By Lizzie Janniello
A friend from college, who is studying to become a family physician, messaged me and asked for some advice. She wanted to know how she could have a stronger relationship with her patients and asked if I had any suggestions for how she could be the kind of doctor that I needed throughout my recovery. So thank you, Nicole, for reaching out and for trying to improve an overlooked quality of medical care: understanding mental illnesses, especially eating disorders. This is a very important topic to me, hence the length of this long post.
Before I begin, I want to be clear: I am not a medical professional. I am just going to share some information that might be helpful to medical professionals (or to anyone for that matter, including spouses, parents, friends, co-workers, etc.). If you are talking with someone you suspect might have an eating disorder, here is some advice to keep in mind:
1. Ask questions about their relationship with food, and their attitudes towards their appearance and weight. When I was younger, I was very deceptive and often lied about how I felt about my body. I understand this is hard. How do you identify an eating disorder when your loved one or patient is lying to you? But there were also times when I was very honest with my friends and doctors about what I had (and had not) eaten and how I viewed my size and appearance. Even after telling them my distortions, many doctors did not bat an eye. Friends often showed concern for my well-being, while doctors appeared not to care. No matter what your relationship is, ask questions, get involved, and show that you care about their health.
2. Please learn the signs of eating disorders and recognize when someone may not have a healthy relationship with food, their weight, or their body. Moreover, if someone is brave enough to be explicit about their unhealthy relationship with food, listen, be attentive, and make sure they receive the proper care. Here are some things to look for:
- If their weight is towards the low end of the spectrum, ask how they feel about their body and their weight. If they say things like “I’ve been on a diet”, “I feel fat”, “I want to lose x number of pounds”, “I’m afraid of gaining weight”, etc., these are warning signs that they might have an eating disorder. Try to ask follow-up questions about their relationship with food and their body.
- If they have lost weight, ask about how they feel about their body and their weight. Ask if they intentionally lost weight. Ask if they have a goal weight. It is possible that they might not be honest with you. Eating disorders can make us very deceptive. But if they are honest, and they do give you a “goal weight” that is too low, ask further questions. A goal weight that is lower than the recommended weight could be a sign of an eating disorder.
- Even if your loved one or patient is at a normal weight, ask about their relationship with food to determine if they are at risk for an eating disorder. Many people suffer from an eating disorder while maintaining a normal weight. Moreover, a lot more people than you think have disordered eating, even if it is not a full-blown eating disorder. I think that if disordered eating is addressed early, it could potentially prevent someone from developing an eating disorder.
3. If they are not ready to open up about their eating disorder, look for signs like:
- Anxiety when asked about food, weight, and their appearance
- Wearing baggy clothes, though thin or underweight
- Constantly cold; poor circulation
- Low energy
- Dizziness when standing or fainting
- Brittle nails; dry hair that is falling out
- Cutting out certain food groups, like carbs or proteins
- Withdrawal from activities or friends
- Change in mood
These warning signs are mostly for anorexia, as this is what I have personally experienced. The warning signs are slightly different for other eating disorders.
4. Be careful when commenting on weight. I saw medical professionals at various weights, including dangerously low weights, but it never seemed low enough to nurses and doctors. I heard many comments (when I was at normal and low weights) about how I “don’t look like I have an eating disorder”. People with eating disorders come in all shapes and sizes. Commenting on weight only fuels the eating disorder voices. Whether it’s “you’ve lost a lot of weight” (which only reinforces that I was successful at having an eating disorder and that I should continue to see how low I can go) or “your weight is normal, you must not have an eating disorder” (which only reinforces that I have to work harder at losing weight). So please be careful when talking about weight with someone you suspect might have an eating disorder, and especially with someone who has specifically said, “I have anorexia”.
5. On the topic of weight, if someone tells you they have or have had a history of an eating disorder, do not tell them their weight. I went to several nurses and doctors, specifically asked to be weighed backwards because I had an eating disorder (or was in recovery), only to be told moments later what my weight was. It was also always on the paperwork they gave me at the end of the appointment. This was very triggering and often led me into a downward spiral. At all costs, please try to avoid showing or telling your patient their weight if they have or have had an eating disorder in the past.
6. This is not a phase. I had one doctor tell me that it will be okay because this is just a phase I am going through. Eating disorders are not a phase. They are serious mental disorders that require treatment.
7. Do not advise them to start working out. Often, those with eating disorders struggle with compulsive exercise. Exercise should only be added when the entire treatment team agrees they are ready. Adding exercise too early in recovery could be extremely detrimental. Even though we are taught exercise can help with depression, and is necessary to be healthy, it can often be triggering to those with eating disorders, so please be cautious when talking with someone with an eating disorder.
8. Understand that people come to medical professionals at various times during their eating disorder. It is never too soon, or too late, to seek professional help. Someone might seek professional help in the beginning before they have lost weight. It might be when their weight is shrinking, or it might be when their weight is dangerously low. It might also be when someone is in the depths of their eating disorder, yet their weight has remained normal or even above average. Please understand that at all stages of an eating disorder, they need your help. As a friend, co-worker, teacher, parent, sibling, or medical professional, you could be the difference between life and death. Please, take them seriously. Early detection is critical, but most only seek medical attention when their eating disorder has fully taken over. Please know the signs and symptoms and learn how to identify eating disorders before it is too late. Always encourage your loved one to seek professional help. Eating disorders thrive in isolation. You can’t do it alone.
9. Do not tell them there must be some “organic reasons” they are restricting food intake. Please do not say that lab results will determine whether they have an eating disorder. At my lowest weight, my blood work came back mostly normal. I was, however, very sick. Lab results are not an indicator that there is a problem. It is someone’s attitudes and relationship with food, weight, and appearance, which determine if one has an eating disorder.
10. Read the DSM (Diagnostic and Statistical Manual of Mental Disorders). While the diagnoses are constantly changing, it is important to be up to date and understand how anorexia and other eating disorders are diagnosed.
11. Do not belittle their mental health disorders. After I started recovery from my eating disorder, I began to struggle with self-harm. I once had a doctor tell me, that since my cuts were “superficial”, and since I never needed stitches, it was not much of a concern. Lab results and tests cannot diagnose mental health issues, but that does not mean that they are not serious or in need of professional treatment.
12. Most importantly, be compassionate. Understand that telling someone (especially a doctor) “I may have an eating disorder” was one of the scariest things I’ve ever done. I was terrified of getting treatment. I was terrified of gaining weight. I was terrified that everyone would know my secret. Being honest about my thoughts was extremely difficult. Please do not be dismissive, especially when I am telling you something that I can barely verbally talk about. If someone tells you they have an eating disorder, please listen and try to understand to the best of your ability. If you do not understand eating disorders, explain this to them, and refer them to a therapist or psychiatrist that can better address their health needs. In general, when talking with your loved one or patient, think of them as your children. If you noticed that your daughter lost weight and had cuts on her arms, how would you respond? Would you belittle her or would you show concern and worry? Treat them as you would your own children.
As always, stay strong, keep fighting, and never give up hope. Recovery is possible. Yes, it’s even possible for you.
About the Author:
Lizzie studied psychology at Hillsdale College, a small liberal arts school in Michigan. She currently works as a research assistant in Washington, D.C. She is in recovery and hopes to one-day use her experiences to help those struggling with eating disorders. She will post once a month, so if you have any topics you are interested in hearing about, please comment below! Lots of love, and please be strong. You’ve got this!