If an employee has an eating disorder it can have a severe effect on their physical and psychological health as well as their ability to function and stay in work. But it can also be something easily hidden within, and even exacerbated by, the workplace. Dr Shazia Bhatti looks at how occupational health can take a lead in supporting employees and managers.
It is estimated by the charity Beat Eating Disorders that approximately 1.25 million people in the UK struggle with an eating disorder and, like any other illness, eating disorders can affect people in workplace.
If an eating disorder goes untreated it can affect a sufferer physically, psychologically and socially, and may even be life-threatening. Occupational health practitioners can play an important role and can lead on taking responsibility for supporting employees or managers who suspect they or a colleague may have an eating disorder.
But what steps should occupational health practitioners take – and what do they need to know – to help employees in need?
About the author
Dr Shazia Bhatti is a general practitioner at London Doctors Clinic
What should occupational health practitioners know about eating disorders?
First, it is important to recognise that an eating disorder is actually a mental health condition that has seriously damaging physical and emotional consequences.
People with eating disorders tend to compare their appearance and accomplishments against unrealistic standards and typically find themselves lacking. They may be hugely concerned about what others think of them, rather than what they think of themselves.
It is important to remember that eating disorders are not actually about food but about feelings. The way the person interacts with food is a coping strategy – it may simply make them feel able to cope with another issue or to feel in control.
Triggers such as stress, low self-esteem, bullying, abusive relationships or feeling out of control, can bring about an eating disorder – and eating disorders can be caused by genetic, social and neurological factors, or even personality traits.
Research tells us the majority of people with eating disorders are female. However, studies also suggest that up to 25% of all those suffering could be male.
The clear message therefore is that eating disorders can affect anyone, with people from all backgrounds and ethnic groups being equally vulnerable. In the working population, eating disorders are most likely to be found in the 16- to 30-year-old age range. However, it is possible to have an eating disorder for many years, even for life, so older employees may also be affected.
The difficulty for employers is that eating disorders are not easy to recognise – because the disorder is a coping mechanism for the person they try to keep it secret.
Eating disorders can have an impact on person’s ability to function in the workplace, which can be seen as “weakening” quality or quantity of work. However, if you are an occupational health practitioner, there are a few tell-tale signs you can take notice of. These include:
- Obsessing over thinness and thin people, making comments about being overweight, despite being very thin
- Always occupied with food, dieting and counting calories
- Avoiding eating in front of others
- Exercising excessively
- Mood swings
- Poor decision-making abilities
- Difficulties concentrating
- Increasing stress and anxiety
- Social withdrawal
- Missing deadlines
- Avoiding workplace events where food might be present
- Evidence of purging, smells of vomiting
What could trigger an eating disorder at work?
Stress is a major culprit. When individuals get stressed, they often act in impulsive ways because they do not know how to transfer the stress into something productive. For people diagnosed with an eating disorder, these impulses from environmental and social stressors can cause individuals to not eat enough food, purge after a meal, or engage in a binge-eating episode.
Feelings of shame and guilt about one’s body image can cause individuals to continue on a cycle of stress if they do not have a productive outlet.
The relationship between stress and eating disorders can be a vicious cycle. Feelings of being stressed or overwhelmed can trigger disordered eating behaviours, which are used as a coping mechanism. In a similar way the compulsive behaviour, fears and constant negative thoughts that characterise eating disorders raises stress levels.
Eating disorders are often associated with isolation and secrecy, and being stressed can be similarly isolating.
The workplace culture within an organisation can also play a role. In some companies there is a culture around being “too busy for lunch”, which is the perfect excuse for employees with anorexia to mask the condition or develop it.
Occupational health and HR should therefore work together to identify whether a culture around missing lunchbreaks exists and, if so, take the necessary steps to remedy this and work to create a culture where people feel they have “permission” to take a proper break at lunch.
It is also important to look at what foods are actually available at work. Is the canteen only providing a range of specific foods? Is there too much emphasis on vending machines offering chocolates, sweets or snacks, all of which can exacerbate the guilt/stress cycle?
What does treatment involve, and how can OH help?
When an employer suspects an employee of having an eating disorder and needs treatment, directing the employee to a medical provider is usually the first step in this process.
No single treatment is suitable for everyone; where some people respond positively to a self-help approach, others will need to take extensive time off work for medical and/or psychiatric care.
For a person with an eating disorder, managing their weight and eating should occur in conjunction with psychological help to treat the underlying problems.
Treatment for an eating disorder will vary for each individual and will be based on the needs of the individual and the type of eating disorder they have been diagnosed with. It is usually offered on an outpatient basis at weekly, fortnightly or monthly intervals, and can last for many months.
Some patients will require inpatient treatment with an average length of stay of 18 weeks, to follow this treatment with subsequent day and outpatient care. An employee who is admitted to hospital may therefore be absent from work for a considerable period.
For those undergoing treatment, the support and understanding of an employer is invaluable. A flexible approach to work hours, which enables the person with an eating disorder to attend medical appointments, is extremely helpful.
Finally, modifications in the work environment and schedule can help to facilitate recovery from an eating disorder. Employers can offer several options to encourage recovery including:
- Time off. Individuals with an eating disorder will need time off for medical appointments to consult with therapists, dieticians, and doctors involved in their care.
- Flexible scheduling. Scheduling changes can help toward encouraging an employee receiving adequate treatment.
- Limited/routine work schedules. It is important for an employee with an eating disorder to have a regular schedule in terms of meal times so that normal eating behaviours can develop.
A time-limited accommodation of a regular work shift and reduced or limited work hours can also be helpful until the employee has shown better eating and coping habits.
How Many People Have an Eating Disorder in the UK?, https://www.beateatingdisorders.org.uk/how-many-people-eating-disorder-uk
Statistics and research on eating disorders, National Eating Disorders Association, https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
Statistics, Anorexia and Bulimia Care, http://www.anorexiabulimiacare.org.uk/about/statistics