5 Next Steps When You Suspect A Loved One Has An Eating Disorder

What does a healthy body look like? There is no straightforward answer. The media often tells us that an ideal, healthy body is thin and muscular. However, a healthy body varies extremely in both size and shape. 

For example, a healthy 13-year-old girl who is 5’2” tall could weigh between 88 to 123 pounds. Weight alone is not an indicator of health, nor of an eating disorder. Instead, eating behaviors and significant changes in weight are signs that someone could be struggling.  This is important because people of all shapes and sizes develop eating disorders. 

What I want to highlight today is the importance of paying attention to the early warning signs of an eating disorder, and what to do if you suspect that your child or adolescent is struggling.  

It’s important to act fast if you have concerns about a loved one. If you catch symptoms early, the chances of your child getting better are far greater. However, if left untreated, many people with eating disorders do not recover. More people die from anorexia than from any other mental illness.

If you suspect that a loved one has an eating disorder, below are some recommended next steps. While these suggestions are applicable to all eating disorders, I am going to specifically highlight anorexia nervosa.

5 Next Steps When You Suspect A Loved One Has An Eating Disorder


1. Understand who’s at risk

Eating disorders can occur in anyone regardless of age, gender, ethnicity, race, or sexual orientation.  Anorexia is most likely to develop in girls, ages 12-13. However, more boys are developing the illness than ever before. Our clinic treats youth and young adults with eating disorders between ages 8 and 24. It’s rare in 8-year olds, but it can happen. Although most people experience body dissatisfaction and go on a diet at some point in their lives, only a small minority develop full-blown anorexia. 

Both biology and environment come into play in the development of anorexia

Biological factors include an individual’s family history of eating disorders and other mental illnesses, genetics, and their personality characteristics. These factors are believed to be responsible for 50-80% of why a person develops anorexia.  Common personality characteristics include perfectionism, high-achieving, conscientiousness, and sensitive.  Youth at-risk for anorexia are typically “model” kids. They do well in school and rarely get in trouble. 

Environment also plays a role in the development of anorexia. A diet is started for variety of reasons, such as beliefs that weight loss will lead to improved athletic abilities; increased confidence and peer acceptance; fears of becoming overweight; beliefs that losing weight will improve their life in some way; or previous teasing about weight. So they set a goal to lose weight and invest in making it happen. 

How being malnourished impacts brain functioning

As they lose weight, they become malnourished and this directly impacts brain functioning, which leads to worsening mood, difficulties making decisions, and impaired reasoning abilities. They become more irritable, anxious, and depressed; become increasingly afraid of eating certain foods; and have irrational fears about gaining weight.

They no longer see their bodies accurately and may believe that they are larger than they truly are. Additionally, while most people enjoy food, eating often becomes less rewarding in anorexia. They lose the ability to recognize when they are hungry and full.  Their ability to taste and smell food becomes impaired. Digestion is slowed and eating can be physically uncomfortable.  We know that these consequences are due, in part, to changes happening in the brain when a person with anorexia becomes malnourished. Therefore, while it seems like someone with anorexia should just be able to eat, it is much more complicated than that.  

2. Understand who’s most likely to recover

There are a lot of misconceptions about eating disorders. One of the most common is that people think that once someone has an eating disorder, they will have it for the rest of their lives. This is not true. Many people completely recover from anorexia and go on to be happy and healthy. The people who have the best chance of recovering are younger, receive treatment quickly, and restore weight and health quickly.

The longer a child struggles with eating disorder symptoms, the more serious the illness and its consequences become. It is also important to find providers with training in specialized eating disorders to provide the best care for your child. Our specialized team provides evidence-based care that has been shown to be the most effective in helping youth recover.  

3. Pay attention to the early warning signs

The National Eating Disorders Association has a page dedicated to the early warning signs of eating disorders. Some examples include skipping meals, eating less than usual, avoiding foods that were previously enjoyed, over-exercising, and avoiding events where food is served. Remember, even people who are a normal weight could be struggling with a serious eating disorder.  Catching symptoms early is critical because it will help your child have the best chance of a full recovery.  

4. Approach Your Loved One

A few things are important to keep in mind here: understanding, compassion, and listening.

Understand that anorexia isn’t just about refusing to eat. It’s not about vanity. Anorexia is a mental illness and individuals struggle with intense guilt, shame, and anxiety. Malnutrition leads to brain impairment and eating becomes a battle, rather than an easy choice. Fears of eating and weight gain become so extreme that normal eating can be terrifying.

Approach your loved one with compassion. Express your concern and tell them how much you care about them. Say something like, “I love you and I’m really worried about you and your eating. I’ve noticed that you’ve been restricting your diet and I’d like to talk about it.”

Focus on listening. Many parents try to “fix” the problem by saying things like “You just need to eat” or “That’s ridiculous.  You aren’t fat and look great.” This approach can lead to increased frustration and defensiveness. Instead, listen to your child and offer support, such as “I have been really worried about your eating. Let’s talk about what’s been going on.” Listen to what he or she has to say and provide comfort and support. You could say “I am so sorry that you have been going through this” and “Let’s try to come up with a plan to help you feel better.”

Some individuals may get upset, deny the problem, and refuse to talk about it. This can be very challenging, but it is common and does not mean that you should drop it. The reality is that when someone has an eating disorder, part of them wants to get better, but the other part is afraid of gaining weight and remains highly invested in the diet.

5. Encourage an evaluation

After you talk with your child about your concerns, insist that he or she see a doctor for a check-up. 

Even if your child says that there is no problem, emphasize that a doctor’s visit is non-negotiable. Stress that you’d like for him or her to be evaluated by a doctor, for peace of mind. If you suspect you’ve caught the eating disorder early, schedule an evaluation with your child’s primary care physician. However, if your child has had a significant change in weight, or you suspect that he or she has a full-blown eating disorder, schedule an appointment with an eating disorders specialist.

To learn more about our Eating Disorders Program, or to schedule an appointment, please call 513-636-9657.


Abigail Matthews, PhD

About the Author: Abigail Matthews, PhD

Abigail Matthews, PhD, is a clinical psychologist in Behavioral Medicine and Clinical Psychology, assistant professor in the U.C. Dept of Pediatrics, and the clinical director of the Inpatient Eating Disorders Program at Cincinnati Children’s.  Dr. Matthews specializes in the treatment of eating disorders in youth and young adults and conducts research on evidence-based treatment in pediatric anorexia nervosa.  Her free time is occupied by her feisty toddler, husband, and rescue dog.

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