Dear Dr. Faizal,

My friend is not eating properly and is working out all the time. It’s come to a point where the gym told her not to come back. All she had today was a muffin! She’s someone who doesn’t really take anything seriously and is always cracking jokes. So when I tell her she needs to eat more and she just makes a joke. I’m concerned for her health. What should I do?

– Concerned Friend

Dear Concerned Friend,

What you’re describing your friend not eating properly (or enough) and excessively exercising raises red flags. To me, it seems she’s dealing with an eating disorder. Whether it’s anorexia nervosa or bulimia nervosa, the cause of such disorders is less about food and more about the emotional instability that some people feel that leads them to use food (or the lack of) to re-gain control of their lives.

If studies are correct, your friend may be dealing with emotional issues in which she may be critical about her weight and body image in general. This must be very painful for her. To compensate for this state, she may be restricting food to gain control. If your friend’s behavior is allowed to continue, she may lose sight of her physical, mental, and emotional condition, something that could lead to a complete breakdown and hospitalization.

Her not “really tak[ing] anything seriously and always cracking jokes,” is her inability to know how to begin a conversation. A conversation with a loved one (with a dear friend like you), however, must take place as soon as possible!

To begin the conversation, bring up some facts that you’re observing about your friend’s behavior (i.e., her not eating properly and exercising excessively). Tell her, without lecturing her (no one wants a lecture, right?) that you love her and are concerned about her health. Tell your friend that you cannot keep silent and watch her get hurt. Ask her if she’s aware of her behavior.

At first, your friend may become defensive and even demonstrate resentment towards you for bringing this issue up. This response is perfectly natural. Facing the truth is not always easy. Do not fall into the trap of trying to prove your claim; doing so would be too overwhelming at this time for your friend to handle. Maintain the position of caring for your loved one. Tell her that you love her, want her to be happy and that you are there for her.

Your friend will need time to process your initial conversation with her. Give her some time and space to do so. Let her know, from time to time, via phone conversations, emails, texts, etc., that you are there for her – to listen, to comfort, and to help her find much-needed treatment.

As your friend begins to break down her barriers of resistance, she will need your support and guidance. At this time, instead of telling her what to do (a condition that would further strip off your friend’s control of her situation), give her options that she could choose from (to rebuild her self-esteem, it’s vital that she feels that she is active in her recovery). Two good options that I can think of include your friend beginning this healing journey by sharing her situation with her family doctor, who should be able to offer her more specific options (i.e., counselling, dieticians, etc.), or she could contact Vancouver Coastal Health herself ( and ask for their Eating Disorders Program.

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