How to help someone with an Eating Disorder – Autonomy and Boundaries

One thing that can easily get blurred with an eating disorder are our boundaries. When family is involved, it is particularly easy for these to be encroached upon as emotions can begin to cloud our judgement. It is easy to offer a concession from time to time, especially when someone we love begins to plead with us. We also know that any individual with an eating disorder who can learn to make their own decisions, will do better throughout recovery. That said, allowing someone with an eating disorder to do entirely what they want will rarely result in a positive outcome. We must balance an individual’s autonomy with firm boundaries around what is acceptable with regards to their behaviour.
An image of a tennis ball right next to the line on a court
It is vital we establish clear boundaries relating to behaviours around eating disorders
In general, when it comes to controlling behaviours around food, allowing individuals to eat alone, allowing them to eat 'special' foods differently to everyone else, and allowing them to refuse that others cook for them are just some of the things we might want to look out for. These will be individual to each person, but it is these types of behaviour that will be perpetuating their problems. For these we will want to draw a line in the sand. We will need to learn to say - NO. Because of their situation, it is vital that they accept that some things will be non-negotiables for them. Yes, other people might be allowed these 'luxuries', but for this person, right now, they need to understand that somethings are not helpful and that they must make and effort to change. This can be hard for many of us to enforce, but developing this assertiveness is often exactly what is needed in this type of environment

How to help someone with an Eating Disorder – Dealing with Denial, Focus & Honesty

What problem?

It is often common for the person you believe to have an eating disorder to deny they have a problem at all. This is where things get tricky. You certainly don't want to engage in a futile and often inflammatory battle of wills, but nor should you completely surrender to their denial. In learning about eating disorders, you will come to understand that this denial, and subsequent anger or refusal to seek help is a part of their illness. They will likely be ashamed of their situation and moreover, fear that by seeking help that they will lose control of their own weight.

Denial
Denial that there is a problem is particularly common in those with an eating disorder

To compromise, you might want to offer up information or point them in the direction of resources that could help them. Allow them to deal with these in their own time. If receptive, you could also offer to go to 'just one' appointment with a doctor, eating disorder specialist or nutritionist with them. This might help start to turn things around without demanding a commitment to ongoing treatment.

Where possible, focus on the person too

When someone's behaviours around food seems problematic, it can be very easy to focus only their eating habits when you speak with them. Likewise, it can be very hard to bite your tongue when someone is blatantly not looking after themselves. Understand that these problems are more about their own emotional battles and difficulties with self-worth than they are about fats and carbs. If and when you do talk about food, make sure you balance it with your concerns about them as an individual.

Be honest, be brave

picture of eggshells
Don't walk on eggshells with an eating disorder, but be careful about how you deliver your message

There is a very fine line between being honest about your feelings relating to someone's behaviour and emotionally unloading your problems onto them. For people with eating disorders, it is good for you to model for them that it is both important and acceptable to get in touch with feelings that might be the source of shame or feel dangerous. Let them know what behaviour or action they have taken you want to discuss, how it has made you feel, and how you are going to personally deal with it. Explaining to them how you have taken the time to learn about eating disorders and just listening to them are great ways of showing them you care without making it seem like you are forcing them to change

How to help someone with an Eating Disorder – Labels and Solutions

Don't label

When you know someone has an eating disorder it can be quite natural to try to label the problem. By giving it a name it can help us to make sense of it, and to mentally partition it as a separate issue. This is not particularly useful for the person involved, and it can be quite dehumanising. We should never label them, or argue with them that there is a problem. If you find yourself becoming accusatory in tone, try to reframe what you say to be more compassionate and understanding. Let them know, that problem or no problem, you are still worried for them and are there to help them find a solution.

eating disorder label
Labelling someone with an eating disorder can be dehumanising

No one-size-fits-all solution

When it comes to helping people with an eating disorder, its as simple as this - there is no one-size-fits all solution. An eating disorder has no single cause, and will be multifactorial in nature. They are complex issues. As a friend or family member of someone with an eating disorder, first do your best to learn as much as you can about eating disorders. If necessary, speak with a qualified therapist to learn more. Those with eating disorders can have a deep ambivalence and resistance to change which might seem at odds with other things they say. Make sure you've done your due diligence before you try to engage with them in depth.

Strength and Conditioning Coaches, Professional Boundaries & Eating Disorders

I recently came across the description of some disturbing behaviour from a young client with an eating disorder. It related to two behaviours of the strength and conditioning coach staff at their training facility. i) The S&C coaches had encouraged the athletes not to eat pudding at lunch. As far as the athlete was concerned there was also ii) the threat that should the coaches see an athlete eating pudding at lunch, they'd come and take it away from them.

image of burger and drink in red danger sign
Banning types of food is a bad idea

Its actually hard to know where to start with this. Now I'm not here to dissect what was actually said, as it doesn't really matter. The NLP presupposition 'the meaning of your communication is the response you get' its a useful one in this instance though.  I hope that the paragraph above makes you at least feel uncomfortable. Either way, I'll try to explain how, and why this sort of rhetoric can be utterly destructive to an athlete, and why it should not be a problem that occurs at all.

The weight of an athlete and performance

Undoubtedly, these comments were uttered with a positive intent. Yes, weight plays a role in athletic performance. Yes, eating less processed foods, and eating more, colourful, fresh fruits and vegetables is going to have a broadly positive impact on health, well-being, body composition and on athletic performance. Yes, the S&C coach wants to help improve many if not all of these things in their athletes.

However...

