainwashed belief that dieting makes people healthier in the long run. That is simply not true. Let’s focus instead on real determinants of health, such as safe places to live, and access to health care, necessities, and education, and healthy social support. There are so many effective ways to improve quality of life and health that have nothing to do with losing weight and its associated risks5,6,7. You may be wondering how you are supposed to eat if you don’t diet or follow food rules. That is where Intuitive Eating 8 comes in.
4. ASK how you can be of support
If you do know someone who is struggling, ask them directly how you can be of support. It is often hard for individuals to ask for what they need due to shame, people pleasing, or not wanting to feel like a burden. Often, they are just doing their best to get through the day. It is better to ask how to help rather than make assumptions. It might feel uncomfortable, but it is better than the alternative, which is more secrecy, avoidance and misunderstanding. If someone broke their leg, there is a good chance you would ask how you can be of support. Mental illness should be no different.
5. Reach out and offer healthy ways to connect
Living with an eating disorder can be a lonely and scary experience. Call, text, message, visit. Suggest playing a game, watching a movie, taking a walk, taking the dogs to the park, etc. Some people in recovery appreciate having meals with others, while others find this too overwhelming. Providing some options of activities might be helpful. Let your loved one know that their value has nothing to do with their body, shape, or weight. Tell them what you admire or appreciate most about them. Let them know that you are here to talk whenever they need it. Explain to your loved one that you might not understand, but you want to learn more and help.
Bottom line, living with an eating disorder is hard AF! It is a constant battle that cannot be understated. Given how debilitating and dangerous these disorders are, why not hit the pause button and try to break our society’s old, ingrained patterns of fat phobia, thin ideal, and diet culture? These attitudes permeate our culture, are rooted in ugly ism’s, and cause tremendous harm. For those impacted by an eating disorder, having to deal with diet culture and weight stigma are equivalent to stepping into psychological land mines. It cannot be understated how helpful it is to have a safe person to provide a supportive, healing space without harmful comments and actions. So, why not learn more about the ways you can be a safe eating disorder recovery ally? There is a good chance you may develop greater body trust and body respect along the way, too!
- Halbeisen, G, Brandt, G, & Paslakis, G. (2022). A plea for diversity in eating disorders research. Front Psychiatry, 18(13):820043. doi: 10.3389/fpsyt.2022.820043
- Van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: Mortality, disability, costs, quality of life, and family burden. Current Opinion in Psychiatry, 33(6), 521-527. DOI: 10.1097/YCO.0000000000000641
- Harrison, C. (2019). Anti-Diet: Reclaim your time, money, well-being, and happiness through intuitive eating. Little, Brown Spark.
- Strings, S. (2019). Fearing the black body: The racial origins of fat phobia. NYU Press.
- Wind, K. (2021). This changed my practice: Why I no longer prescribe weight loss, calculate BMI, or counsel patients on “obesity”. University of British Columbia. (online). https://thischangedmypractice.com/why-i-no-longer-prescribe-weight-loss/
- Ge, L., Sedenghirad, B., Ball, G. D. C., da Costa, B. R., Hitchcock, C. L., Svendrovski, A., Kiflen, R., Quadri, K., Kwon, H. Y., Karamouzian, M., Adams-Webber, T., Ahmed, W., Damanhoury, S., Zeraatkar, D., Nikolakopoulou, A., Tsuyuki, R. T., Tian, J., Yang, K., Guyatt, G. H., & Johnston, B. C. (2020). Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk facto reduction in adults: Systemic review and network meta-analysis of randomized trials. BMJ (online), 369, m696-m696. https://doi.org/10.1136/bmj.m696
- Memon, A. N., Gowda, A. S., Rallabhandi, B., Bidika, E., Fayyaz, H., Salib, M., & Cancarevic, I. (2020). Have our attempts to curb obesity done more harm than good? Curēus (Palo Alto, CA), 12(9), e10275–e10275. https://doi.org/10.7759/cureus.10275
- Tribole, E. and Resch, E. (1995) Intuitive eating: A revolutionary program that works 4th Edition. Saint Martin’s Paperbacks, New York.