Eating Disorders

How to Help a Friend: The IMAD Approach

If you are worried that a friend may be excessively concerned with her eating, exercise or body image, it is a good idea to share your concerns and feelings openly and honestly with her.

Instead of focusing on the number of calories she is eating or the number of pounds she has gained or lost, you may find it helpful to use the following approach to help you address your concerns with your friend.

The “IMAD” Approach (Levine & Hill, 1991)

Focus on the Inefficiency (I), Misery (M), Alienation (A), and Disturbance (D) that your friend’s eating disorder is causing in her life.

  • Inefficiency- Is your friends suffering from physical and psychological lapses in strength, energy, and concentration?
  • Misery- Is your friend clearly suffering? Is she angry, depressed, anxious, obsessed, or sad?
  • Alienation- Is your friend’s constant concern with and thoughts about eating, weight, exercise, and body image cutting her off from you and her family and friends, and even from herself?
  • Disturbance- Is your friend doing things that are frightening, upsetting, or generally disturbing to her and/or to others?

What to Say, Step by Step

  • Set a time to talk. Set aside a time for private, respectful meeting with your friend to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be someplace away from other distractions.
  • Communicate your concerns. Point out a few behavioral instances that indicate to you that you should be concerned about your friend’s health, happiness, and safety. Explain that you think these things may indicate that there may be a problem that needs professional attention.
  • Ask your friend to explore these concerns with a counselor, doctor, nutritionist, or any health professional she feels comfortable enough to see. If you feel comfortable doing so, offer to accompany your friend on her first visit.
  • Avoid conflicts or a battle of the wills with your friend. If your friend refuses to acknowledge that there is a problem or any reason for you to be concerned, re-state your feelings and the reasons for them and leave yourself open and available as a supportive listener.
  • Avoid placing shame, blame, or guilt on your friend for her actions or attitudes. Do not use accusatory “you” statements like “you just need to eat” or “you are acting irresponsibly.”
  • Express your continued support for your friend. Let her know that you care about her and that you want her to be healthy and happy with herself.
  • After talking with your friend, if you are still concerned for her safety and health, find a trusted adult or medical professional to talk to. This is probably a challenging and difficult time for both of you. It could be helpful for you, as well as your friend, to discuss your concerns and seek assistance and support from a professional.

For more information, you can contact Eating Disorder Awareness and Prevention. Inc. at 1-800-931-2237,  And/or you can contact Student Counseling Services at 805-493-3390.