Columbia University Health Services

Eating disorders are not about food, but food is what people with eating disorders abuse. 

The term “eating disorders” refers to anorexia nervosa, bulimia nervosa, and binge eating. These syndromes are characterized by extreme disruptions in eating and intense anxiety over body weight and appearance. Sometimes these disorders can overlap. 

Eating disorders are psychological disorders which have physical manifestations. In fact, severe medical complications which can sometimes even be life-threatening occur. 

When You Think a Friend Has an Eating Disorder

Educate yourself. Learn about eating disorders by reading literature, consulting a professional, or tapping into local resources. Make sure you know what the local resources are for helping a friend with eating problems before you talk to them. 

Consider your approach. Think about what you want to say. Be sure it doesn’t come across in a threatening or accusatory manner. Try to keep the focus away from food, weight, and appearance, as the most innocuous statement may be misinterpreted. Express your concern, focusing on the person’s behavior (“you never go out with us”, “you say you’re not getting enough sleep, but you spend 2 hours at the gym every day”), and maybe even discuss how their behavior is affecting your relationship. Do not assume you know what they are thinking, feeling or struggling with, simply try to give them an opportunity to tell you. Many people with eating problems have low self-confidence, so let your friend know you care about them. 

It is not about food or weight, it is about feelings. Eating disorders are a culmination of many contributory factors. They always start as an attempt to cope with difficulties in life, but quickly become self-defeating for those who struggle with them. When your friend is ready, listen to what she or he needs to talk about, without criticism or judgment. 

Timing is everything. When you bring this up, be sure both of you are calm, relaxed and have plenty of time. It may be a good idea to keep your first approach brief. You can always leave the door open to talk at another time. Do not let your discussion turn into an argument. If either of you becomes angry or defensive, back off! Resume the conversation after you have had time to think about the exchange a bit. You may need to consider how you can be more constructive in your approach. 

Be prepared for rejection. Your friend may deny he or she has a problem. Do not take this personally! People with eating disorders generally feel very alone with their struggles, and very ashamed. Because of this, they are likely to have feelings of both fear and relief about being approached. Continue to stress that you are raising these issues because you care about them, and offer them information about resources that may help them. It often takes time for people to acknowledge their problem and seek help. 

Recovery is a process. Your friend may not accept your help initially, but your efforts will certainly register. Your friend may reject help now, but contact the resources you gave them later. It is important to realize that you cannot change your friend’s bingeing, starving, or purging alone. People with eating disorders require the support and guidance of professionals. 

Know your limits. If your friend continues to struggle with symptoms, and asks for your support, but seems unwilling to seek any professional help, recognize that this may mean you are being asked to provide more than you are able, after all, you are not an eating disorders therapist, physician or nutritionist.

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Primary Care Medical Services (PCMS) provides comprehensive care for routine, urgent, and chronic medical needs for students. Primary Care also provides sexual health, reproductive, and gynecological services, LGBTQ health care, immunizations, and referrals. For more information go to Making Appointments.

Eating Disorders Team
Students struggling with an eating disorder should contact Health Services at Columbia as a resource. Following national standards for excellent eating disorder care, Health Services at Columbia has for over a decade maintained a multidisciplinary team of experts, comprised of physicians, nurse practitioners, nurses, psychologists, and a registered dietician. The team works together to establish a treatment plan for each student. For more information go to Making Appointments.