Eating disorders are a range of complex mental illnesses that can have a devastating impact on those who suffer from them, and in severe cases, may even be life-threatening. They are generally characterized by negative thoughts and feelings around food and body image.
At least 9 percent of the global population are affected by eating disorders, and almost 30 million Americans will experience one over the course of their lifetime, figures from a report published by the Harvard T.H. Chan School of Public Health’s STRIPED (Strategic Training Initiative for the Prevention of Eating Disorders) show.
Eating disorders can afflict people of any age, body type, race, sexual orientation or gender—although women are twice as likely to be affected as men.
These conditions, which include anorexia nervosa, bulimia nervosa, and binge eating disorder (BED), can have a serious impact on the individual, leading to a range of social, psychological or behavioral problems, in addition to medical complications and an increased risk of death or suicide.
More than 10,000 deaths every year can be attributed to an eating disorder, figures from the STRIPED report show.
Challenges of Thanksgiving With an Eating Disorder
Regardless of which eating disorder an individual is dealing with, Thanksgiving can be a challenge.
“Thanksgiving can be tough for people experiencing eating disorders—situations surrounding lots of food and socializing can be particularly tricky for someone with a challenging relationship with food,” Lauren Smolar from the National Eating Disorder Association (NEDA) told Newsweek.
“Feeling uncomfortable and out of control of food choices combined with a lot of people can be incredibly stressful—especially when an individual doesn’t have their regular tools available to navigate these emotions and behaviors,” she said.
For an individual experiencing an eating disorder during the holidays where they may be seeing people they do not regularly see and in celebratory food situations that are not routine, they may feel particularly unprepared for how to handle the food and their disordered eating behaviors, as well as feeling self-conscious about their body.
“This may mean feeling overwhelmed, wanting to leave a situation or avoid it entirely, and other challenging experiences that make it difficult to fully participate in the holiday events,” Smolar said.
Different eating disorders will also present different challenges. With anorexia nervosa—a condition characterized by abnormally low body weight and a fear of gaining weight—the primary concern is often simply being surrounded by so many foods that they consider to be unsafe or anxiety provoking, Cynthia Bulik, PhD, founding director of the University of North Carolina Center of Excellence for Eating Disorders, told Newsweek.
“Another difficult situation to navigate is the unknowing—but probably well-intentioned—relative who naively encourages you to eat: ‘You eat like a bird’ or ‘You need to put some meat on those bones.’ Not that comments like that are ever appropriate, but for someone with anorexia it can be devastating,” Bulik said.
“For those with avoidant or restrictive food intake disorders, the real challenge is being faced with so many foods that cause enormous anxiety that you may just not be able to eat—and again relatives or other guests just not understanding.”
For people with binge-type eating disorders, such as bulimia or BED, being surrounded by tempting foods, nibbling while cooking, and the lure of leftovers can make Thanksgiving a prolonged exercise in trying to fend off an urge to binge.
How to Navigate Thanksgiving With an Eating Disorder
There are a number of steps a person with an eating disorder can take to help with navigating Thanksgiving.
The eating disorder experts both suggest asking for help when necessary, keeping in mind that this is not a sign of weakness and nothing to be ashamed about. Bulik said it is a good idea, if at all possible, to have a safe person who can go through the holidays with you. If this is not possible, at least try to find someone who you can call or message in times of need.
“Someone who will understand, help you navigate tricky situations, and even just take a walk outside to get some fresh air to help you get some respite from a tense situation,” she said. “This can be a partner, sibling, parent, or friend who really ‘gets’ how tough this is for you.”
Bulik also recommends taking a step back from the food and trying to focus on non-food-related things about the holiday that you can enjoy or are thankful for. This may involve appreciating the people you are spending time with or taking part in a board game or other activity.
“It may help elevate you above the tension of the moment and tap into another set of feelings that are not as anxiety-provoking and overwhelming as what is happening around you on the day,” she said.
As an individual experiencing an eating disorder, it may be beneficial to think through situations ahead of the day itself to know what options are available in order to alleviate the stress when an environment becomes too much to handle, Smolar said. This applies to loved ones providing support as well.
“Come up with a plan for how you would handle difficult situations—who can you rely on for support at those events? Are there situations you need to avoid? How have you been able to handle previously challenging experiences like the ones coming up?” Smolar said.
“Talk to a trusted resource such as a treatment professional, friend, or loved one ahead of time and debrief afterwards about how to handle difficult experiences.”
It is also important to have realistic expectations when it comes to Thanksgiving celebrations, and indeed other holidays that revolve around food. Have an exit strategy if need be.
“Figure out how you can take breaks and don’t be afraid to opt out or leave early if events are too overwhelming,” Smolar said.
Experts also recommend trying to be compassionate and patient with yourself, speaking to yourself with kindness and without judgement. It is also helpful to remember that Thanksgiving is just one day and it will eventually pass.
Setting and keeping healthy boundaries is also an important part of dealing with Thanksgiving. This shows the people around you what you will and will not tolerate.
For example, this might involve exiting or not engaging with a conversation if it is having a negative effect on you, or shutting down body-bashing talk. It can also involve speaking with those around you about how you really feel. Aside from this, be mindful about what you are consuming on social media and consider avoiding certain content that does not serve you.
‘I Would Be Holding Back’
Nia Patterson, a 30-year-old from Lincoln, Nebraska, who is in recovery from an eating disorder, told Newsweek about how challenging Thanksgiving can be for people in this position.
Patterson’s condition was particularly complex and stumped medical professionals. They were originally diagnosed with bulimia in 2016 but around two years ago, Patterson, who uses they/them pronouns, discovered that they probably had anorexia. At one point, their therapist diagnosed them with EDNOS, which stands for eating disorder not otherwise specified.
“Thanksgiving is rough because there is so much food and I love cooking,” Patterson said. “I would always cook something for the family and I really loved seeing my family come together around my food and enjoying it.”
“But meanwhile, I would be holding back like, ‘Oh, if I eat that am I going to gain more weight, I don’t want to gain more weight.’”
Patterson also said dealing with certain harmful comments regarding diet culture has been a source of frustration.
“I remember one Thanksgiving I made like this very delicious peach cobbler and everyone was so excited about it, everyone ate it so quickly. And then immediately my family was like, ‘No, you shouldn’t have made us that, there was too many calories.’”
“We all love food but there are still so many unhelpful comments made around food and calories and working out,” Patterson said.
Their number one piece of advice to help people with eating disorders—or those in recovery—to get through the holidays is to make a plan beforehand.
“Even if you have been in recovery for a while, I think having a plan is really important. Whether that plan is knowing what I’m going to say when Aunt Sally tells me that I gained weight, or what I’m going to cook for the day—and even if I don’t want to eat anything else, or I don’t feel safe, or I feel uncomfortable, I know that I can eat the macaroni and cheese that I made, because I know what went into it.”
Patterson also said being compassionate with yourself at this particularly difficult time is important.
“I like to say that big holidays are not necessarily the time to play your best game in terms of recovery. You might not do your best, you might not be 100 percent recovery-minded, you might be super overwhelmed, you might be stressed, you might be scared. Let the criticisms be not as intense on that day, because it is a really hard day.”
“You might not feel as safe as you normally do at home with your normal safe foods. So, if you just show up at your family’s house, or your Friendsgiving and you eat what you can, you’re doing enough,” they said.
If you or someone else needs help, contact your doctor or the National Eating Disorder Association hotline at (800)-931-2237.
