Holidays hold pitfalls for eating disorders

Patients need support at the dinner table

In America, surveys estimate 20 million women and 10 million men will have an eating disorder at some time in their lives, and for many of them, Thanksgiving is a precarious time.

Gluttony is commercialized, calories on our plates are analyzed and stories in our news feeds vacillate between sanctioning holiday binge-eating and pressuring us into diets to recover from them.

“We live in a culture that validates a lot of this thinking and this talk, and particularly around the holidays when there’s almost an endorsement of disordered thinking and behavior,” said Claire Mysko, CEO of the National Eating Disorders Association.

USA TODAY spoke with Mysko and Dena Cabrera, executive clinical director of Rosewood Centers for Eating Disorders, on how people with these illnesses, and those eager to support them, can make Thanksgiving a less stressful time for everyone.

Have a support system in place. It can be a therapist, a dietitian or a family member (though for some people, being around family during the holidays can actually provoke anxiety, Mysko said). If someone you consider a part of your support system is with you during the holiday, talk with the person in advance and let him know “I need you to basically have my back,” Mysko said. Steer clear of negative body talk. Negative body talk at Thanksgiving is as American as apple pie (things like saying “the diet starts tomorrow” or “this stuffing is going straight to my thighs”). If you have an eating disorder, Mysko said, it’s best to avoid that kind of talk.

But if you feel you’re in a place in your recovery where you can use negative body talk to shift the conversation, try to. Mysko, who struggled with an eating disorder herself, said she “often will use these kind of meals ... as a conversation-starter” on body talk. If you have a meal plan, follow it. That doesn’t mean you have to skip dessert. It does mean you shouldn’t starve yourself before the big meal. “You can work through Thanksgiving and Christmas dinner and still stay on your plan and have that structure, and a dietitian can help you with that,” Cabrera said. Have coping mechanisms ready. It’s important to develop a plan for what to do when you feel emotionally overwhelmed. Write down your coping skills and keep them handy, Cabrera said, so you don’t have to scramble when you’re triggered. Don’t be afraid to take a break. Go for a walk. Watch a movie alone. Write in your journal. “Take care of yourself,” Cabrera said.

Focus on gratitude. Thanksgiving is supposed to be about gratitude, so try to embrace that. “We often encourage people to talk about things that they’re grateful for in their lives,” Mysko said. “Think about them, write about them, as part of the recovery process.” It can help shift the focus away from food.

Make sure you understand the disease. For someone whose loved one has an eating disorder, “the most important thing you can do is to make sure that you educate yourself,” Mysko said. “These are very complex illnesses. The food and the weight obsession — that’s the surface part of it — but there’s so much else going on.”

If you see behavior in a loved one that’s concerning, talk to the person.

It could be on that day, but it may be at a later time. It’s important to find a quiet, private space, and to gauge how the person is feeling, Mysko said. Does the person seem especially anxious? Then wait for another time.

“These are very complex illnesses. The food and the weight obsession — that’s the surface part of it.”

Claire Mysko CEO, National Eating Disorders Association