Dear Jamie

DEAR JAMIE:

I have a friend who I’ve been increasingly concerned about lately. She’s beautiful, and her body is amazing, but she never seems to see herself in the same light that others see her in and has even resorted to some unhealthy habits to conform to her own ideals.

She’s skinny — eats like a bird. Yet, when she lets herself enjoy a filling meal, she ends up feeling terrible and convinces herself that she has to not eat in order to maintain a good physique. Every pound gained is criminal to her, even though the extra weight is exactly what she needs.

I wish she could be okay with her body, because there is absolutely nothing wrong with it. She is one of the most genuine, caring people I’ve ever had the pleasure of knowing but is the harshest critic when it comes to her own body image.

I care a lot about her, and I really don’t want to see my friend hurt herself any further. However, at the same time, I’m afraid to confront her about this because I don’t want to upset her or have her be angry with me.

What should I do? How can I help her?

— CONCERNED FRIEND

DEAR CONCERNED FRIEND:

Thank you so much for reaching out. Your friend is lucky to have you, and through your example of care, I hope others in similar situations can be blessed too.

Understanding the warning signs

Though I’m not sure what exact “unhealthy habits” she has, I do know that her mentality resembles that of a person with an eating disorder, such as anorexia nervosa or bulimia. “Every pound gained is criminal to her” sounds all too dangerously familiar; I know from my own battle with bulimia, and so I sincerely thank you and hope that you can keep looking out for her.

Pay attention to signals. Seemingly controllable, harmless statements and actions, like “I’ll just control what I eat from now on,” can quickly snowball to become more serious: “I won’t have that sandwich either. Or my next meal. I’ll just skip one day … or two.”

Trying to consistently restrict what one eats is incredibly difficult. It sounds like when your friend has a seemingly normal-sized meal, she feels like she just binged. For someone whose sense of self-worth can fluctuate with her weight, it can be tempting to purge afterwards.

As I’m sure you’ve heard, starving and binge-purging are both extremely damaging to one’s health for a variety of reasons. If you’re with her, take note if she consistently goes to the bathroom within 30 minutes to an hour after eating. Other physical signs include acid reflux, hair loss, irregular menstruation, frequent dizziness or fatigue, bloating, mouth and teeth decay, laxative abuse and weight loss or gain; contrary to belief, bulimia actually tends to cause more weight gain than loss. Even if her thoughts and feelings don’t lead to an eating disorder, it is better to be cautious.

Supporting a positive lifestyle 

A good way to help someone stop a problematic behavior is to provide an alternative method of coping. For instance, you can offer to make a balanced, healthy eating schedule with her and to explore new activities that make her feel more positive about her overall self, not just her body. Your biggest role is just being a good friend by showing that positive change is possible. But remember, you are not the only one who can help her. There are others who are trained, available and wanting to help too.

Seeking trusted adults

When eating disorders get to a certain point of severity, professional help is imperative. Eating disorders affect how the brain processes information, including advice from close friends, so at a certain point, food may be the only medicine.

If your friend has low energy, is often sick or missing school, faints or seems to be thinking significantly more slowly, tell an adult immediately. Even if you don’t see severe signals, I encourage you to seek adult guidance anyways. Talk to your parents, a counselor, a psychiatrist or another dependable adult for professional wisdom, and encourage your friend to reach out to trusted adult mentors to help her through any struggle.

Identifying the real issue

More importantly, keep in mind that weight may not be the root problem. Your friend’s dissatisfaction with her appearance may come from a deeper unhappiness about something else in her life; when we feel like things in our life are spinning out of our control, it can become easier to fixate on one aspect that we believe others value and think we can control.

Talk with your friend about other areas of her life that she feels particularly discontent with. Is it academics? Extracurricular performance? Loneliness? Identify ways to strengthen and fill those lacking areas, even if it’s just one. Use your own experience and examples of others’ strengths as guides. Really encourage her by trying activities with her and by getting other good friends to join too.

Having the conversation

I know it may feel scary to confront your friend with your concerns, but trust me, enduring a little rough patch and getting help for a potentially bigger problem is better than letting her face dangerous struggles on her own. In the long run, she will be more likely to appreciate it.

To initiate a conversation with your friend, make sure you’re in a private setting when she’s not in a hurry. Open with a normal conversation and show that you appreciate her, love her and care for her well-being. Then, mention your concern. Emphasize that you only want the best for her, and ask her to tell you honestly and openly how she feels is the best way you can provide support. As you shared with me, tell her how you value her for more than just her amazing body or physical beauty — that she is “one of the most genuine, caring people [you have] ever had the pleasure of knowing” — and that there are likely others who feel the same way. Point out special personality traits or talents that aren’t tied to appearance. One conversation could change your friend’s life.

Painting a perspective

Weight is really just a number on a scale at one moment in time, and it does not measure worth. Think of a precious glass cup. You can fill it with as much water or substance as you want, but no matter how much its weight fluctuates, its value and importance stay the same. It could even be left to gather dust, and it would be precious all the same. We often convince ourselves that because the number is related to our own body and life, we should be able to control it, but this is not true; everything in life fluctuates and affects us in different ways that are out of our control. Thankfully, you can choose how you complement, appreciate and love yourself and your body for more than your appearance. Keep this image in mind when you’re with her and for yourself too.

I hope your friend’s eyes can be opened to the beauty and worth she holds beyond her outer appearance. Remember, you, too, are a lovely person who is blessing so many people through your bravery.

WITH LOVE: JAMIE

Dr. Moira Kessler, a child psychiatrist at the Stanford University Department of Child and Adolescent Psychiatry, offers feedback to the column writer. She is not providing any clinical services.

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