“But What Do I Say?” A Clinician’s Guide to Navigating Conversations About Eating Disorders

Written by: Courtenay Vickers RD
Time to read: 6 minutes

For many healthcare providers, the thought of working with a client who has an eating disorder can be daunting. Questions like What if I say the wrong thing? or What if I make things worse? are common, and this uncertainty can make clinicians hesitate or feel stuck. With some practice and guidance, effective communication and building rapport can be life-changing for that client sitting across from you! 

This blog post offers some helpful strategies for having compassionate conversations with eating disorder clients, integrating self-reflection, examples of what to say and what to avoid, and actionable steps for clinicians to build their confidence in this area.

Before we dig in, an invitation to remain curious rather than judgemental about your current/past self! Wherever you are at on your learning journey, that is ok. And I’m so glad you stumbled upon this post today.

First, what’s the difference between an eating disorder and disordered eating?

It’s important to recognize that there is a difference between an eating disorder and disordered eating when working with clients:

  • Eating Disorders are diagnosable mental health conditions outlined in the DSM, including:
    • Anorexia Nervosa (AN)
    • Bulimia Nervosa (BN)
    • Binge Eating Disorder (BED)
    • Avoidant/Restrictive Food Intake Disorder (ARFID)
    • Other Specified Feeding and Eating Disorders (OSFED)
  • Disordered Eating refers to a broader range of harmful eating patterns or behaviours that don’t meet diagnostic criteria but can still significantly affect physical and emotional health. Disordered eating can be a precursor to an eating disorder. Sometimes disordered eating looks like someone going on a diet, actively pursuing weight loss through dietary restriction, or even being “watchful” of what they eat. It’s not something to ever brush past.

With nearly 2 million Canadians affected by eating disorders—and the second-highest mortality rate among mental health conditions—it’s critical for clinicians to be prepared to address these complex issues with care and sensitivity.

Self-Reflection: Starting with Yourself

Let’s take a moment to do a little self-reflection. You might want to pull out a pad of paper for these questions. Before we get started, it’s important to know that how you approach eating disorder clients can be influenced by your own relationship with food, body image, and assumptions about health. Now, take a moment to reflect on these key questions:

  1. How has your relationship with food and your body influenced how you view and work with clients as a healthcare provider?
  2. Have you ever made assumptions about a person’s health or behaviours based on their weight? How could this affect your care?
  3. How do you interact with patients in larger bodies? Do you notice any differences in how you approach patients in smaller or very thin bodies?

Self-awareness is vital. Recognizing and addressing personal biases is an important step toward creating an environment of trust and support for your clients.

Let’s explore some examples of what to say (and not to say)

Compassionate communication can make a significant difference in how clients feel about their care and recovery. Here are examples of what to avoid saying, along with alternatives that foster trust and understanding:

Instead of: “Just eat!”

Try: “It seems like eating is difficult for you. Tell me more about what challenges come up for you with eating.”

Instead of: “You don’t look like you have an eating disorder.”

Try: “Eating disorders can affect anyone, any age, any gender, any body size. Your experience is valid.”

Instead of: “You’re just going through a phase. Everyone feels insecure about their body sometimes.”

Try: “I imagine what you’re going through is incredibly difficult.”

Instead of: “Your vitals and blood work are fine; you don’t need to worry.”

Try: “Your body is working hard to keep things medically stable right now. I know other behaviours are going on, so let’s explore ways to better support you and reduce harm.”

Instead of: “I wish I had your self-control!”

Try: “The eating disorder is not your fault. It’s a complex brain-based illness, and you deserve to receive supportive care.”

Instead of: “You look healthy/better.”

Try: “How are you feeling about your recovery journey so far?”

Instead of: (silence)

Try: “I’m concerned about your eating. I’m wondering if we can explore your relationship with food a bit more together.”

Instead of: “Don’t worry, you’re not fat! You won’t get fat.”

Try: “I can imagine the idea of gaining weight feels scary for you. That makes sense, given how focused our society and healthcare system are on weight loss. Regardless of your body size, you are deserving and worthy of recovery.”

Instead of: “You have an eating disorder? Sorry, I can’t help you.”

Try: “It sounds like you’re having some real challenges with food and eating. You deserve proper care and support. Are you okay if we talk more about some options to help you?”

Actionable Steps for Clinicians

Working with eating disorder clients doesn’t mean you have to know everything, but there are clear steps you can take to provide meaningful support:

  1. Learn About Eating Disorders
    Expand your knowledge by reading books like Sick Enough by Dr. Jennifer Gaudiani, Life Without Ed by Jenni Schaefer, and The Body Is Not an Apology by Sonya Renee Taylor. Food Psych by Christy Harrison is a wonderful podcast to learn more from. A great Canadian website about eating disorders that we often recommend is the National Eating Disorders Information Centre (NEDIC).
  2. Practice Active Listening
    Listening without judgment or a need to immediately “fix” can be a powerful tool. Validating a client’s feelings and experience can make them feel seen and understood.
  3. Collaborate with a Care Team
    Eating disorder treatment is often multidisciplinary. Work with dietitians, therapists, and medical professionals to ensure comprehensive care. If a client doesn’t have a team, help build a team or consult with other professionals on behalf of your client.
  4. Refer When Necessary
    Know the options for higher levels of care and how to connect clients. If waitlists are long, continue supporting your client with compassion and harm-reduction strategies while they wait.
  5. Advocate for your clients
    Advocacy can make a huge difference, whether it’s within the healthcare system, with family members, or through education about eating disorders in your community.

Building Confidence Through Practice

Feeling confident in conversations about eating disorders takes practice and support. If you want further guidance, consider joining Confident and Competent: Eating Disorder Clinician Consultation Group, starting in February 2025. This program offers group calls, practical skills, and a supportive community to deepen your expertise. Email us at thealeocollective@gmail.com to learn more and get on the waitlist.

Remember, you don’t have to be perfect or have all the answers to make a positive impact. By showing up with compassion, humility, and a willingness to learn, you can help clients feel supported and valued on their recovery journey.

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