Need to know:
- Eating disorders affect more than 725,000 people in the UK, with the number increasing at an average of 7% a year since 2009.
- Warning signs include weight loss or gain, marked changes in behaviour such as an obsession with food or exercising, mood swings, lack of concentration and increased absence.
- Recovery strategies can vary hugely so employers should ask the individual what support they need and how it can help.
- An open and supportive workplace is key, with policies on eating disorders, awareness days and employee assistance programmes helping to create this environment.
More than 725,000 people are affected by eating disorders in the UK, according to The costs of eating disorders: social, health and economic impacts report, published by eating disorder charity Beat and PricewaterhouseCoopers (PWC) in February 2015.
But, while many of these individuals are employed, further research by Beat, conducted in December 2015 and January 2016, found that stigma and discrimination in the workplace can hinder their recovery.
This latter research found that 32% of respondents felt they were stigmatised or discriminated against because of their eating disorder, with 29% saying their employer was not helpful in their recovery. Rebecca Field, head of communications at Beat, says: “There are plenty of myths around eating disorders so it’s not surprising people don’t understand what they can do to help. But these are serious mental illnesses: employers have an important role to play in supporting recovery.”
Employers also have a legal responsibility. Under the Equality Act 2010, employers have a duty to make reasonable adjustments in order to accommodate employees with a disability, which includes mental illnesses such as eating disorders.
And, with the PWC and Beat report finding that the number of people being diagnosed and entering in-patient treatment for eating disorders has increased at an average rate of 7% year on year since 2009 in England, it is clearly an issue that must be tackled.
Hidden problem
Part of the problem for employers is that it is not always easy to recognise that an employee has an eating disorder. Becky Brooks, member engagement officer at the Employers Network for Equality and Inclusion, which worked with Beat to produce a guide for employers, Eating disorders in the workplace, says: “There can be physical signs with anorexia but with the other eating disorders, there’s often nothing to see.
“Managers should look for any marked changes in behaviour such as an obsession with food or exercising, low self-esteem, mood swings and lack of concentration. An employee may also be absent more, either due to the illness or to attend appointments for treatment.”
Like many health conditions, early intervention is key to increasing the chances of recovery. Providing a range of support mechanisms such as an employee assistance programme and occupational health can be useful. Dr Joanna Livingstone, head of psychological services at Axa PPP Healthcare, says: “Our counsellors can assess an employee for factors that may be suggestive of, or contributing to, an eating disorder.
“We would then direct them to appropriate support, including the NHS, private treatment and charity organisations. We can also support an employer, providing occupational health advice and suggesting strategies that might help the employee and their colleagues.”
An open culture where employees feel able to ask for help is even more important. “If an organisation can show it is supportive, this can encourage sufferers to come forward,” says Brooks. “Running awareness days but also talking generally about healthy lifestyles and mental health support can make a big difference in creating the right culture.”
Practical support
As well as offering this understanding, organisations can also provide practical support to employees with eating disorders. Vicky Roberts, head of v-learning at Vista, says: “Employees’ needs vary so start by asking them what help they would like. Organisations should be able to work with them to accommodate their needs, whether this is extra time off for treatment or moving into a less-stressful role so they can focus on their recovery.”
Changes can also be made to the workplace. For example, even in recovery some people will still find eating a major cause of stress, says Field. “Being able to take extra breaks or having a discreet place to eat can make a big difference,” she adds. “Speak to the person and find out what they want.”
Financial support can be an option too. Although the NHS provides treatment for eating disorders, private treatment can often be accessed more quickly. As this can be expensive, employers may want to consider funding or even lending the employee the money to help them access treatment, says Brooks.
Private medical insurance can also help. “Eating disorders often benefit from a multi-disciplinary approach including a psychiatrist, psychologist, nurse and dietician,” says Livingstone. “Elements of this may be funded by [a] medical insurance policy but it will depend on the severity and chronicity of the eating disorder.”
Other employees can also play an important support role. “The individual with the eating disorder has to decide what information they want shared in the workplace,” says Field. “But, where the employee is happy to share, colleagues can have a very positive impact on their recovery.”
KPMG raises awareness of eating disorders with wellbeing events
Accountancy firm KPMG employs more than 13,000 staff across 22 locations in the UK. It is committed to supporting its employees and set up its Be Mindful Network in May 2015 to help improve mental health across the organisation. Jessica Carmody, head of Be Mindful at KPMG, says: “We run regular health awareness events and in February, we decided to focus on eating disorders to tie in with Eating Disorders Awareness Week. There is more we can do as an employer to educate ourselves and support colleagues who may experience these conditions.”
The event consisted of a number of elements, including a Sock It day where employees were encouraged to wear their most flamboyant socks, posting their #Sockitselfies to Twitter and the firm’s intranet to raise awareness.
In addition, Carmody worked with charity Beat and colleague Jack Jacobs, an audit associate at KPMG and former anorexia sufferer, to organise an event focusing on eating disorders in the workplace. This brought together a panel of speakers, including Jacobs, a representative from Credit Suisse whose partner had suffered from an eating disorder, Beat’s director of fundraising, and a nutritionist from Nuffield Health.
Jacobs says: “We were able to cover everything from challenging some of the perceptions around eating disorders to what someone could do to support a colleague with a disorder. It was very powerful to talk about personal experiences.”
The session also flagged up some of the support mechanisms that KPMG already has in place. This includes an employee assistance programme and its HR advisory team, which can give advice to leaders and individuals on any health concerns. “We want to support employees and enable them to feel comfortable about talking about any issues they might have,” says Carmody. “Raising awareness of eating disorders in the workplace is an important part of that.”
Viewpoint: How to approach an employee with an eating disorder
In order to help someone with an eating disorder, you need to have spotted the signs, understand something of the nature of eating disorders and why someone develops one.
Anorexia nervosa, bulimia nervosa and binge eating disorder are the three main eating disorders. There is still a lot of stigma, judgement and misunderstanding about them, particularly that they are about dieting and vanity or greed or lack of control.
Eating disorders affect all ages and genders. They are essentially coping strategies, helping the person feel more in control of life. Stress, relationship difficulties, gender issues, bereavement, bullying and all forms of abuse are triggers. They are caused by a complex interplay of genetic, social and neurological factors.
Anorexia is easier to notice because food avoidance and sustained weight loss is evident. Binge-eating disorder is evident by weight gain, but there are little signs to see for bulimia nervosa because for those struggling (where self-induced vomiting is the key symptom), weight stays in normal limits. Secrecy and guilt prevent someone from coming forward, so if you notice tell-tale signs in the staff toilets, or see someone going there frequently, then do not confront them. Consider placing helpline information leaflets there. For all eating disorders, tact, understanding and a thoughtful approach are necessary.
Decide who is best to have a discreet and private conversation with the employee to see how they are coping generally. Someone close to them who has their trust is best, however, it will take time for them to open up. Where the person’s health is clearly at risk, for example, having difficulty concentrating, feeling faint at work, complaining of chest pains, then someone senior needs to be involved. Eating disorders have the highest mortality of all mental health conditions, so it is important employees receive on-going medical monitoring, therapy and dietetic advice and support.
Jane Smith is chief executive officer at Anorexia and Bulimia Care (ABC)