Anorexia is an eating disorder characterized by an intense fear of gaining weight, distorted body image, and low body weight. Individuals with anorexia seriously restrict the food they eat in order to avoid gaining weight or to lose more weight. Anorexics may also try to control caloric intake by exercising excessively, vomiting after eating, or misusing enemas, diet pills, diuretics, or laxatives. Anorexia can lead to a number of medical complications, including heart problems, anemia, bone and muscle loss, kidney problems, and death.

If you have a loved one who’s struggling with anorexia, you may feel helpless. While it’s true that you cannot force your loved one to seek help, there are many things you can do to help him.

Realize It’s Not About Food

On the surface, anorexia appears to be about food and weight, but it’s much more complicated than that. Your loved one is using anorexia as a coping strategy. The eating disorder is an attempt to deal with emotional issues.

Express Your Concerns

Though it will be a difficult conversation to have, expressing your concerns to your loved one is important. Choose a time and place to talk with your loved one. Choose a place you can talk privately without distractions or interruptions. Focus on specific behaviors you’ve observed. For instance, “I’ve noticed that you don’t eat dinner with us anymore,” or, “I’m worried about how much time you spend at the gym.” Avoid commenting on your loved one’s appearance or weight; instead, focus on health.

Use, “I,” statements when you talk to your loved one. Statements, such as, “You’re not eating enough,” and, “You’re exercising too much,” are accusatory and will put your friend or family member on the defensive. Avoid giving ultimatums. Unless your loved one is under the age of 18, you cannot force her to get help. Ultimatums won’t help; they promote more secrecy. It’s also important to avoid giving simple solutions, such as, “Just eat,” or, “You just need to stop worrying about your weight.”

Expect Negative Reactions

Your loved one may be grateful that you’ve noticed his struggle. Alternatively, he may react defensively or angrily when you express your concerns. He may deny that he has a problem and refuse to talk about it. He may insist that he doesn’t need help. He may even insist that you are the one with a problem, not him. These reactions are normal.

If your loved one responds in a negative way, remain calm. Reiterate your concerns, and let him know that you are available to talk. Let your loved one know that you care and that you’ll be there for him.

Encourage Her to Seek Help

While your support and care for your loved one are essential to your family member or friend’s recovery, so is professional help. Eating disorders are complex and require psychological treatment. Your loved one may also need medical treatment for any medical complications the anorexia has caused. Anorexia treatment centers specialize in treating anorexia and disorders that often co-occur with it, such as depression, anxiety disorders, and substance abuse.

Recognize that seeking treatment for an eating disorder is scary. Your loved one may initially refuse to seek help. Alternatively, she may be ambivalent about whether she wants to seek treatment. Ask her if she wants help making an appointment with a therapist who specializes in eating disorders. Offer to go with her to her first appointment; this may help ease her fear.

The first therapist your loved one sees may not be a good fit. If this is the case, encourage him to seek out another therapist. Finding a therapist who is a good fit can be challenging, and it may take several tries before your loved one finds a therapist he feels comfortable with. Assure your loved one that this is normal, and encourage him not to give up.

In addition to therapy, encourage your loved one to see a medical doctor for a checkup. Anorexia can cause numerous medical complications. Addressing any health issues the eating disorder has caused is an important part of the recovery process.

Watching a loved one struggle with anorexia is incredibly difficult. If your loved one is over the age of 18, you cannot force her to seek the treatment she needs. However, what you can do is be a supportive and caring friend or family member. Though you may feel helpless, your care and support is an essential component to your loved one’s recovery.