This is a population of potentially vulnerable individuals. Of individuals with perfectionist tendencies. These people will often struggle to appropriately process and assimilate information regarding any sort of food restraint.

There is a very fine line between advice around food restraint and being a food bully. I think this falls on the wrong side of that line. Coaches must respect that their words come from a position of authority, and carry more weight. What implications might this approach have for someone with lower self esteem, or poor body image. We want to build our athletes up, not break them down.

Consider the shame and embarassment and even fear that would be created from such an statement or the environment it creates. Not exactly conducive to 'high performance'.  There is a place for almost any food (in moderation) in a healthy and balanced diet. It almost goes without saying that we don't want to be linking any food group or type to negative emotional states. The generality of this unguarded comment has clearly been misconstrued and has unfortunately resulted in almost the opposite of the intended effect.

Few S&C coaches are actually adequately trained and qualified to dispense appropriate nutritional advice on weight loss. Just because weight and body composition is related to athletic performance, S&C coaches MUST NOT be mistaken in thinking they can or should advise on the matter. If you do think its something worthwhile changing, engage with qualified professionals. I've said this before, but unless you understand the physiological and psychological consequences of such advice, its best to keep your mouth shut. Now I don't know if these coaches were qualified or not to dispense such advice, but I'd argue that if the individuals involved had been qualified, they probably wouldn't have delivered the 'advice' it in the way they did. Food choices, although we might not be aware, can extremely personal to us and carry or convey underlying values and meaning. Quarrel with these at your own peril.

Ultimately, the overriding issue is that the mental health of an athlete must be prioritised before performance, especially if performance is your end goal. Perhaps this is a statement that not all of you will agree with, but without this hierarchy, I believe we’ll be seeing a few more Phyrric victories than necessary. Remember, we’re people first, and everything has a cost!

Codes of Conduct

Be honest, how many of you know any of the codes of conduct of your professional organisation? Whether accredited with the UKSCA or not, I would strongly urge you to all revisit your professional or personal codes of conduct from time to time. I know at least one coach at the organisation involved in the above anecdote to be UKSCA accredited, and while this is not a whistleblowing exercise, there are arguably several points within the UKSCA codes of conduct that have been disregarded from just one seemingly innocent throwaway comment. I’ve copied out some of the most relevant ones to this situation below, but please take the time to read through the rest though, it’ll certainly be worthwhile:

  • Not to exceed my own competence, expertise and qualifications in any aspect of any services I may provide, and not to carry out work above my level, as in the Scope of Practice document.
  • To refer to an appropriate professional any matter which appears to lie or does lie within another specialist’s area of expertise.
  • To seek appropriate advice in any situation where I may lack the necessary experience or competence.
  • I agree at all times that I will act in the best interest of the athlete/client.
  • To comply with all Child Protection, Vulnerable individuals, Racial, Sexual and Disability Discrimination legislation.

The UKSCA Codes of Conduct

When it comes to eating disorders, just one comment can be the precipitant for someone developing lasting problems. So when it comes to nutrition, unless qualified, you really are best off following Kelvin Giles' advice:

In coaching you will have thousands of opportunities to keep your mouth shut. Take advantage of all of them.

Know your ethical and professional boundaries. Respect them. For adolescents and their nutrition, they are perhaps best left largely alone. If you must do something, broadly educate them on what constitutes a balanced diet, be emphatic when it comes to the serious risks of underrating or purging behaviour. Only once they are older, and when they have consistently demonstrated they have no problems with food, should a qualified and trained professional begin to approach them with more specific or targeted dietary interventions (with caution) IF necessary.

How to help someone with an Eating Disorder – Talk to them

So you've seen some of the warning signs, and you suspect someone might have an eating disorder - but what do you do next? When you think that someone might have an eating disorder, it can be hard to approach them. Knowing what to say, or whether you should say anything at all is hard. After all, catching someone at the wrong time, or saying the wrong thing can make it feel like you've made things worse. Despite this, it is certainly worthwhile reaching out to them. Leaving an eating disorder to run its natural course can quite literally be a deadly. Here are some pieces of advice on reaching out to someone you suspect might have an eating disorder.

Make a plan

Arrange to meet with them at a low stress time, in a non-confrontational environment. Speaking out when you've just noticed something about what they are or are not eating, is not a good moment. Take the pressure off them, and try not to say 'you' too much as this can create resistance. They will naturally be defensive and prickly about their decisions around food as they are part of a way they have learned to cope. Speak in the first person, ask them to help you talk about your concerns, as opposed their behaviour.

image of two people speaking on a park bench
Make a plan to speak with them in a non-confrontational, calm, non-judgemental way

Be caring, be clear

Let them know that you care, and be specific about what your concerns are. Their behaviour might well make you upset or even angry, so ready yourself when you do speak to them. Maintain a calm and composed demeanour, no matter how seemingly irrational or strange their response.

Find out more

They might not want to talk about their problem or might not even be aware that there is one. Try to just investigate with non-judgemental curiosity what is going on. Communicate your openness and willingness to learn about what is going on both in general and specific ways.

Leave the door open and don't rush

How often when you've debated with someone on a difference of opinion have they immediately been talked around to your viewpoint? I'm guessing maybe never, or hardly at all. Chances are, the person you've spoken with will have a lot invested in their way of doing things. If they are going to change, it won't be overnight. It's important when you first speak to them, to let them know that 'your door is open' to discuss things again with them, on their terms, whenever they might be ready. Despite our intentions, we'll never truly be able to understand another's perspective, so if they do come back, listening very carefully, and again non-judgementally is key.