Patient information from BMJ

Anorexia: how to help if someone you know may have it

Last published:Sep 17, 2024

Anorexia is a serious medical condition. Seeing someone you know become very underweight can be upsetting. You may feel helpless and anxious.

It’s important that people with anorexia get help. It can impact their health and can even be life-threatening. Treatments can help people with anorexia feel better about themselves so that anorexia does not take over their life.

What is anorexia?

Anorexia is an eating disorder where people try to keep their weight as low as possible, even though they’re already underweight. It’s much more common in females than males. Eating disorders usually start during the teenage years.

People with anorexia are very afraid of gaining weight and try hard to avoid it. They may be very thin and weigh much less than is healthy. They often eat little and skip meals. They might believe that they’re overweight when actually they’re underweight.

Some people with anorexia also make themselves vomit, take laxatives (medicines that make you go to the toilet), or spend hours exercising.

Many people with anorexia may not understand why they feel this way. They may feel embarrassed and guilty about their behaviour and often try to hide it.

Anorexia can be life-threatening. Eating enough food is important to keep the body working properly. Not getting enough nutrients can cause serious damage to the body and even lead to death from starvation. That’s why it’s important to offer help if you think that a loved one might have anorexia.

How can I tell if someone has anorexia?

People who have eating disorders often try hard to keep them secret. Some things that suggest that someone might have anorexia or another eating disorder include:

• Eating small portions of food and skipping meals

• Avoiding high-calorie foods such as full fat dairy products and sweet foods

• Behaving strangely around food (for example, cutting food into small pieces and moving it around the plate but not eating it)

• Not wanting to eat with others

• Constantly talking about food

• Saying they feel 'fat' when they are underweight

• Preparing big meals for family and friends but not eating the food or eating just a little

• Only eating low-calorie foods

• Being irritable and distressed, especially around mealtimes

• Saying they feel full after eating only a small amount of food

• Leaving the table during or straight after a meal, often to go to the toilet

• Lying about food and being very secretive (for example, saying, 'I ate earlier' or ‘I’ll eat later’ to avoid a meal)

• Exercising more than is normal

• Being so underweight that the outline of their bones shows through their clothes

• Having fine hair on their face

• Always feeling cold

• Drinking lots of water or fizzy, low-calorie drinks to take away hunger pangs

• Missing school or work.

It’s important to remember that many children and teenagers are picky eaters at times. It isn't necessarily a sign of an eating disorder. If you notice these behaviours, the best thing you can do is talk to the person about how they’re feeling.

Getting help

The most important thing you can do is to encourage your friend or family member to see a doctor. You could offer to go with them if they feel that would help. People are more likely to recover from anorexia if they get treatment quickly. However, if someone has had anorexia for a long time, it’s still worth getting help.

Talking to someone about whether they have an eating disorder can be very difficult. They may not want to admit they have a problem or they may say they don't want help. They may get angry. It’s important to remain patient and understanding.

Even if your loved one doesn’t want to see a doctor yet, you can still be there for them and keep offering your support. You can continue to encourage them to seek help when they are ready.

What are the treatment options for anorexia?

If your loved one decides to seek help, they will get support and advice from healthcare professionals. They may be referred to a team that is specially trained to treat eating disorders.

Talking treatment

Talking treatment can help people with anorexia change how they think about themselves and food. It involves having conversations with someone specially trained to help people with eating disorders.

They will talk with your loved one to understand their feelings. They will help them figure out why they might not want to eat. These chats can teach them new ways to feel better about themselves and food so they can start eating in a healthy way.

Different types of talking treatments include:

• Cognitive behaviour therapy (CBT)

• Specialist supportive clinical management (SSCM)

• Maudsley anorexia nervosa treatment for adults (MANTRA)

• Focal psychodynamic therapy.

If your loved one is under 18 years old, they will be offered family therapy. This is where other family members are involved so everyone can support them in getting better.

Each type of talking treatment is slightly different. If your friend or family member doesn’t like one type, they can always try a different type to see what works best for them.

Keeping your loved one healthy

A big part of treating anorexia is making your friend or family member healthy again. To do this, they will need to start changing the way they eat. They will need to eat enough to reach a healthy weight and make sure their body is getting enough nutrients to work properly.

This might sound hard, but support from healthcare professionals can help. They will:

• Keep track of your loved one’s health, like checking their blood sugar and organ function

• Help them with an eating plan

• Make sure they’re drinking a healthy amount

• Give them vitamin and mineral supplements if needed.

Treatment with medicines

There are no medicines that can treat anorexia. But some people with anorexia have other conditions like depression, anxiety, or OCD (obsessive-compulsive disorder).

If your friend or family member has another condition, it will be treated alongside their anorexia. They might be offered medicines like antidepressants to treat their other condition.

Where treatment will happen

Anorexia treatment can happen in different places depending on your loved one’s health and how they’re feeling.

Many people with anorexia can live at home and visit a clinic for treatment. But some people need to be admitted to hospital. This may be because:

• Home treatment hasn’t worked

• They’re very underweight or are quickly losing weight

• Their health is at risk

• They might be at risk of harming themselves.

A doctor or specialist team will decide if your friend or family member needs to go to hospital. They will be able to watch your loved one’s health closely and give them the best chance of getting better.

If someone with anorexia is very sick and doesn't want help, doctors might have to make them go to hospital to get better. This happens only if there are no other options. The main goal is to keep your loved one safe and healthy.

Where to get more help

If you're worried about someone who may have anorexia, there are charities and support groups that can help. Many people find it helpful to talk to others who have been through similar experiences.

Your loved one’s doctor can refer them to a local support group where they’ll find useful resources and services. These groups might also connect them with someone who understands what they’re going through.

There are also groups to support friends and family members of people with anorexia. You might find that talking to others who have supported a child, friend or spouse with anorexia may help you cope with the situation.