How Should You Approach Eating Disorders at Work?

​She complains of being "fat" when she appears too thin. He declines all lunch invitations and refuses to eat in front of others. She exercises excessively, looks fatigued, has frequent mood swings and blames inappropriate outbursts on being "tired."

Could your employee have an eating disorder? And if so, what can—or even, should—a manager or HR professional do about it?

"It is impossible to tell if someone has an eating disorder simply by looking at them," said Claire Mysko, CEO of the National Eating Disorders Association (NEDA), which notes that in the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their lives. "As with many illnesses, eating disorders have serious health effects that, if untreated, may lead to lost productivity and long-term medical problems."

To Confront or Not?

In a recent online discussion for Society for Human Resource Management (SHRM) members, an HR professional sought advice about a worker who repeatedly vomited at her desk in her office. The worker told managers that she didn't have an eating disorder, but rather a gastrointestinal illness. The HR professional wrote that although the company had "issued a warning" telling the woman she could no longer vomit at her desk, the behavior continued.

The advice from HR professionals who responded to this post included: asking the worker to stay home until she and her doctor could address her illness, insisting she use the bathroom to vomit, consulting with a workplace attorney about accommodating the worker, and considering accommodations for her under the Americans with Disabilities Act. One responder cautioned that "clearly she has some kind of medical condition. I would not be disciplining her for it."

SHRM's advice is similar. "Eating disorders, such as anorexia and bulimia, fall within the framework of the Americans with Disabilities Act as mental conditions," SHRM states in an article from SHRM's HR Knowledge Center.

A supervisor should approach a worker about a suspected eating disorder only if the worker's job performance has faltered, SHRM recommends. 

"Assuming there are no job-related problems occurring as a result of the individual's weight loss, the employer should be extremely cautious if one chooses to address the issue," the SHRM article says. "To do so would be entering into discussions regarding an employee's personal life."

"Avoid making any assumptions based on the employee's appearance alone," Mysko said. "If you are concerned about the health of one of your employees, set up a private meeting with [the] human resources department."

SHRM noted that some supervisors are close enough to their workers to feel comfortable broaching such a sensitive conversation with a casual remark like, "You've been looking a little under the weather lately. Are you feeling OK?"

Mysko suggested that if a worker tells a manager about an eating disorder, "listen without judgment and encourage him or her to seek professional help." One resource, she noted, is NEDA's confidential helpline (1-800-931-2237). 

Eating Disorder Symptoms to Watch For

According to eating-disorder experts, some of the common signs of an eating disorder are:

• Dramatic weight loss.
  
• Wearing loose, bulky clothes to hide weight loss.
  
• Making comments about being "fat" despite appearing thin.
  
• Obsessing over thinness and thin people. People suffering from an eating disorder will often point out the thin people around them and express envy.
  
• Preoccupation with food, dieting and counting calories. 
  
• Refusal to eat certain foods, such as those that are high in carbs or fats.
  
• Avoiding meals or eating in front of others. People with an eating disorder typically have an excuse for not eating, such as that they aren't hungry, they feel sick or they just ate.
  
• Preparing elaborate meals for others but refusing to eat them.
  
• Exercising excessively. Often the exercise regimes will be frequent and harsh.
  
• Denying their feelings. People with an eating disorder may have trouble discussing the way they feel about something. They may dismiss emotional outbursts such as anger with excuses like being tired or stressed.
  
• Mood swings. Even low-key interactions can trigger strong emotions and possibly tantrums or withdrawal.
  
• Poor decision-making abilities. Those suffering from an eating disorder are more likely to make regrettable choices about their sex lives, money and career paths. They can have troubles with stealing, lying, and making or honoring commitments. 
  
• Complaining about constipation or stomach pain. 
  
• Evidence of purging, including trips to the bathroom after meals, sounds or smells of vomiting, or packages of laxatives or diuretics.
  
• Scarred knuckles from repeatedly inducing vomiting.
  
• Using gum, mouthwash or mints excessively.
  

Experts caution that some of these symptoms may point not to an eating disorder but to another illness that may be causing weight loss or mood swings.

Eating Disorder Accommodations

Keep in mind, SHRM noted, that "if the employee does have an eating disorder, denial often will be the first response to inquiries."

In addition to encouraging a welcoming and inclusive workplace, human resource departments can counter common misconceptions about eating disorders through education and awareness efforts.

"Eating disorders are life-threatening illnesses, and they are not the fault of the sufferer," Mysko said. "Current research indicates that there are significant genetic contributions to eating disorders, and anorexia nervosa has the highest mortality rate of any psychiatric disorder."

All supervisors should be taught that eating disorders are considered to be mental health conditions under the Americans with Disabilities Act, Mysko suggested. It is also important that supervisors and employees are aware of the accommodations available for those who need them.

If an employee indicates that he or she is struggling with an eating disorder or a "medical condition" but doesn't wish to offer specifics, SHRM suggests first referring the worker to an employee assistance program.

Employers that believe a worker can't perform his or her job functions should ask for a medical assessment before deciding on a course of action, SHRM advises. "Keep in mind that unless you are this employee's health care provider, you are not qualified to diagnose your employee's medical condition," SHRM cautions. "It is possible that the weight loss has been caused by other medical problems that the employee does not wish to discuss."

 [SHRM members-only HR Q&A: Disability Accommodations: Should an employer provide an accommodation to an employee suspected of having an eating disorder?]

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