- Symptoms of an eating disorder include trouble sleeping, low confidence and self-esteem, food anxiety, and feelings of shame, guilt and irritability.
- There is no one-size-fits all response, so employers need to be as flexible as possible.
- Employee assistance programmes can offer counselling, access to relaxation techniques for insomnia and cognitive behavioural therapy, and support to start around exercise routines.
The Royal College of Psychiatrists’ May 2022 Medical emergencies in eating disorders guidance revealed that there was a 79% increase in adults with an eating disorder admitted to hospital in 2020/21 compared to 2015/16. This shocking increase suggests that more support is needed for individuals suffering from an eating disorder, with the workplace being one possible channel. So, what support can employers offer employees with eating disorders?
Mental and physical impact
Eating disorders can be difficult to identify in an individual. Employers should look out for employees worrying about their weight and body shape, avoiding food-centred socialising, eating very little, vomiting or taking laxatives after food, exercising too much, strict food habits or routines, or feeling cold, tired or dizzy. They may also have trouble sleeping, low confidence and self-esteem, food anxiety, feelings of shame, guilt and irritability, and be increasingly withdrawn.
The first signs of an eating disorder are likely to be behavioural or psychological, which can impact working life, explains Umairah Malik, clinical advice coordinator at eating disorder charity, Beat.
“There may be an increase in sickness absence or a person being late to work," she says. "There may also be changes in their focus or standard of work, or they may appear less interested in tasks they would usually enjoy. Eating disorders are mental illnesses, so regularly checking in with all employees can help encourage them to be honest about their feelings.”
Other signs to watch out for include poor concentration that affects work quality and productivity, and a reluctance to travel to meetings if they work remotely.
Diagnosis support
At the earliest opportunity, and ideally before an employee discloses an eating disorder, employers should make sure that their workforce is aware of the signs and how to recognise these.
If an employer notices these in an employee, and believes that it has reached a point where their work and life are being negatively impacted, it can offer support by suggesting a GP appointment to receive help and a diagnosis. This is often the first step in a recovery journey, so a virtual GP service can be beneficial to an employee needing immediate support.
In order for this to happen, it is important to have a workplace culture in which employees feel they can be open and honest with their employer if they are struggling, with no fear of repercussions.
Providing training is important to ensure that managers understand the impact eating disorders can have and how to support a recovery journey, recommends Kate Palmer, HR advice and consultancy director at Peninsula.
“Managers should listen to the employee, reassure them that their situation will be kept confidential and signpost them to appropriate sources of help," she says. "This could include occupational health, mental health first aiders (MHFAs), specialist charities and the NHS for diagnosis support.”
The exact support an employee might need will differ from person to person, so employers need to keep an open mind and be as flexible as possible. Eating Disorder Awareness Week, which ran between 27 February - 5 March this year, could act as a focal point for highlighting mental health and wellbeing support and resources to employees.
A supportive environment with regular check-ins with the employee is important, says Malik. “This might include general catch-ups or offering reassurance, and should always include listening without judgment in a safe space.”
Health and wellbeing benefits
Many employee assistance programmes (EAPs) offer nutrition counselling services to help employees develop healthier eating habits and access healthy recipes. EAPs can also help with insomnia or sleep apnoea symptoms by offering access to tools and resources such as relaxation techniques and cognitive behavioural therapy for insomnia, says Frost.
“Improving sleep habits can lead to higher levels of concentration, improved mood, and better overall productivity," she says.
Early intervention within group income protection schemes can be useful if the disorder means the worker can no longer do their job and are at risk of absence, says Debra Clark, head of wellbeing at Towergate Health and Protection. “This can also support the employee to return to their normal health and back to work if they are insured.”
An employee with an acute eating disorder could get treatment costs for both mental health support and physical health support through a private medical insurance (PMI) scheme. However, they are unlikely to be eligible if it is deemed chronic.
Additionally, MHFAs, who have been trained to spot signs, approach, assess and assist with mental health problems, can signpost individuals to appropriate resources and professional advice.
Employers should always ask the employee what help they would like and be guided by them, says Christine Husbands, commercial director at RedArc.
“In terms of more serious side effects and complications that can occur as a result of an eating disorder, such as heart issues, osteoporosis and poor bone health, PMI can be used so employees can be seen quicker for tests," she explains. "If it's a complex eating disorder though, this cannot be a replacement for NHS specialist services.”
Time away from work
If an employee is hospitalised as a result of their illness or requires an extended period of time off work, employers should talk to their employee about what would be useful for them during this time, if anything, and support them to address any concerns.
Signposting for further information and advice where appropriate is useful, says Malik. “Employers should follow their occupational health policy if they have one. A referral can also help an employer understand what adjustments are needed to support an employee at work, or when returning to work.”
Employees who are sectioned or hospitalised under the Mental Health Act 1983 may not be able to contact their employer or receive any communication. Employers may need to contact the employee’s next of kin instead, so they can assess the situation and see whether they can do anything.
Employers should take a step back and accept that the employee will need some time on sick leave to focus on their recovery, explains Palmer. “Employees may be unable to initially provide a fit note, so employers should consider whether sick pay should still be paid even without one.”
When an employee can return to work, discussions held in advance will be important to understand any support that the employee may need.
Organisations can put in place reasonable adjustments that make work life more manageable before and after a diagnosis, as well as upon returning to the workplace, says Kayleigh Frost, head of clinical support at Health Assured.
“These could include longer lunch breaks if the employee eats at a slower place, removing a requirement to attend work lunches, a temporary change in days and hours of work, or allowing time off during working hours to attend related medical appointments and extra time around them if needed due to the mental toll,” she says. “The aim is to remove the barrier that the disorder presents to the employee carrying out their role effectively and recovering from the illness.”
Agreeing on what will be communicated to colleagues will also help them feel more comfortable about coming back, as well as a meeting on their first day back and regular catch ups.
Legal support
As eating disorders are a form of mental illness, they may be classed as a disability in accordance with the Equality Act 2010 provided that the condition meets the statutory definition, that the adverse effects are substantial, long-term and affect daily activities.
Sarah Bogues, employment lawyer at Freeths, says: “Employers are legally required to make reasonable adjustments to premises or working practices, but should be careful not to dismiss a suggestion without full consideration. This means adapting the employee’s workplace, schedule or environment so that they aren’t at a disadvantage compared to other members of staff.”
Palmer adds: “If a tribunal finds that it was reasonable for an employer to have made an adjustment, and it failed to implement it, it will be a form of discrimination. Employers owe employees a duty of care.”
It is important that employers let employees know what support is available, even if they are not quite ready to admit it may be beneficial. One option is to simply ask the employee what support they would most value, allowing them control over what happens next.
