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<p>My friends and I are kind of at a loss about how to deal with this.  We have all been friends since childhood and are now in our mid-30's.  A few of us still live in the area where we grew up, but others are living elsewhere now.</p>
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<p>We are very concerned about our friend A.  She has been living far away from all of us for years now, so we only see her once or twice a year maybe.  My friend S talks to A every day.  My friends M and K and myself talk to/email with A far less frequently but still, of course, care a great deal about her.  During her teen and early 20's years, A was concerned about her weight, but at no point was she ever overweight/chunky.  She played sports in high school and was fit.  Her mom was always concerned about and struggled a bit with her own weight.  Her father was verbally (and sometimes physically) abusive and I don't know/don't remember if he ever teased her about her weight.  She has had/has issues with depression and anxiety.  She also has (non-yet-symptomatic) MS.</p>
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<p>Starting about 4 years ago we began noticing that she was losing a lot of weight.  About a year and a half ago things kind of came to a head...  A and her husband were driving a few hours to meet S and her husband to go snowboarding.  During the drive A started having seizures.  Her husband took her to a local hospital.  It was determined that she had had seizures because she had been off her MS meds for a while because she was trying to get pregnant.  Some of us were concerned that the seizures could have been related to starving herself.  So over the course of the next few months we all took the opportunity to talk to her about our concerns.  She admitted to not eating enough.  S said that when she went out to dinner with A and A's husband a few days after the seizures that A not only was very careful to not eat a lot (enough!), she also criticized her own husband for eating and kinda forced him to stop eating (he's an average, slender-ish guy).  When I spoke to her I came at it from the TTC angle...that she needed a healthy BMI to conceive.  She did eventually become pregnant after deciding to do in vitro - she claimed at the time she needed to do in vitro so she could get pregnant ASAP so she could get back in her MS meds.  Apparently she just admitted to S that they did in vitro only because she wanted a baby ASAP and that her Dr. says it's fine for her to be off the meds until she done having all the kids she wants to have.</p>
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<p>I saw her when she was pregnant, and I did see her eat while she was pregnant, but aside from her belly she was still super skinny.</p>
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<p>I saw her yesterday for the first time since the baby was born (baby is 6 months) and I was shocked by how skinny she looked.  Her face looks gaunt, her hair and skin is dull, her pants looked loose on her, her hands look too big for her arms....I haven't seen her with bare arms of legs for a few years, so I don't know how her limbs look.  I can't imagine that any doctor could look at her and not think that there's a problem.  We're not sure if she on any anti-depressants or anti-anxiety right now.  She has sometimes talked with therpists (psychologists) but has never stuck with it.  She's in total denial about her lousy childhood.  By some miracle, she is able to nurse her baby.</p>
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<p>I asked about her husband's work schedule and whether they get to eat dinner together.  She said in a kind of off-hand way "oh, well, I don't eat that much, but, yeah, we do get to have dinner together."  S said that A told her she never cooks, so I don't know if her husband cooks for her or they get take out...</p>
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<p>She did eat a bowl of soup that I made (DH and I each ate two bowls) and a small piece of cake when she was over.</p>
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<p>So...my friends and I feel like we need to talk to her about this again, but my friend M brought up the fact that it could be...weird/not helpful to take one of the few times we ever see her to say "we think you (still) have an eating problem" and then kinda send her on her merry way all the way across the country where we're not physically present and able to support her.  We can't really keep tabs on her.  S says she often doesn't believe the things A tells her over the phone.</p>
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<p>Do we say something?  Say nothing?</p>
 

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<p>Honestly, there isn't much you can do except what you have been doing. If she does have an ED, she is also an adult and can't be forced to admit it or enter treatment. Maybe if you can, talk to her husband about your concerns and see what he says.</p>
 

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<p>My SIL has struggled with anorexia & bulimia. She was hospitalized for it at one point - getting her to that point was HARD work for all of us. We brought her to emergency several times before it was bad enough for them to admit her. And convincing her to let us bring her or that there was a problem took months of persistence.</p>
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<p>As friends who are not in her every day life you can certainly express a concern to her but leave it at that. You're not there enough to make a difference but perhaps your concerns added to other people's concerns will eventually bring her to the point of admitting there is a problem. And quite likely, if there is a problem, she is already well aware of it. The process to recovery is VERY slow.</p>
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<p>FWIW - my SIL would never have eaten a whole bowl of soup & definitely not a piece of cake, in front of anyone else. She would have pushed the food around, played with, ruined with salt & pepper or condiments. Pretended she was eating but at the end of the meal the food would still be there. SIL is doing pretty well with her weight now but she still NEVER sits down to eat with other people - she does all her eating alone, in the kitchen in little sneaks & bits.</p>
 

