How to constructively engage a female friend with possible body image problems?

Question

A few months ago, I happened to reconnect with one of my friends, and noticed she was thinner than I remember. She had always been a thin girl, but now she looked even more so. Just yesterday I saw her again this time looking even slimmer to the point I felt concerned. I pressed the point a little and she revealed she now weighs only 86 pounds on her 5'1" or so frame (~155cm and 39kg). I tried to light-heartedly suggest she eat more, but she deflected and told me I should lose weight too (I'm 5'9" 160 lbs – 175 cm and ~73 kg – so a tad chubby but nothing remarkable).

I'm worried she might have an eating disorder and I want to help, but I don't know how to constructively engage with her. I don't want to appear as overbearing or mansplaining to her and I'm aware ultimately it's none of my business, but I'm concerned she's going to keep losing weight and hurt herself. Any help would be greatly appreciated.

EDIT: A few clarifications and more information based on comments. We are both in our late 20's. I met her when she was a research assistant in my city about 2 years ago. She is an international student, and just started a PhD program about 7 hour drive from where I live. I don't think she has any friends/support system in her new city and has minimal close friends in this country at all. Her family is also still in her home country; I'm unsure of their relationship. Either way I don't know enough about to get in touch with family/friends, and I believe I'm one of her closer friends on this side of the ocean.

She does seem to have at least mild health symptoms of being malnourished. I made a joke about telling time from my receding hairline, and she responded that she was losing her hair too in a much more serious tone. She stayed in my guest room and when I changed the sheets this morning I did notice she left more than a few strands on the pillows. She complained of being tired quite frequently during her visit. She also has noticeably sunken cheeks, and her ribs were visible through a thin tight fitting shirt she was wearing. She doesn't look like she's on death's door, but clearly looks underweight from a visual perspective. The weekend she spent with me she ate what I considered to be a smaller than normal portion (ie for dinner she ate ~6 chicken wings and a handful of berries and yogurt for dessert after having a small salad for lunch) but she didn't seem to be avoiding food or uncomfortable at meal time.

Answer 1

I do have some experience with Anorexia nervosa and will try to provide some help, although request caution with everything a stranger on the Internet writes.

There are two main problems you are facing:

1. You don't know what problem she has.
2. You are "only" an old friend who didn't have contact with her for a very long time.

Possibility 1: No Eating Disorder

It's her body and her decision, not yours.

Possibility 2: Eating Disorder

It is understandable, that you are concerned. Eating Disorders are potentially lethal mental illnesses. In this case, she needs professional help and support from her family and close friends.

Your options are limited here and I would suggest you to be a good friend to her:

• support her and be there for her, if she needs you.
• be someone she can trust (and who deserves her trust).
• respect her and her wishes, else you will merely alienate her.
• ask her how she is, how she feels etc. to give her a chance to open up and then be a good listener.

The most direct action you could take is to inform her family, in the unlikely case they didn't notice yet (and you don't have too much information either).

I agree with Xander's answer, that you need to get informed first. You may not be aware (judging from your question and especially that light-hearted suggestion) just how serious her condition may be and how distorted her picture of herself potentially is.

You won't be able to cure her, no matter what you say.

Putting pressure on her or telling her something to the effect that you can't watch her wasting away or the like (e. g. to "friendly" blackmail her into eating more) will drive her into isolation, but not help her. It may help you, as you then no longer have to watch her suffer, but she will only suffer on alone.

If she suffers from that illness, she can't just eat because someone light-heartedly told her to or threatened to walk away. It's like telling someone who lost his legs to just get up and walk.

Ostracising is of no help to her and your messages may be misunderstood (e. g. you say that you think it's gross how thin she is or that she binges, but she thinks she was too fat, she may believe that you think she was disgustingly obese (and a liar)). She needs every support from friends, even if it's just a friendly face saying "Hi" and "How are?".

Eating is a very sensitive issue, so I would suggest you to only bring it up just like you would with someone of regular weight, i. e. a more subtle approach than a direct "Eat more!". Especially, since you don't know what's wrong with her. But you can give her chances to eat, e. g. like in Tycho's Nose's answer. And if you observe problematic behaviour, you could reach out to her family.

