When Marina Zhukova was 17 and studying abroad in Germany, her host mother pulled her aside during a welcome dinner and asked a startling question: “Are you struggling with anorexia?”
She wasn’t—she was queasy from a stomach bug and could barely sip tea, let alone touch the hearty feast. But years later, as a psychologist who treats adolescents with eating disorders, Zhukova still thinks about that moment. For someone struggling with disordered eating, she says, a direct question could be lifesaving.
“I really applaud her vigilance,” says Zhukova, director of the Center for Eating Disorders at UTHealth Houston. “This was our very first meeting, and she spoke up anyway. She spotted a potential red flag and didn’t wait at all.”
Often, people bite back their concerned comments because their loved one doesn’t look “sick enough,” she says. They can still go to school or work, exercise, and generally function—creating the illusion that there’s no urgency. In reality, the sooner you speak up, the better.
Zhukova teaches people to look for these eating disorder warning signs: behavioral changes like skipping meals consistently and exercising multiple times a day, even when injured or sick; eliminating certain food groups; attaching moral labels to food; making frequent excuses for not participating in social gatherings; visiting the restroom immediately after a meal; and a focus on body checking, or compulsively measuring body parts or scrutinizing how clothing fits. Physical symptoms can include feeling dizzy or faint; being cold all the time; and irregular menstrual periods.
“It’s not one thing—we’re looking for a pattern and a change over time,” Zhukova says. “What often stops early treatment is that loved ones wait for the person to ask for help.” But that rarely happens. Eating disorders are what clinicians call “ego-syntonic,” she explains—“a very fancy term that just means it feels like part of the personality, something people can feel proud of.”
In other words, waiting for someone to admit they need help can mean waiting too long. If you’re concerned, experts say it’s better to speak up early—and to do so thoughtfully.
How to open the conversation
Once you decide to address your concerns, make sure you’re in a quiet, private place when neither of you is rushed for time. It shouldn’t be on the heels of a stressful meal or in any other food-centric scenario, says Alexandra Kasputis, a therapist and certified eating disorders specialist in New York. That helps prevent your loved one from feeling ambushed. “What you say matters,” she says, “but how you say it often determines whether or not the person feels safe enough to hear you.”
The goal of that first conversation isn’t to diagnose someone; rather, it’s to create space for support, Kasputis says. It’s important to make it clear that your concern is grounded in curiosity and compassion, and that you’re not there to make judgments or assumptions. “There’s no expectation to say things perfectly,” she adds. “You’re not going to. What matters the most is showing up with genuine care.”
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Speak from a first-person perspective, and don’t name specific behaviors, Kasputis advises. Stick to observations: “I’ve noticed you seem a little more stressed around food lately, and I just wanted to check in. How are things feeling for you?” Or: “I’ve noticed lately that when we go out for lunch, you tend to say you’ve already eaten and don’t order anything.”
These kinds of neutral observations work well because they’re pointing out what you’ve noticed, rather than labeling or assigning motives, says Cherie Miller, an eating disorder and body image therapist in Southlake, Texas. If your loved one does open up, start by validating their emotions rather than jumping straight into solutions: “That sounds really hard, and I’m so glad you told me.” Eventually, you can gently ask if they’re open to finding a therapist or other professional help—and remind them that doesn’t mean you’re going anywhere.
Let your friend or family member know they don’t have to figure everything out right away, that they’re not alone, and you’ll be at their side one step at a time. “It’s OK to say, ‘I don’t know exactly what to say, but I’m here for you, and we’ll figure it out together,’” Miller says.
If they swear everything is OK
Not every conversation will be productive. If your loved one insists they’re fine, don’t force them to listen to your concerns, Kasputis advises. She prefers acknowledging their boundary: “OK, I just wanted to check in because I care. If you do notice that food is feeling stressful, or things are feeling harder in general, please know I’m here.”
If that initial conversation doesn’t go anywhere, don’t get discouraged, Kasputis adds; instead, check in consistently with your friend. That sends a powerful message: “I’m here for you, and I’m not going away.”
“Sometimes the most important outcome of that first conversation is simply them knowing that you’re a safe person,” she says. “We can open the door, but we can’t make anyone walk through it. It’s the fact that our loved ones know it’s open.”
What not to say
Certain comments can push your friend or family member away, or prove harmful in other ways. Body talk is off-limits, Miller says: You don’t want to tell someone they look super thin, for example. Miller recently overheard a father telling his daughter that she was so skinny, she looked “disgusting.”
“I understand the motivation there is, ‘You’re scaring me with what’s happening, and I’m trying to motivate you to get well,’” Miller says. “But that is definitely not going to be a helpful thing to say.” Such a comment could fuel restrictive habits—“Oh, good, it’s working”—or push someone deeper into shame and secrecy.
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Avoid communicating in a way that centers your fear, Kasputis says, like going on and on about how worried you are. Comments like “I can’t keep watching this” aren’t helpful, either. “When we let fear lead, it usually just results in increased shame and pressure,” she says. “It’s unintentionally shifting that focus away from our loved one’s experience, and that’s what we really want to be creating the most space for.”
It’s also a good idea to avoid rattling off numbers, like how many calories per day your loved one needs, or how low their BMI is. “Eating disorders are illogical,” Zhukova says. “They’re disorders for a reason—so don’t try to reason.”
Speaking up won’t guarantee immediate change. Eating disorders are complex, and often tied to identity, control, and shame. But early conversations—even imperfect ones—can interrupt isolation and plant the seed that help is possible. And over time, that can make all the difference.
“It’s going to be awkward. It’s supposed to be awkward,” Zhukova says. “And it’s still very important to do this. Loved ones are the engine of change.”
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