To many, the holidays are a much-anticipated time of love and togetherness. But for the 30 million people living with an eating disorder, the thought of holiday gatherings can trigger tremendous stress and anxiety. Navigating an abundance of food—and conversation about food—can be overwhelming for someone with an eating disorder.
In this Q&A, Kara Becker, LMFT, CEDS-C, Newport’s National Director of Eating Disorder Programs and AAMFT Approved Supervisor, along with our Dietary Services Specialist, Annaliese DiFabbio, RD, CEDS, offer tips for managing holiday gatherings, as someone with an eating disorder or as a host. They share best practices for planning ahead, accommodating a guest with an eating disorder, and how to support a loved one during this special time of year.
What challenges do young people struggling with or recovering from an eating disorder face around the holidays?
Kara: For people with eating disorders, Thanksgiving can be the Superbowl of all holidays. There can be a real or perceived pressure to present as recovered in addition to dealing with the chaos—and at times stress—that can accompany these holidays. Thanksgiving may be the first time in a long time, young people are seeing friends and family which may activate feelings of comparison and the need to be seen in a particular way. Also, our bodies change over time and in our society body and food comments are often made at holiday celebrations.
Annaliese: Holiday meals are usually comprised of foods we don’t typically eat, which can feel threatening and unfamiliar for people with eating disorders. Eating in abundance or ending up in a “food coma” is normalized during holidays, which can feed into disordered eating behaviors.
What are some additional stressors young people with eating disorders experience as they anticipate seeing family?
Kara: Our bodies are always evolving and changing, much like our environments and life situations. But if you haven’t seen someone for a while, they can become an unwelcome focus. Some young people, especially those who have been away at school, may be entering social or familial situations where they are likely to receive comments about any changes to their bodies, which can be anxiety provoking.
Do you have advice for what “to say” or what “not to say” to someone with eating disorder?
Kara: For someone with an eating disorder it is best to not make any comments about their bodies or their plates! It’s more helpful to focus comments or compliments on other areas of their identify such as what they are studying in school, their friendships or relationships, or any other topic you know is easy for them to talk about. Thanksgiving and any holiday setting is not the time for hard hitting decisions – those should be saved for family therapy!
How can someone with an eating disorder prepare to navigate family conversations?
Kara: We teach our clients to have a “cope ahead” plan. If there are certain comments or conversations that they know are likely to come up and likely to trigger them, they can have a plan on how to manage that. The plan could be giving “the look” to a cousin you trust who will help you get out of a tough interaction and step outside with you for a few minutes. It could also include making a list of conversation starters to help ease the social aspects of the meal. Or it could look like practicing radical acceptance—knowing that what others think and feel about their bodies is not how you have to think and feel about yours.
What are some best practices for hosting someone with an eating disorder?
Kara: Assigning seats at the table is one simple but effective strategy. If the host knows there are certain guests who are more likely to be triggering for the person with an eating disorder—a cousin who won’t stop talking about working out or an aunt who is always speaking about weight loss—they can make sure they’re on opposite sides of the table. Also, providing to-go containers gives a signal to guests that it’s okay to take food home and not have to consume all the food on their plate. Having a casual dress code is also supportive, to avoid additional stress around appearance and body image. Another approach is to simply ask them what they need and how you can best support them.
Annaliese: Having to-go containers is a great option and can feel supportive to someone who is trying to honor their fullness cues. However, it’s important to not pressure your loved one into taking leftovers home. You may be asking them to take foods that are challenging for them, so offer, but don’t push.
Should I plan to accommodate the family member/guest with a dish request?
Kara: This will depend on your relationship with the person. Whether you decide to make them something special or not, it’s important to not take it personally if they choose not to eat what you’ve made. For some people, just sitting at a table full of food may be challenging.
Annaliese: It can be helpful to let your loved one with an eating disorder know the menu in advance—as well as offer a special food accommodation. Knowing this information ahead of time can reduce anxiety around the unknown and allow them to set realistic goals or expectations for the meal.
Eating Disorder Treatment at Newport
Newport Healthcare views eating disorders and body images issues as manifestations of underlying mental health conditions, such as anxiety, depression, low self-esteem, and trauma. Our outpatient and residential programs for teens ages 12–18 and young adults ages 18–35 address these underlying issues using tailored treatment plans. Contact us today to learn how Newport can help you or someone you love start the path to recovery.