How to support employees with an eating disorder

Eating disorders are becoming an increasingly prevalent condition, with a report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders reporting that 8%* of US adults reported to have one in their lifetime (although the true picture is likely much higher) and BEAT, the national eating disorder charity in the UK believing that 1.25 million people at any one time have one. Eating disorders don’t discriminate, affecting individuals across all spectrums of age, gender, ethnicity, and life experiences. An estimated 25% of those with eating disorders are male, demonstrating that anyone can be at risk of developing eating disorders.  Unfortunately, individuals who do not conform to the stereotypical image of someone with an eating disorder frequently face neglect, misdiagnosis, and a lack of necessary support.

What are the types of eating disorders?

There are eight types of feeding and eating disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) – rumination disorder (an obsessive focus on foods), avoidant/restrictive food intake disorder (ARFID) (only being able to eat certain foods), anorexia nervosa (usually intense fear of gaining weight and low intake), bulimia nervosa (purging foods, either by vomiting or excessive exercise), binge eating disorder (BED) (characterised by eating large amounts of food), atypical anorexia nervosa (usually defined as fitting the criteria for anorexia but not having a low body mass index), purging disorder (similar to bulimia in that an individual purges food through forced vomiting or bowel movements), night eating syndrome (eating what is considered abnormal amounts of food at night) and unspecified feeding or eating disorder (UFED) (other eating behaviors that are considered unhealthy). People do not need to be dangerously underweight or have serious complications to be experiencing disordered eating, but all come with risk factors that can be life threatening, such as because of significant weight loss or gain, severe dehydration, excessive exercise, heart complications, lack of strength and increased risk of comorbidities of other mental disorders and medical conditions. 

People with eating disorders can recover, which is why it is important to seek treatment early and help people on the road to health.

How do eating disorders impact work?

The implications for individuals, healthcare, society and employers are huge. A research paper in 2021 found that the annual economic cost of eating disorders in the US is around $400 billion, when you consider everything from health interventions to reduced productivity. Anorexia also has the highest mortality rate of any psychiatric illness, and all eating disorders come with increased physical complications including cardiac issues, osteoporosis, and infertility. In the US there are 10,200 deaths each year that are the direct result of an eating disorder – or one every 52 minutes.

Clearly, they are having an impact on individuals, health, society and our businesses. 

Eating disorders can manifest in the workplace through changes in behavior or performance, having significant implications on performance and productivity. When experiencing an eating disorder it can be hard to focus, either due to the mental preoccupation with food and weight, healthy eating habits, fear of gaining weight or losing weight, and food rituals. There are also severe physiological changes that occur in the brain as a result of starvation or bingeing making it hard to focus, and as a result mistakes happen and performance can wane. There may be time taken out for eating disorder behaviors, such as extreme exercise. Team dynamics can suffer as people withdraw into isolation, or are unable to participate in social gatherings, alongside the mood swings and irritability that affect relationships at work and home. People with eating disorders often do everything they can to mask the signs, and as a result isolation and secrecy can be prevalent. It’s important to note that not everyone loses or gains weight, and appearance in isolation should not be the focus. 

Managing eating disorders in the workplace

As an employer you have a duty of care to support employees with their overall wellbeing. But whilst there is a lot of advice out there about physical health and some common mental health challenges, eating disorders are often more complex. But that doesn’t mean the subject should be avoided, and there are definitely strategies, policies and actions that businesses and organizations can put in place to help anyone either with an eating disorder, or presenting with challenges.

Employee Assistance Programmes (EAPs)

EAPs can be instrumental in supporting employees with eating disorders by offering confidential counseling services to help employees deal with mental health issues, including eating disorders. They can also facilitate referrals to specialists and treatment programs specifically tailored to eating disorders.

Training and Education

Provide education and training, which encompasses support groups and workshops on healthy eating, stress management, and body image. This extends from team members to managers and leaders, helping everyone recognize the signs of eating disorders and what to do if they are concerned about someone. You can host virtual workshops and webinars on topics relevant to mental health and well-being, including managing eating disorders, and also provide resources and information to all employees about eating disorders and available support services.

Change the chat

Unfortunately, we live in a world where talk about diet, weight and exercise is normalized and this can be unhelpful and even triggering for people with eating disorders. Try not to use language such as ‘oh I’m so naughty’ or ‘I’m being bad.’ Move away from praising people for weight loss, or indeed making any comment on their appearance. If you must, compliment them on a nice jumper, or their glowing skin, or something that isn’t around body shape and size.

Don’t make it all about food

Often team bonding activities centre around food and drink. It’s important to recognize that team lunches or drinks can be part of a healthy and balanced lifestyle, and everyone should be invited and included. But don’t make attendance mandatory, and have other options available such as bowling, craft workshops or walk and talks. If you have things such as biscuits or cakes in the office it’s ok to offer them to everyone, but if they say no or go in for a second, it’s absolutely not your place to push or comment. 

Accommodate flexible working

Those with an eating disorder may require time off for medical appointments or therapy. Those we spoke to in All Worked Up said that for many of those with anxiety and/or depression don’t get help because the help they need isn’t available at times that work for them – most of the time it’s still in the working day. Eating disorders, and indeed any mental illness, can be tiring, so thinking about how hours can be flexed to work with sleep and energy can be really helpful, otherwise, there is a risk of burnout. Where possible don’t put in meetings around ‘typical’ breakfast, lunch and dinner times, as this can throw people off a structured plan that is often helpful when trying to manage or recover from an eating disorder.

Open channels of communication

Create an environment where individuals feel comfortable knowing that they can speak up. In All Worked Up we found that 8 in 10 people would choose an app over HR, and management are in the dark about the scale of worries and issues employees are facing. Make it clear that anyone is able to come forward and speak about their mental health, challenges at work, and help they might need, and not face discrimination or lack of support. 

Use of digital tools

Digital tools and platforms can offer additional support through support designed to help with some of the stress and anxiety that comes from having an eating disorder. Wysa is not designed for eating disorder treatment and should not be used as such, but can help with adjacent issues such as anxiety, sleep and ruminating thought processes.

There are also apps designed to promote recovery by tracking eating habits, offering nutritional guidance, and connecting users with peer support or professional help. However, users need to be mindful as to which type of eating disorder they are designed for, as all manifest differently, and use them in conjunction with human professional support. We are seeing a move to online therapy and counseling services that provide flexible, accessible mental health support that can fit into busy lifestyles.

Don’t ignore it

If you’re concerned about a colleague or employee, don’t ignore the issue. So often people deteriorate or think they’re not that sick because no-one noticed. Speak with HR teams who will be able to advise on the best approach, but it usually involves sensitive listening, flexibility, and appropriate signposting.

By recognizing the signs of eating disorders, understanding their impact on individuals and the workplace, and leveraging employee assistance programs and digital tools, employers can provide critical support to affected employees – helping not only in the recovery and wellbeing of the individual employee but also contributing to a healthier, more productive workplace and society.

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