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<p>Perhaps you could talk to her husband, and then confront her together. This way he can be steady support back home and you can support her from afar. </p>
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<p>As one who has struggled with eating disorders (both personally and among friends), I want to let you know that your concern and care are so important, even if your friend can't see or appreciate that right now. </p>
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<p>Good luck!</p>
 

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<p>I just want to throw out there that she may not have an eating disorder. I have a cousin who is tiny and appears painfully thin. She's tried to gain weight all her life, sometimes successful, sometimes not.</p>
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<p>After having her first child her weight dropped quite a bit. she was trying to breastfeed, and I remember her tearfully telling me that she just couldn't get all the calories she needed to make enough for her baby. Her mom and dad and brother are also small. Sometimes people can't control their weight.</p>
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<p>As for not cooking etc, I often say I don't cook (because I don't), and I hate prying questions about how much I eat, etc. I'm overweight.</p>
 

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<p>Her MS may also be a factor.  My husband has mostly asymptomatic MS and he cannot keep weight on.  He eats massive amounts of calories (four or five thousand calories a day at least) and still is 135lbs at 6ft. </p>
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<p>She could be struggling with an eating disorder and she could just be ill.</p>
 

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Discussion Starter #8
<p>Appreciating the responses so far.  Thanks, everyone, for helping me think this through.</p>
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<p>I've wondered at times whether any meds that she was taking were messing with her appetite or ability to gain weight.  I'm having trouble remembering how many years she was on her MS meds.  But I do know she's been off them for at least 1.5-2 years.  And the weight loss issues started before that.  I looked at a photo of her at my wedding 6 years ago and she looks really good.  She's slim, but not scary skinny.  Her face still had the beautiful fullness to it that she had always had.  She got married about 2...3....years after that and by then we were noticing she had lost a lot of weight.  She doesn't talk to me about weight issues because she tends to be a kinda competitive person and always concerned about being judged and she took issue with the fact (as she told me once in our early 20's) that I, as she put it, "never had to worry about [my] weight."  But she has spoken to S over the years about not wanting to get too heavy.  I think her issues with depression and anxiety are also taking a big toll...I know loss of appetite can be a symptom of depression.  I know she's not really happy to be living where she is.  She's doing the SAHM thing now and she's definitely a person who needs projects to keep her busy/fulfilled.  And she said as much to me the other day.  She really needs to be in therapy, but I don't think she's ever stuck it out long enough to let her guard down to her therapist (or herself).</p>
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<p>S said that she thinks A's husband just cooks dinner for himself when he comes home - I guess cuz he figures she won't eat it...?  And she told S, when they were talking about not liking to cook, "well, you know me...I could just eat some crackers and go to bed."  S thinks she probably does just consider a few crackers a meal.  When A had her seizures, S did talk to A's husband about how thin A was, and her husband was agreement and said he was worried.  BUT, he's apparently too passive a person to take a stand, implement tough love, whatever...</p>
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<p>I think I'm going to try to find a time while she's here to just quickly let her know that I'm feeling concerned, and that I realize she may not want to talk about it, but if she ever does, I'm there for her.  And maybe I can get her husband's email address so I can check in with him from time to time, too.</p>
 

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<p>I think it is kind of you, OP, to be so concerned about your friend's health.  But, as someone who has suffered from a life-long eating disorder, I can tell you that the well-intended attempted interventions of friends and family have not been welcome.  In fact, (and I'm speaking only from my personal feelings on the subject), if someone tried to intervene it would push me further into the condition.  Because for me, it has ultimately been about control.  The whole tough love thing is a real put off.  Maybe this works when one is in her/his teens.  I'm 46 years old and as an adult this is something that I need to come to terms with myself.  </p>
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<p>I like your idea about just letting her know that you are thinking about her and will be there for her if she ever needs to talk.  I don't mean to be harsh but this more complicated than just getting someone to eat dinner.  I imagine your friend, if she is suffering from an ED, already knows that she is.  Just be there for her if she needs you.  :)</p>
 
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