Once a month, I stand at the communion table focusing on my breathing – inhale, exhale – while reciting the familiar and ancient words: “Eat this bread, drink this cup.” The words sound so inviting, yet they taste sour on my lips. Inside me, a different refrain screams its warnings: carbs, sugar, germs, public eating!
What is intended as a moment of grace becomes a site of anxiety that I work desperately to conceal with a smile. I break the bread and pour the cup with practiced flourish, look out at my beloved congregation, and feel utterly alone.
What is intended as a moment of grace becomes a site of anxiety…
I remember a time when I felt differently, when I eagerly looked forward to stretching my legs and dipping my bland wafer into the sweet juice. But life moved on, anxiety grew, and what had once been a cherished ritual became a heart-squeezing, full-body ache. I knew something was wrong, yet it took me a long time to accept the truth: I have an eating disorder.
In my 29 years, I have never heard the words eating disorder or anorexia spoken from the pulpit, much less at the communion table. While many churches have thoughtfully adapted communion practices to address concerns such as alcoholism, allergies and disability, little attention has been given to those living with eating disorders. That silence is striking given how common these illnesses are.
According to a 2020 Harvard study, approximately 9% of people in the United States will meet the diagnostic criteria for an eating disorder during their lifetime. More recently, a 2024 study found that one in three adolescents reported engaging in disordered eating behaviors influenced by social media. Eating disorders affect elders, deacons, pastors, Sunday school teachers, youth, young parents and everyone in between. Yet churches have largely treated them as individual struggles rather than deeply embodied realities that shape people’s experience of worship.
If we are to faithfully uphold the ideal of an “open table,” we must reconsider both how communion is theologically understood and how it is pastorally practiced. Communion is one of the most visible and embodied rituals of Christian life. It involves public participation, the consumption of bread and cup, and profound theological claims about nourishment, grace and belonging. For someone living with an eating disorder, those same elements can transform a sacrament of comfort into a moment of profound distress.
Grace before consumption
There is room within the Reformed tradition for someone to participate in communion without eating or drinking. Communion is more than the biological acts of ingestion. Presbyterians understand the Lord’s Supper as a means of “God’s sustaining grace offered to all people” (Book of Order, W-3.0409). Grace is freely offered by God before we do anything to earn or deserve it — even before we partake of the elements.
In the words of John Calvin, “The secret energy of the Spirit is the bond of our participation with Christ” (Institutes of the Christian Religion, IV.xvii.12). While the bread and cup are indispensable signs of God’s grace, the sacrament is fundamentally centered on what God has done for us. We do not receive communion because our bodies are perfect or our faith is complete. We receive because Christ graciously invites us.
The Book of Order likewise affirms that “the opportunity to eat and drink with Christ is not a right bestowed upon the worthy but a privilege given to the undeserving who come in faith” (W-3.0409). Communion rests in our faithful, communal response to God’s gracious initiative.
At its heart, communion is a communal act of remembrance and participation in Christ’s story through the Spirit. While eating and drinking are essential sacramental signs, the meal proclaims that we belong to Christ and to one another before it asks anything of us.
The meal proclaims that we belong to Christ and to one another before it asks anything of us.
Accommodation without avoidance
Despite being communal, the decision of whether and how to participate in communion is deeply personal. Eating disorders frequently thrive through patterns of avoidance, and accommodations that permanently remove someone from receiving the elements could unintentionally reinforce the illness rather than support recovery.
The goal, therefore, should be neither to require participation at any cost nor to normalize avoidance indefinitely. Recovery unfolds differently for every person. Decisions about communion participation are best made through ongoing discernment involving the individual, their pastor, and medical and mental health professionals. The church’s responsibility is not to prescribe a single faithful response but to ensure that no one is shamed, coerced or excluded while seeking healing.
Some adaptations remain fully within the standard practice of communion. Many congregations already provide gluten-free bread, alcohol-free juice or prepackaged communion elements for pastoral reasons. Additional flexibility — offering smaller portions, allowing communicants to hold the elements before deciding whether to consume them, naming the option to consume only one element or reducing the pressure of public eating through multiple serving stations — may help some people participate more fully.
Making belonging visible
Other practices can serve as concurrent pastoral expressions of belonging for those unable to receive the elements during a particular season. Some congregations invite worshippers to receive a blessing instead of or in addition to the elements or to remain seated in prayer. When these options are intentionally named and accompanied by liturgical language affirming that abstaining does not place someone outside the grace of God, the table becomes less a burdensome obligation and more a compassionate invitation.
Churches might also offer pastoral rituals such as anointing with oil or giving a small stone or cross — not as replacements for communion but as visible reminders that Christ’s care extends to those whose illnesses complicate sacramental participation.
These practices reflect one of the Reformed tradition’s deepest convictions: the table belongs to Christ, not to the church. Accommodations should not create new barriers to belonging or diminish the significance of the sacrament. Instead, they should reflect the church’s responsibility to accompany people faithfully as they seek healing and communion with Christ.
Communing without bread is not the absence of sacrament but an expansion of our imaginations. Providing accommodations and other expressions of belonging reminds us that God’s grace at the table is not confined to a single mode of reception.
For a long time, I believed I was the only person standing at the communion table carrying this hidden burden. I suspect I am not. Somewhere in every congregation are people silently negotiating fear while longing to encounter grace, convinced they must choose between panic and participation.
Somewhere in every congregation are people silently negotiating fear while longing to encounter grace, convinced they must choose between panic and participation.
The church proclaims that Christ welcomes us before we are whole. If we affirm this as true, then our practice at the table must make room for those whose illnesses complicate receiving the elements without suggesting that healing lies either in forced participation or permanent avoidance. Faithful pastoral care holds together both: welcoming people exactly where they are while walking patiently with them toward greater freedom.
My hope is that by speaking aloud what has so often remained hidden, the church will become a place where no one has to suffer in silence. Perhaps then, when I stand at the table and say, “Eat this bread, drink this cup,” I will no longer feel so alone — and neither will anyone else.
