A doctor's advice on eating disorders in the workplace

Approximately 1.25million people in the UK struggle with an eating disorder, and, like any other illness, eating disorders can affect people in the workplace.

However, if an eating disorder goes untreated, it can impact the sufferer physically, psychologically and socially, and may even be life-threatening. Therefore, employers have an important role and responsibility, as well as a moral obligation, to support any staff members who may be struggling.

What should employees know about eating disorders?

Firstly, it’s important to know 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 are hugely concerned about what others think of them, rather than what they think of themselves.

It’s 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 like stress, low self-esteem, bullying, abusive relationships or feeling out of control, can bring about an eating disorder – and they 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 suggest that up to 25% of all those suffering could be male. 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; although 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 it is a coping mechanism for the person, they try to keep it secret.

Eating disorders can have an impact on a person’s ability to function in the workplace which can be seen as weakening quality or quantity of work.

However, if you suspect an employee may be struggling, there are a few tell-tale signs you can take notice of.

• 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
• Irritability
• 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 is 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 characterize eating disorders raises stress levels.

Eating disorders are often associated with isolation and secrecy and being stressed can be similarly isolating.

Other triggers at the workplace can be:

• Not enough time for lunch breaks
• Canteens at work providing specific foods, as opposed to options
• Vending machines with chocolates, sweets or snacks can exacerbate the guilt/stress cycle

What does treatment involve, and how can you 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 is 18 weeks, to follow this treatment with subsequent day and outpatient care. An employee who is admitted to hospital may 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.

Modifications in the work environment and schedule can help 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 be helpful until the employee has shown better eating and coping habits.

Dr Shazia Bhatti, general practitioner at London Doctors Clinic