As many as 725,000 men and women in the UK suffer from an eating disorder. Dr Nicola Davies explores how these conditions can cause issues in the workplace.
Irrespective of gender, eating disorders can take a tremendous toll on workplace productivity. This article provides useful advice on how human resources, line managers and OH practitioners can sensitively approach the problem.
What are eating disorders?
People erroneously assume that eating disorders are preoccupations with body weight or appearance. However, they are usually a symptom of deeper issues, and an eating disorder is often a symptom of a serious underlying psychological problem.
A person affected by an eating disorder may appear composed, but their mind is actually in chaos. The eating disorder is an attempt to compensate for this internal chaos by exerting strict control over food and weight.
Marie McCabe is a licensed certified social worker authorised to practise in both New Jersey and New York, who has been practising psychoanalysis, clinical social work and psychotherapy for more than 25 years.
McCabe advises: “A person with an eating disorder can appear competent, since there is an element o perfectionism with this disorder, but this is only a façade. Although the person longs for control and order in their life, they are actually feeling out of control.”
In this way, eating disorders represent out-of-control behaviour expressed in the pursuit of greate control – a paradox.
McCabe further explains: “The management of the food is symbolic of how the individual manage themselves, and how well the person feels about their ability to control their lives. The real problem isn’t necessarily the eating disorder, since this is a symptom, but rather the person trying to manage themselves and life.”
Generally, an eating disorder manifests as one of four identifiable conditions: anorexia nervosa; bulimia nervosa; binge eating disorder; and emotional overeating. When an eating disorder is diagnosed but defies classification, it goes into the “eating disorder not otherwise specified” (EDNOS) category.
The two most well-known eating disorders are anorexia and bulimia.
It is a fallacy that all people affected by anorexia are underweight, although this is often the case. It is important to remember, however, that eating disorders are psychological in nature, not physical. Beat, the UK’s leading eating disorder resource, defines anorexia as: “A serious mental illness where people keep their body weight low by dieting, vomiting, using laxatives or excessively exercising.”
Anorexia has more to do with an individual’s perception of themselves than what is actually observable. McCabe says: “I have one woman who comes to see me who works in a finance firm. She is obsessed with her appearance, mainly her weight. She restricts her calories to achieve a very thin appearance. She struggles with her relationships at work because she assumes that the men sexualise her and the women are in competition. She tends to isolate herself because she believes others think of her as an object to be either admired or envied.”
So, how can anorexia be identified in the workplace? There are both behavioural signs and physical signs to look for.
Behavioural signs can include:
- a discrepancy between reality (they are underweight) and their perception (that they are overweight);
- preoccupation with body weight;
- cutting food into tiny pieces – so it is less obvious how much they have eaten; and
- social withdrawal and isolation.
Physical signs can include:
- oedema – unexplained swelling in the face, hands and feet;
- unexplained hair loss; and
- lanugo – soft, downy hair that grows all over the body.
A person afflicted with bulimia believes that they are unable to control their eating and bases their self worth on how thin they are. Unlike those suffering with anorexia, people affected by bulimia can eat a great deal, but the food is flushed from their system before their body can reap any nutritional benefit.
After overeating, the sufferer will intentionally vomit, take laxatives, or over exercise. This process is called “purging” and is normally done immediately after a meal or “binge”. This is part of the reason that those affected by bulimia become increasingly isolated – sufferers prefer that no one discovers their habits, and they tend to avoid forming relationships so that it is easier to hide their behaviour.
Behavioural signs include:
- hastening to the bathroom immediately after eating;
- bingeing – eating large amounts of high-calorie food in a short space of time;
- mood swings; and
- unusual secrecy.
Physical signs include:
- amenorrhea (interruption in regular period cycle);
- calluses on hands (from inducing vomit); and
- regular weight fluctuation.
Recognising an eating disorder is not an easy task. McCabe notes: “Unless someone is willing to disclose an eating disorder, it is very difficult to detect. In our Western culture, a person is rewarded for being thin. It is wrongly assumed that a person who is thin is in control and someone who is not slim is out of control. This is a socially constructed fallacy.”
How should people with eating disorders be approached?
Food nourishes the body and provides energy, so it is vital to work performance that all staff are eating healthily and regularly. Above and beyond productivity concerns, there are more important reasons for HR managers and OH practitioners to be vigilant about employee eating disorders; an individual’s mental health is at stake.
McCabe advises: “The best way to help someone who has an eating disorder is not to act on a feeling of rejection and avoid the person, but rather reach out to their loneliness. A person with an eating disorder is often very alone, and rejection of others is a defence mechanism.
“If the person can keep others at a distance, their secret is presumed safe and they can continue to psychologically batter themselves for eating or not eating, for looking heavy or thin, and for not measuring up to personal, familial, or societal standards.”
HR, line managers and OH practitioners should seek guidance from legal and health professionals, as well as relevant safety at work regulations. In addition, the two factors discussed below should be taken into consideration prior to approaching an employee in an official capacity regarding concern about a perceived eating disorder.
Address the person, not the label
Even if it appears that a person may be affected by an eating disorder, do not jump to conclusions. Eating disorders are medical conditions that require diagnosis by a medical professional. Rather than accost an employee and accuse them of having anorexia or bulimia, it is more appropriate to focus on their job performance.
If it becomes obvious that the employee has health problems that are impacting their job performance – perhaps the individual is weak to the point of fainting, taking excessive bathroom breaks, or work quality has reduced – speak to the employee in private. Perhaps there is another reason for their behaviour that has not been considered.
Be sure to offer support while respecting the person’s privacy. Again, this should be framed in terms of addressing a work-performance issue, not as an attempt to diagnose or label the person.
Maintain boundaries and respect privacy
If other staff express concern about an employee, encourage them to contact line managers or HR directly. Likewise, HR staff should refrain from discussing the details of individual cases with other employees. It is imperative that HR and management encourage a professional and respectful atmosphere at work.
Joy Nollenberg, director of the Joy Project, a non-profit organisation dedicated to ending eating disorders, advises those professionals in the unenviable situation of having to walk the tightrope required to achieve the best outcome for the employee and the organisation.
She notes that time should be set aside to hold a private meeting with the affected employee: “Ideally, the conversation should be led by someone from HR. If this isn’t possible, then a senior manager can lead the conversation.”
Avoid becomeing a counsellor
Managers, including HR, should avoid trying to counsel the individual. Doing so veers into the realm of assuming a diagnosis, and it can expose the organisation to liability for a discrimination claim.
It is crucial to ensure that the discussion does not take the form of a lecture. It is also important that the employee has an opportunity to address the concerns that are raised at the meeting. Avoid beginning a conversation with expressions such as “we think you have an eating disorder and you’re clearly impaired”. The employee is likely to become immediately defensive and refuse to engage further in the conversation.
The representative should express concern, and be sensitive to the possibility of the employee interpreting the discussion as an attack. Nollenberg gives some examples: “It may be appropriate to say, ‘you appear to have lost a significant amount of weight in the past few months. I am concerned, and want to make sure you are doing ok.’
“It is not appropriate, however, to say, ‘clearly, your diet is too extreme and you should quit trying to look like a supermodel’.” After expressing concern, Nollenberg believes that it is also appropriate to direct the employee to helpful resources.
People suffering from eating disorders are in dire need of a change in perspective, but their disorder makes it difficult for them to accept that their viewpoint needs to be modified.
However, with sufficient support – including in the workplace – in time they can usually start to envision a new, healthy perspective and regain their position as a productive, valued employee.