Answer 2

It is hard for me to say. I had a health issue going on that apparently was hard for doctors to diagnose as it took a rather long time. In the meantime, every one else's focus on my weight felt awful. It caused me to want to avoid social interactions as much as I could, and just stay home. I wasn't skinny on purpose, I didn't like it either, I was scared about my own health, and being constantly reminded of it every time I went places just made it unappealing to go. I even had doctors try to suggest it was an eating disorder and not believe my food journal I was keeping. It was truly scary (I thought I'd die before I was sorted out because it appeared no one wanted to think it wasn't some secret eating disorder). I have talked to enough others with similar stories to know that assuming thin young women always are think on purpose is a damaging thought process.

I would not recommend suggesting to someone they eat more. I had people say that to me often. It was so highly insulting. I ate a lot, all the time. That wasn't my issue and it came off as if they thought this was a "simple" fix.

Answer 3

I have been almost as thin as your friend in the past, though I'm a few inches taller but I didn't have an eating disorder nor was I excessively exercising.

You won't know what is going on unless you spend time enough time with her to actually witness her eating habits (and/or exercise habits).

If you are really concerned about your friend's weight, come up with ways to incorporate eating when you hang out together. You could suggest cooking at your place along with watching a movie, or grabbing pizza or some other food she enjoys while doing something else. If she avoids the eating part and you start noticing a pattern then you might want to consider helping her open up about what is going on without pressuring her. So far, this could be just you speculating.

Additional thoughts after your update:

She is a phD student and she's an international student. Being or looking underweight could be related to stress due to studying, being away from home and/or being on a budget so she might be trying to limit her portions in addition to trying to stay/be healthy at the same time.

Does she take any vitamins? She might need some supplements now that she studies a lot. I don't know how stressful her program is but perhaps you could try to find out. Also, if she has insurance it might be a good idea to check her thyroid, iron. Such deficiencies could result in hair loss (stress too). Just try to be supportive and if you feel comfortable asking, try to find things out carefully.

Answer 4

Eating disorders are very serious business and should be treated soon or the damage to both body and mind can be devastating. Having said that, it seems that your friend is in denial and it will be really hard to make her see that she's damaging herself.

The best thing you can do for starters if you really wanna help her, is educate yourself. Understand what this disease is and what she's going through. I would suggest researching online, talking to a psychologist that specializes in eating disorders or contact a helpline (USA: 1-800-931-2237).

Helping someone with an eating disorder can be delicate, here are a few things to consider:

• Timing is everything. Try to do this somewhere privately without distractions. Avoid public places and make sure she's is in a good state of mind.
• Explain your concerns. It's really important to make sure you don't come off like you're lecturing or criticizing her. Tell her specific situations that you have noticed and why they worry you. Make sure to tell her you care for her and you'd like to help.
• Denial As you have already observed, there's a good chance that she will become angry or defensive. If that happens, make sure you remain calm, focused and respectful. Don't take it personally.
• Be supportive. Don't give up on her after your first try. You need to make sure that you keep the lines of communications open. Show her that you only say these things out of love and that you care for her.

A few things to avoid:

• Avoid ultimatums. She must decide on her own to seek treatment. Threatening her only adds pressure which leads to her being even more secretive and sink deeper into denial.
• Avoid appearance/weight related discussions. People with these kind of disorders naturally care about their appearance. Assuring her she's not fat can some times have the opposite effects than the one intended. It's better to talk about emotions: Why are you afraid of being fat? What do you gain by being thin?
• Avoid shaming and blaming. Avoid accusatory "you" statements. (e.g. You need to eat more! or You're damaging your body for no reason). Instead make it about yourself, "I find it hard watching you waste away".

After you establish that she's indeed suffering from an eating disorder, I would suggest you reach out to her family and friends.

Answer 5

It would be tricky for strangers on the internet to know exactly what's going on with your friend, so let me offer an alternative scenario, in case it's not an eating disorder per se, but perhaps something more along the lines of just not bothering to eat enough (due to forgetfulness, loneliness, etc.):

I'm naturally slender myself (decent baseline: 5'9", ~145lbs, male), and there are times when my weight's dropped a bit and friends have expressed concern as a result. In my case, the reasons were/are likely either absent-mindedness (yes, I forget to eat sometimes), a listless mood, or lack of physical activity.

