10 Things You Should Know About Supporting Someone With an Eating Disorder and Type 1 Diabetes

Knowing how to talk to someone struggling with a serious mental illness like an eating disorder or chronic illness like type 1 diabetes can sometimes seem like a minefield for family and friends. Both conditions are regarded as invisible illnesses and are often misunderstood. Innocent comments can quite easily be taken the wrong way entirely.

My eating disorder will reframe and misconstrue anything it can potentially collude with and use against me. It feels like you somehow become psychic and can read minds. It’s often the case I know I am being duped but I’ll gladly fall head first down the rabbit hole.

That said, I’ve written some gentle suggestions of what not to say to someone with an eating disorder, type 1 diabetes or a comorbidity of the two. Mostly they are flippant remarks that can’t be caught until they are said out loud and then realization hits. Sometimes it can be ignorance. Sometimes it can be frustration and anger and shock tactics, none of which work, but all of which are born from desperation.

I hope this might be of use to individuals in a supporting position for someone who is ill. Often the way our minds twist things can make absolutely no sense. I’ve devised these pointers not just through my own experience but with the experiences of other people I know with eating disorders, my close friends and members of online communities.

1. Try to avoid diet talk.

Yes, sadly it’s normal. It seems inescapable. Women in coffee shops opting for “skinny” drinks because they think they need to lose a few pounds or gaggles of young girls asking “do I look fat in this?” as they stand in front of the changing room mirrors. But making an effort not to talk directly about weight loss and diets to someone with an eating disorder is important.

For example, I have enough of this kind of talk going on in my head to contend with. You should never ask someone with an eating disorder for diet tips. Actually, I believe you should never ask anyone for reasons behind their weight loss or gain at all.

2. Avoid body-focused compliments.

“You look so much better. Your face is so much fuller!”

OK, so we might know these are intended as compliments because they show compassion and concern from someone who is relieved to see you looking healthier. But again, someone with an eating disorder can manipulate those words automatically. We might hear “you look fat” or “you must not be ill anymore.”

“But you don’t look sick” is another jarring comment that can often prompt the automatic competitive thought, “Well, I’ll show you what sick is.” Outside appearance can also be deceptive. A person with diabulimia may present as OK on the outside yet be in acute diabetic ketoacidosis (DKA) and in need of emergency assistance. Ultimately, any kind of commentary relating to appearance around someone with an eating disorder should be vetoed wherever possible. Positive or negative, it can be taken the wrong way.

3. Educate yourself on type 1 diabetes and eating disorders.

It can be really disheartening to hear ignorant comments like, “Did you become diabetic from eating too much sugar?” or “Are you allowed to eat that?!” Just no. Educate yourself, please.

4. Don’t tell someone to stop talking about their illness.

In my situation, it’s hard for me to ignore because it feels like this thing on my back every single second of every single day. Please don’t stigmatize something many people with diabetes and eating disorders have struggled to accept and acknowledge. Let us talk, it helps and is far better than denying it exists.

5. Don’t comment on food.

“Wow, that’s a huge dinner.”

“Ooh that looks like a nice treat!”

“Glad to see your appetite is back.”

I have to say, this often seems to be a dad thing. These comments aren’t helpful to someone struggling with an eating disorder or diabulimia. As with the point about body comments, just refrain from commenting on our food unless we specifically ask for your help or guidance. It has to come from us. Don’t be the food police, as it can cause us to want to isolate even more and protect the disorder, as twisted as that sounds.

“You just need a good burger/sandwich/slice of cake in you!”

Comments like this are made worse if followed by a term of endearment like “dear” or “darling” and are really unhelpful. Eating disorders are not just stubbornness or forgetting to have breakfast in the morning. Often someone struggling a lot will find it a huge challenge to eat in public and that’s not to mention the effort someone with type 1 diabetes needs to do to determine carbohydrates and insulin doses. I shouldn’t have to put on a show to someone else about my eating.

6. Don’t try to guilt someone into eating.

“Please eat, for me?”

This kind of emotional pleading is not fair for someone with an eating disorder. Their recovery is their own and you can support in ways that don’t involve manipulation. Making them eat because they feel they have to may lead to feelings of shame and possible self-damaging behaviors later on.

7. Someone’s eating disorder is about them, not you.

“If you think you are fat you must think I am obese!”

“What did I do wrong?”

“Why are you doing this to me?”

This one is a hard one, because it often comes from a parent who feels helpless. Personally, the hardest part of being ill has been the hurt it has caused to my loved ones. But my eating disorder is not about you. Regardless of any relevant cause factors, it comes down to the way I react.

To suggest I would do this to myself to spite another person can be painful when most people with eating disorders only want to hurt themselves. It is a mental disorder and rational thought can be compromised. It can be so powerful that you just don’t realize it’s pulling the strings and the control you believed you had was actually your eating disorder.

8. Understand eating disorders aren’t just about weight.

“I wish I could lose weight that quickly!”

“I wish I was as thin as you.”

“What’s your secret?!”

These are all completely inappropriate comments if someone doesn’t know the circumstances of someone’s weight or behaviors. Again, eating disorders are all specific to the one struggling. For example, someone with body dysmorphia may see a different image in the mirror than what others around them can see. Additionally, for people with diabulimia, weight is not an accurate risk indicator, HBA1C levels are. People with diabulimia will often have huge fluctuations in weight as they manipulate insulin levels and so this cannot be used to determine how well or unwell someone is.

9. Be mindful of the way you talk about dangers of an eating disorder.

“This could kill you, you know?”

Sometimes, being told of the damage we are doing to ourselves can come off as patronizing. For example, I’m well aware of the risks. It’s not lack of intelligence that causes a person with an eating disorder to neglect their health needs. An eating disorder can make someone focus more on their destructive behaviors than their safety.

10. Don’t imply someone with an eating disorder can’t date.

“You do realize men like a bit of meat on a woman’s bones, right?”

It’s hurtful to imply someone with an eating disorder is engaging in the behavior to “get a man.” I don’t quite understand how this one seems to crop up so often. Eating disorders are not about vanity.