According to Beat, one of the UK’s eating disorder charities, almost one in ten (6.4%) adults display signs of an eating disorder, whether it’s eating too little (anorexia), eating too much (over-eating), inducing vomiting (bulimia), or following restrictive diets that avoid essential nutrients (orthorexia).

A shocking 20% of anorexia sufferers die prematurely, the highest mortality rate of any psychiatric condition. Falsely seen as an illness that affects only young women, a quarter of eating disorder sufferers are male. This means eating disorders can affect, and are affecting, anyone of all genders and ages.

However, with little awareness of eating disorders, HR and managers are at risk of discrimination if they can’t spot the early signs. Eating disorders are psychological conditions that can last for 12 months or longer. As such they can be considered a disability under the Equality Act 2010, and therefore should be treated in the same way as any other disability in terms of employer responsibility.

It really isn’t as simple as encouraging sufferers to eat more or to exercise less; there are a lot of sensitive matters surrounding and causing the issue. Additionally, those who suffer from an eating disorder can sit in one of two groups: those who deny they have a problem and desist help, and those who know they have a problem but can’t get out of the habit despite the help they are given.

Like some other mental health issues, the behaviour can develop after a particular incident, or incidents, for example:

• A traumatic experience

• Bullying (usually, but not always, weight-related)

• Feeling like they have a general lack of control

• Their eating habits have become an addiction, especially if they are having the desired results

The signs and consequences of eating disorders in the workplace

As sufferers try hard to hide their condition, eating disorders don’t always have an impact on their work or attendance. However, the condition can lead to a number of physical health issues that can have a detrimental impact on their working life. Early signs and symptoms are usually:

• Dizziness or lightheadedness

• Lack of focus and attention

• Lack of self-esteem and confidence

• Lack of energy

• Shaking, trembling hands (a sign of low blood sugar levels)

• Mental and physical exhaustion

• Depression and anxiety

• Mood swings

• Increased sickness absence (due to their low immune system)

• Hospitalisation (in extreme cases)

Beyond the symptoms that affect performance at work, the employee may also experience drastic weight loss or gain over a short period of time, dental problems and hair loss.

The responsibilities of managers

Should managers step in if they suspect someone has an eating disorder, something not work-related? We are all aware that managers have a responsibility of raising a concern about mental ill-health with an employee, and eating disorders are no exception. It’s a complicated and sensitive subject to bring up with someone but this alone shouldn’t be a deterrent for intervention.

Managers know their team the best and are therefore placed in the best position for early intervention in the workplace. Turning a blind eye will only lead to the employee suffering for longer and potentially, from a business point of view, performance issues, increased absence, and discrimination if not dealt with correctly.

As a crucial reminder, managers should avoid direct encouragement to the employee’s progress.

Managers should ensure they get the right training for having difficult conversations so that they can approach the subject tactfully, sympathetically and confidently.

They are not there to be a counsellor or to encourage the employee to simply eat more. But they are there to signpost them to appropriate support, for example occupational health referrals, employee assistance programmes and any other assistance the organisation can offer (e.g. mental health first aiders).

Knowing which group the affected individual sits within

It will help managers to understand in which group (as mentioned above) the employee sits. Those who deny they have a problem will perceive any help from the manager, HR or occupational health professional as people who are out to sabotage their efforts.

As such, pushing the label of ‘anorexia’ or ‘bulimia’ etc. should be discouraged. Instead allow the medical professionals to approach the symptoms rather than the label, and how these directly affect the individual to carry out their work.

If, however, they fall within the other group where they realise they have a problem, they simply can’t go back to eating a normal diet again, then managers need to be patient with their recovery. Being told that gaining weight is a step to recovery is an oxymoron in their mind and a difficult step to take.

Recovery for those from either group will most likely be in the form of psychological help in the form of habitual reprogramming like cognitive behavioural therapy (CBT) or cognitive analytic therapy (CAT).

Managers are encouraged to explore the feasibility in accommodating attendance to these therapy sessions and should discuss the timings with the employee that works for everyone, for example arranging sessions at the beginning or the end of the day to minimise business impact.

We can offer appropriate support, and make accommodations and adjustments where feasible, but eating disorders are battles that only the individual can fight.

Ultimately, there is an equal onus on the individual to manage their own mental health so it must be recorded when therapy has been offered by the organisation’s occupational health provider, but the individual decides not to take it up. This will provide fundamental evidence should the impact (e.g. recurring absence) become an issue that warrants formal action.

As a crucial reminder, managers should avoid direct encouragement to the employee’s progress. This may sound heartless and contradictory to manager best practice, but any words of encouragement (‘you’re looking healthier’ or ‘you’re looking great’) will be heard by the sufferer as ‘you’ve gained weight’ or ‘you’re not a slim as you were before’.

Instead, managers should always ask the employee how they feel they have progressed; if they feel they are getting better and healthier, the manager can voice their encouragement by working with their feeling better.

The responsibilities of HR

It is HR’s responsibility to coach managers in managing employees who are experiencing mental ill-health, including eating disorders. Applying discretion with attendance and performance policies should be adopted, as with any long-term health condition.

As eating disorders can be an issue around control, HR should also work with managers to explore the possibility of job redesign.

Redesigning a role that allows greater autonomy and decision-making empowers the employee and gives them a better sense of control in a much healthier outlet. These changes can be temporary, and in which case should be clearly explained to the employee.

HR should also work closely with managers when making reasonable adjustments following advice from occupational health where appropriate. Adjustments can include allowing reasonable time off to attend therapy or adjusting attendance trigger points proportionately.

While it’s easy to get too involved with an employee’s wellbeing if you’re particularly close to them, HR and managers need to remind themselves of the boundaries between a condition’s impact on work and the individual’s personal life.

We can offer appropriate support, and make accommodations and adjustments where feasible, but eating disorders are battles that only the individual can fight. We just need to be there to make it a little easier for them.