A letter to family about your child’s anorexia (what to say/what not to say)

When you have a child with anorexia, it may be necessary to teach family members about the eating disorder and explain what to say and what not to say, and a letter can work well for this. This is especially true if your child’s eating disorder is visible. While there are many eating disorders that are invisible, low-weight anorexia can be surprising and even distressing for loved ones to see. This can lead to unhelpful and even harmful comments.

One problem with eating disorders is that people think they understand them. After all, eating disorders appear simple: a person doesn’t want to eat because they want to be thin. But this definition misses the vast experience of having anorexia, its physical consequences, and the depth of its mental distortions. 

Anorexia, like all eating disorders, is a health condition, not a choice. It’s not something that even the most well-meaning and loving family member can talk your child out of. This is not a situation in which a TV-style intervention will likely be helpful.

In fact, often well-meaning family members accidentally make things worse, not better. Of course, all they want is for your child to feel better, but they are operating out of instinct, not knowledge. And unfortunately, instinct doesn’t typically serve us well when we’re dealing with an eating disorder.

What to tell family members about anorexia

If your child is visibly ill with anorexia, then it may be helpful to provide family members with some guidance about the illness, what to say, and what not to say. However, this should be done carefully and thoughtfully. Anorexia is a personal health condition, and you should respect your child’s right to privacy as much as possible.

I recommend you talk to your child about whether and how to talk about their condition with family members. You may want to bring in their therapist to help you address this. When an eating disorder is visible, it can be very helpful to educate family members so they don’t say the wrong thing. But we must be very aware of privacy when doing it.

There are no hard and fast rules about whether and how to do this, but it’s important to think carefully and consciously about how to proceed.

Following is an email/letter you could provide to family members if your child has agreed to this language. Of course, there are hundreds of ways to write this letter – this is just one option.

Family letter: about anorexia

Dear Family,

It’s been another crazy year, and we’re looking forward to seeing you at Marcy’s wedding this summer! Before we get together I wanted to share some information with you about Ellen’s health. I’m sharing this information with Ellen’s permission because we know you will have questions and want to do our best to address them before the wedding.

Ellen has anorexia nervosa. This is an eating disorder that we’re working hard to address with the appropriate professionals. When you see her, you may be surprised by Ellen’s appearance, and we’d like you to consider the best response when you see her since I know how much you love her and want her to be safe and healthy. 

Here’s what we’d like you to know:

Eating disorders are an illness, not a choice

It looks like there’s a simple choice to eat or not eat. But eating disorders are complex medical and psychological conditions that do not respond to simple encouragement or willpower. Treatment relies on highly-trained specialists.

When loved ones assume that eating disorders are a choice, their well-meaning comments can actually make things worse (not better). Please believe us when we say that we have explored the necessary options for Ellen’s care and that it’s more complex than most people realize. That’s why I’m sharing this letter with the family about anorexia. I know most people don’t know much about it, and I hope this guidance is helpful.

What to say when you greet a person who has an eating disorder

When you see Ellen, you may be tempted to say something about her appearance. But focusing on her appearance, positive or negative, can be harmful. So instead, say things like:

• I’m so happy to see you!
• It’s wonderful to catch up with you!
• I’ve missed you! 
• How are you?

What not to say: “You’re so small/thin/tiny/like a skeleton.” While you may think the person needs to “wake up” and see that they have a problem, comments about their appearance do nothing to reverse the trajectory of the eating disorder. In fact, they actually give the eating disorder a dopamine hit. This sort of comment will not “wake her up,” but it will “wake up” the eating disorder and give it more power (not less).

What else not to say: After getting this letter, you may find that Ellen’s appearance is healthier than you assumed it would be. You may be tempted to praise her for that. But it’s actually just as harmful to comment on her appearance positively as it is to comment on it negatively. Just stay away from appearance-based comments including: 

• You look so healthy! 
• You look radiant!
• You’re glowing!
• That dress fits you like a glove!

The bottom line is to please focus on Ellen as a person, not her body.

What to say when a person with an eating disorder doesn’t eat

Now that you know about her eating disorder, you may feel as if you need to encourage her to eat. Please don’t do this! If you find yourself distressed by her eating habits, you can say things like:

• So what’s been going on with you lately?
• How are you?
• Can I share something that happened to me recently? (this should not be about food, eating, weight, or health)

What not to say: “Just eat” (or any variation). This assumes that eating is a simple choice for Ellen. It’s not. This is like telling a cancer patient that they just need to stop growing tumor cells. An eating disorder is a health problem that needs to be treated by trained health professionals. Your care and love are so helpful, but please don’t try to treat the eating disorder by convincing her to eat. 

