At this time of year, when festive food is abundant, most people are simply trying not to overeat. But for those with eating disorders, the challenge is more complex because they’re already constantly preoccupied with food.

It’s a greater problem than you might think, says Graham Redgrave, M.D., assistant director of the Johns Hopkins Eating Disorders Program. According to the National Association of Anorexia Nervosa and Associated Disorders, at least 30 million people of all ages and genders in the U.S. suffer from an eating disorder. And, every 62 minutes, at least one person dies as a direct result of one.

The program at Johns Hopkins treats patients with a variety of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, among others — along with co-occurring psychiatric or medical conditions.

Redgrave recently shared his take on how people should respond when they suspect that someone they love or care about is avoiding food or has lost a significant amount of weight rapidly, and may have an eating disorder.

When do people usually show signs of having an eating disorder?

There’s a wide range of ages, but eating disorders typically start in adolescence. For those whose disorders are diagnosed later on in life, there is often a past history of body image concerns, preoccupation with healthy eating, intense exercise to control weight, or yo-yo dieting.

What are the risk factors?

For anorexia and bulimia, the biggest risk factor is dieting, and many young people diet. Two to 4 percent of them will develop bulimia. Genetics also plays a role — a second twin is more likely to develop an eating disorder if the first one does, and this relationship is stronger for identical twins, who share more of their genes compared with fraternal twins. Anxiety disorders are also more prevalent in families with eating disorders.

Does this time of year present unique challenges?

Yes — holidays are a stressful time in lots of ways. There’s an emphasis on food, and it’s also a social time and usually involves spending more time with family. This could be a little too close for comfort, especially if someone who has developed an eating disorder while away is back in town for the holidays. That said, certain stressors have nothing to do with the holidays. People can be stressed out at school or in relationships.

If you suspect that a loved one has an eating disorder, should you say anything?

It’s better to say something than not to. Lots of patients tell us that no one has ever said anything. It may depend, however, on when the eating disorder begins. It’s much easier to notice a problem when someone is in middle school or high school and lives at home. At college, things are different. It can start abruptly. Overall, I think expressions of concern work better than an accusation. (“I’m worried about you,” rather than, “You have an eating disorder — I know it.”) And clarity is better than vagueness. (“I’m worried that you are too extreme in your exercise and dieting, and that it might even be an eating disorder. Can we get you to see someone?”) You can’t control how someone is going to feel — the risk for alienating people is there. But that’s balanced by looking out for the person’s well-being. Eating disorders are serious. It’s better to say something.

What shouldn't you say?

You don’t want to joke about it. You don’t want to say, “I wish I had a little anorexia” or “some of your willpower.” Remember: These disorders are a burden to people, causing lots of distress.

What might surprise people about eating disorders?

You might notice weight loss, but most persons with eating disorders are at a roughly normal weight or slightly overweight. Another misconception is that the eating disorder is a form of control. Feeling anxious about bodily changes like the onset of puberty, or feeling emotionally out of control with anxiety or depression, can help trigger eating disorders, but that does not mean the eating disorder is “about” control. Though every person’s story is different, eating disorders often begin with a very ordinary desire to diet — to improve appearance or health, or to avoid pain or discomfort associated with eating certain foods. For reasons we do not fully understand, the behaviors then spiral out of control, as the young person becomes more preoccupied with body image, weight, “healthy” eating, etc. It’s a lot like alcoholism in the way that it starts in an ordinary, gradual way and then eventually takes over the mind entirely.