With food everywhere you look, difficult relatives and pressure to create perfect memories, the holidays can be a tough time for those who struggle with eating disorders.
People dealing with binge eating or bulimia nervosa may find that the emotional challenges of the season, coupled with extra eating opportunities, can trigger their unhealthy behaviors.
Anorexia nervosa patients often work to combat perfectionistic tendencies, and the holidays - a time that everyone wants to be perfect but which seldom is - can lead to problems if not handled carefully.
Dr. Martha Levine, director of the partial-hospitalization and intensive-outpatient programs for treatment of eating disorders at Penn State Hershey, says people with eating disorders often find themselves in a double bind.
"People make all this food and say, 'Eat, eat!' but then they also make comments about weight and appearances," she said. "If you really listen to how much we talk about food, you see it can be a challenging time."
She encourages her patients to seek out a supportive family member ahead of time who can play interference during holiday gatherings when people make comments about filling up plates, weight gained or lost, and the diet they are thinking about trying.
Patients should make a plan to handle unstructured days where the eating never stops or occurs at different times of day. When the festivities and conversation trigger anxiety, Levine's advice is to breathe, then seek distraction with non-food activities.
"Go for a walk, suggest a game everyone can play, or find something else to do," she said. "I always tell my patients that emotions are like the weather - if you can just get through them, they pass and the next moment can be very different."
Family members can help their loved ones who struggle with an eating disorder by providing quiet support. That means not greeting the person with a "You look good!" or "You look healthy!" - both of which are often interpreted to mean "You look fat."
"It can get overwhelming if too many people are commenting on it," she said.
Rather than focusing on physical appearance, Levine suggests those wanting to show support use comments such as "You look brighter" or "You look like you have more energy," which focus on internal qualities.
Guiding conversation to light topics such as books, movies and current events that don't involve food or appearance can also help.
Families who step up with support during the person's initial bout with the illness and then back off may also trigger relapses. "The message is almost that they have to stay sick to keep them involved in their lives," Levine said.
And the focus should always remain on health rather than weight, size or physical appearance. She said, "Look at your body as a tool that you want to make as healthy as possible so that you are able to do more things."
Penn State Milton S. Hershey Medical Center