Avoid comments like:

• Try the cake, it’s delicious!
• Come on, you’ve got to try this amazing hamburger!
• Wouldn’t you like just one bite of my salad? You always liked it when you were younger!
• You look hungry! Have a bite!
• Let’s put some meat on those bones!

As with appearance, it’s best to focus on Ellen the person, not what she’s eating.

What to say when a person with an eating disorder is upset

At times Ellen may look sad or distressed to you. Please consider whether this is something that demands a response. While I’m sure you want to cheer her up and make her feel better, just like convincing her to eat, it’s rarely helpful. But if she is clearly upset and you believe the time is right, you could say things like:

• Would you like to talk?
• Weddings can be pretty stressful, huh?
• Is there anything I can do to support you right now?

What not to say: “Come on, why are you so upset? Cheer up!” Any version of “snap out of it” is like telling her to “just eat.” It’s not going to be helpful and may be harmful. Ellen, like all people, has feelings and emotional experiences. And sometimes she may be resting her face or relaxing – just because she’s not smiling doesn’t mean she’s sad. And if she is sad, we’re working on validating and supporting her rather than asking her to suppress her feelings and move on.

What to say to me

Yes, this has been a real challenge for our family, and I appreciate the concern that I anticipate you have. Sometimes I may want to talk about it, and sometimes I won’t want to. I would really appreciate it if you would treat me fairly normally by asking the usual questions like “how are you,” without asking for details about Ellen’s health. Many times I won’t be able to answer your questions. I hope you can understand this. The greatest support you can give me is compassion without questions. 

What not to say: “Have you tried acupuncture/natural medicine/hypnosis” (or any other treatment you have in mind). Please trust that we have her professional treatment team lined up and are addressing this. I’ll ask for advice if I want it, but unsolicited advice, no matter how well-meaning it is, can be really hurtful to me right now. Some other things I’d rather you not say include:

• Why is she doing this?
• How long will she have this?
• Where did this come from?
• What’s wrong with her?
• She looks so thin! 
• She looks terrible!
• Don’t all girls today have some type of eating disorder?
• My friend’s daughter had anorexia and she …

The bottom line is that I’m a lot more sensitive than usual right now.

We want to talk about other things

We are working hard to address this, and sometimes it’s nice to have a break. So what we would like most of all is to enjoy the wedding. For Marcy’s sake and for ours, we’d appreciate it if Ellen’s health isn’t a topic of conversation. I know you love Ellen and are concerned, but unless one of us seeks you out to talk about it, let’s just enjoy each other and the wedding itself.

Thank you so much for making it through this letter. I’m sure you can imagine it was hard for me to write. I hope it’s been helpful, and we look forward to seeing you in June!

Love, Jordan

How to send a letter to family about anorexia

If you decide that a letter is the best way to educate your family about anorexia, then you should first consider what should and should not be included. Every family is different, and every case of anorexia is unique. So you should create a letter that fits your family and unique circumstances.

Once you’ve settled on the letter’s content, you can either email it or mail it. Of course, email is much easier, and you have the added benefit of being able to send it to everyone at the same time. You may want to use the BCC field of emails, which will avoid having a long email chain of responses. While some families might want to include everyone and begin a big “Reply-all” email exchange, if you want to avoid that, you can use BCC.

Once you have sent the email, you should expect to hear back from people in some way. Depending on your family, these responses may be supportive and thoughtful. Some responses may not respect the boundaries you set out in the letter. This is fairly normal and to be expected. Remember that you are not obligated to answer questions about your child’s health or treatment.

A good response for overly-nosey emails is “Thank you so much for checking in. I know you are concerned and appreciate that. To respect Ellen’s privacy, I can’t share any details beyond what I included in the letter. Thanks for understanding!” Boundaries don’t have to be rude to be effective.

Another thing that might happen is that people might feel hurt that you didn’t tell them earlier or reach out for help from them. While understandable, this response also requires you to hold a boundary. You can say something like “I really appreciate your concern and know that you would have helped if you could. For now, we’re handling it the best we can. Thank you for your support!”

How your family responds to your letter about anorexia may be wonderful or make you feel bad. But either way, you should know that holding your and your child’s boundaries is valid and important. While of course people like to be informed, we don’t owe our family our children’s private health information. And remember: you are doing the best you can when you can. Thank you for caring for your child’s health and privacy.eating disorde

See Our Parent’s Guide To The Different Types Of Eating Disorders