What I would have found really useful is if a friend offered me low-effort invitations to eat food that I want to gorge myself on, or to go do physical activities where exercise is a side-effect of having fun. What that is would vary from person to person, naturally. As an example, a dinner invitation involving a big bowl of bean dip and chips, or some good Chinese take-out with a bunch of dishes that I want sample, would help with loneliness at the same time as incentivizing me to actually eat a decent amount. Similarly, having someone offer to drive the both of us (or a group) out to a hiking spot where there are some light rock climbing/bouldering opportunities would result in me getting exercise as a side-effect of a fun day out, and I'd also likely want food afterwards due to burning calories. Of course, those are just examples; maybe someone else would like a big thing of mac 'n' cheese (too cheesy) and a swimming trip (not my thing).

You mentioned that your friend ate a small-ish portion, but didn't seem stressed by eating, right? Maybe she's just not that interested in eating large amounts of those foodstuffs, and doesn't have a routine which would make sure her appetite is as large as it should be. If you happen to be good at cooking, you could perhaps ask if there are any foods that she misses and which would be feasible for you to try cooking; or if you're not good at cooking (and if restaurants are affordable enough), you could ask her to introduce you to some food she's fond of at a restaurant.

Nagging, on the other hand, would not really be helpful; one or two comments to make sure I'm aware of my low weight might be useful (I'm sometimes absent-minded, after all), but beyond that, I'd likely just get annoyed at being nagged. This includes repeated expressions of concern, unless maybe if accompanied by "so let's get some food".

Another thing that is slightly helpful, but not really an ideal solution, is reminding me to eat - there have been times when I've realized at 4pm that the reason I'm having trouble concentrating is because I got up at 11am, got engrossed in something, and haven't had breakfast yet. So, being asked at 2pm "hey, have you had food yet?" might be useful for me; but better would be if I got onto a schedule/routine where that sort of reminder isn't necessary in the first place.

One other thing that is very helpful for me, but which is pretty personal, is having copious snacks available which fill in whatever nutritional deficit I have (sometimes this includes cookies, if the most-pressing deficit is calories). If your friend is the sort who needs snacks to graze on, there isn't a whole lot I'd expect you to do, other than perhaps make sure that your place has snacks available if she's hanging out there.

Answer 6

I've found that friends with eating disorders are most likely to open up to me about their eating disorders, or about concerns that they have that they might have one, if we are talking about those eating disorders in a context other than themselves. "I ran across a video on eating disorders yesterday, and man, it's made me think about my life. I can't imagine what it'd be like to ____!" or "Wow, I was reading about [celebrity]'s struggles with their eating disorder! That sounds like such a difficult problem to overcome!"

Be aware that this is a risky tactic, though. If you come off as wheedling, as trying to force them to talk about their problems or otherwise shine a spotlight on it rather than to provide a constructive environment for the discussion, then it can feel more like an intrusion than an invitation. And what's more, it can come off as a little underhanded...as perhaps it is. And it might be more prone to that kind of failure in this case if she took your previous suggestion that she should eat more to heart and is still hurting from that conversation.

Still, this is a strategy that serves me well with many topics that are nonconstructively culturally taboo, or topics that tend to be wound up tightly with one's self-esteem or insecurities: provide a non-judgmental environment in which discussing the topic feels natural, but do not press.

Answer 7

It could also be that she has no eating disorder, but some other issue than more stress than she can handle, and from what you explain, this is a realistic option.

About her hair loss, I also suffered from that when my then-roommate whas becoming more and more agressive, and I felt all the time in danger.

What you can do for her is being there when you have time, and just be her friend. Better avoid subjects like her weight or her hair, unless she wants to talk about it. If you have the energy to listen to her problems, you can also explicitly offer her to listen to them.

In case she has some mental illness (eating disorder or something else), do not try to fix her, basically because this is something dangerous to do. This should be done by a professional. Helping her to find one is ok, though.

Good luck with her.

Answer 8

Is she grotesquely thin? Women tend to fluctuate in weight. After I broke up with a boyfriend I was super thin. When I got a new boyfriend I packed the pounds back on.If you don't have more information, other than assumptions, say nothing, or your newly reacquainted friendship will strained or disappear from your life again. If you have more information such as knowledge of her binging, and purging,teeth may be effected, excessive exercise, or obsessing over every calorie she consumes, this is the time to say something. If she does these types of acts in front of you, this would be the time to say something. Let her know what you are noticing. Do not enable her in anyway. Tell her you do not want to be around her when she engages in this behavior because it is to hard to watch her self destruct.