In America, surveys estimate 20 million women and 10 million men will have an eating disorder at some time in their lives, and for many of them Thanksgiving is a precarious time.

Gluttony is commercialized, the calories on our plates analyzed and the stories in our news feeds vacillate between sanctioning holiday binge eating and pressuring us into diets to recover from them.

"We live in a culture that validates a lot of this thinking and this talk, and particularly around the holidays when there's almost an endorsement of disordered thinking and behavior," said Claire Mysko, CEO of the National Eating Disorders Association (NEDA).

USA TODAY spoke with Mysko and Dena Cabrera, executive clinical director of Rosewood Centers for Eating Disorders, on how people suffering from these illnesses, and those eager to support them, can make Thanksgiving a less stressful time for everyone around the table.

How to tell if someone has an eating disorder

There's a broad spectrum of disordered eating — which refers to a number of abnormal behaviors like calorie counting or a rigid exercise routine — but there are specific criteria for eating disorders, which are diagnosed mental illnesses. The big three are anorexia, bulimia and binge eating disorder (each with their own specific warning signs).

"Someone with an eating disorder is held hostage by their thoughts and emotions as it pertains to food, weight, body image — and so their behaviors are significantly impairing their daily functioning, because that's all they're thinking about," Cabrera said. "It influences anxiety. It triggers depression. It impacts how they think about themselves."

Mysko said "the basic litmus test" to determine if someone is suffering from an eating disorder is whether "thoughts and attitudes around food, weight and exercise are making it difficult ... to enjoy life."

Signs to look for:

  • An obsessive relationship with weight, food, calories or exercise
  • Constantly talking about food
  • Uncomfortable eating around other people
  • Disappears after eating
  • Puts restrictions on whole categories of food
  • Dramatic weight loss

What to do on holidays if you're suffering from an eating disorder

Have a support system in place: It can be a therapist, a dietitian or a family member (though for some people, being around family during the holidays can actually provoke anxiety, Mysko said). If someone who you consider a part of your support system is with you during the holiday, talk with them in advance and let them know, "I need you to basically have my back," Mysko said.

Steer clear of negative body talk: Negative body talk at Thanksgiving is as American as apple pie (things like saying "the diet starts tomorrow" or "this stuffing is going straight to my thighs"). If you're suffering from an eating disorder, Mysko said it's best to avoid this kind of talk.

However, if you feel like you're in a place in your recovery where you can use negative body talk to shift the conversation, try to. Mysko, who struggled with an eating disorder, said she "often will use these kind of meals ... as a conversation starter" on the impact negative body talk has on all of us.

If you have a meal plan, follow it: This doesn't mean you have to skip dessert. It does mean you shouldn't starve yourself all day in advance of the big meal. "You can work through Thanksgiving and Christmas dinner and still stay on your meal plan and have that structure, and a dietitian can help you with that," Cabrera said.

Have coping mechanisms ready: It's important to develop a plan for what to do when you feel emotionally overwhelmed. Write down your coping skills and keep them handy, Cabrera said, so that you don't have to scramble when you're triggered. Don't be afraid to take a break. Go for a walk. Watch a movie alone. Write in your journal. "Take care of yourself," Cabrera said.

Focus on gratitude: Thanksgiving is supposed to be about gratitude, so try to embrace that. "We often encourage people to talk about things that they're grateful for in their lives," Mysko said. "Think about them, write about them, as part of the recovery process." It can help shift the focus away from food.

What loved ones should do

Make sure you understand the disease: "The most important thing you can do as someone who is supporting someone in recovery from an eating disorder is to make sure that you educate yourself," Mysko said. "These are very complex illnesses. The food and the weight obsession — that’s the surface part of it — but there’s so much else going on."

Eating disorders are influenced by "a range of biological, psychological, and sociocultural factors," according to NEDA

Don't be afraid to ask: "Prior to the event, ask the person 'how can I support you?'" Cabrera said.

Honor the request, even if it seems strange: "I have a little patient who wants to have their dinner by themselves," Cabrera said. "They don’t want to sit with the family." And he should be allowed to do that, though hopefully in the years to come he will rejoin the family table, she said.

If you see behavior that's concerning, talk to the person. It could be on that day, but it may be at a later time. It's important to find a quiet, private space, and to gauge how the person is feeling, Mysko said. Does the person seem especially anxious? Then wait for another time.

"Probably the most important thing to keep in mind is that often times people who are struggling with eating disorders are experiencing a lot of shame, so you want to approach the conversation and be very clear that you’re not judging that person, that you care about them," Mysko said. "And then you can cite the specific things that you've observed that have led you to believe that there could be an issue."

What not to do

Quit the "food moralizing": We're all guilty of it. Things like saying "good foods" (turkey) and "bad foods" (pie) and "I'm being so bad." Mysko said these conversations have become commonplace, and we must make a conscious effort to avoid them.

Don't remark on the physical appearance of someone suffering from an eating disorder. Especially if a person seems like they're doing better, resist the urge to pay them a compliment.

"For the person who's in recovery, that can be interpreted as 'Oh my God, I'm gaining weight and everyone's noticing it,'" Mysko said. "So the general rule is to avoid comments about people's physical appearance. Don't say anything. Ask them how they're doing, ask them about their lives but do not comment on physical appearance."

Cabrera said this is a good rule for all of us to follow all the time.

"My rule in in my family is 'lets not talk about our own bodies and let's not talk about other people’s bodies,'" she said.

How we can all approach Thanksgiving in a healthier way

Mykos and Cabrera said we ought to shift the focus away from bodies entirely.

"There are all these really meaningful aspects of the holidays that tend to get lost in the mix when everything is focused on 'Oh, I'm going to indulge in this pie,' or 'I'm going to have to make up for this.' ... It takes a conscious shift because this type of approach and this language has become so ingrained."

The bottom line? Don't worry about who's eating a slice of pie and who had two. Don't pay too much attention to who's running the Turkey Trot and who's sleeping instead. Eat when you're hungry, stop when you're full and try to make your conversations with family about the things that really matter.

"Let's not talk about weight at this time," Cabrera said. "That shouldn't even factor. Our time should be about our connections and our relationships with others and what we value."

If you are suffering from an eating disorder and want to speak with someone, call the National Eating Disorders Association helpline at 1-800-931-2237.

You can also use this screening tool to determine if you need to seek professional help.