When Marina Zhukova was 17 and studying in Germany, her host mother asked her a question that has stayed with her ever since: “Are you struggling with anorexia?” Zhukova, who was queasy from a stomach bug, was not—but the moment highlighted how early intervention can be crucial for young people with eating disorders. Today, Zhukova is a psychologist and director of the Center for Eating Disorders at UTHealth Houston, treating adolescents with such conditions.
Zhukova said speaking up early can be lifesaving. “We often hesitate because someone doesn’t look ‘sick enough,’” she explained. “But eating disorders are ego-syntonic—they feel like part of the personality. Waiting for the person to ask for help can be too late.”
She advises looking for patterns over time rather than focusing on a single behaviour. Warning signs include skipping meals, exercising excessively even when ill or injured, eliminating certain foods, attaching moral labels to food, avoiding social situations, visiting the restroom immediately after eating, and compulsively checking one’s body. Physical symptoms can include dizziness, feeling cold, or irregular menstrual cycles.
Experts say the approach to raising concerns should be thoughtful. Alexandra Kasputis, a therapist and certified eating disorders specialist in New York, recommends speaking in a private, calm setting, away from mealtimes. “What you say matters, but how you say it often determines whether the person feels safe enough to hear you,” she said.
First conversations should focus on observations rather than accusations. Neutral statements like, “I’ve noticed you seem stressed around food lately, and I wanted to check in,” allow the person to respond without feeling judged. Cherie Miller, a therapist in Texas, added that validating emotions is key. “If they open up, say, ‘That sounds really hard, and I’m glad you told me,’ before gently asking if they’re open to professional help,” she said.
If a loved one insists they are fine, Kasputis advises respecting their boundaries while continuing to check in regularly. “We can open the door, but we can’t make anyone walk through it,” she said.
Experts caution against comments that focus on appearance or numbers, such as weight or calories, which can worsen shame or secrecy. Zhukova said reasoning with someone about their disorder is rarely effective. “Eating disorders are illogical. They’re disorders for a reason—so don’t try to reason,” she explained.
While speaking up may not produce immediate change, early, supportive conversations can interrupt isolation and signal that help is possible. Zhukova emphasized the role of loved ones: “It’s going to be awkward. It’s supposed to be awkward. But loved ones are the engine of change.”
