Managing someone with an eating disorder can be one of the most delicate and complex challenges a line manager can face. Often associated with younger females and conditions such as Anorexia or Bulimia, that’s only part of the story. Anyone can be affected and those with a condition will often keep it well hidden. Often eating disorders develop for a feeling of control using food to cope with feelings, stressors and emotional discomfort.
This is why we are supporting Eating Disorders Awareness Week, taking place 26 February to 3rd March 2024. As we will cover, eating disorder is a complex and varied mental health condition. Organisations need greater awareness to offer their people the support they need if affected.
The extent of eating disorders in the UK
Eating disorders reportedly affect around 1.25 million people in the UK. This represents around 9% of people with a mental health condition. What’s more, one in four identify as male. The shame that many who are affected feel means that they try very hard to disguise their conditions.
Media coverage has shaped the conversation about eating disorders and created a narrow awareness of a problem that’s far bigger than many of us think. And social media carries some of the blame. Research by the University College London has linked social media usage to eating disorders in young people. They found that those aged between 10-24 who use social media sites may potentially be at risk of developing image concerns, eating disorders and poor mental health. Social media creates risks of negative body image, social comparison and often promotes the idea that it is vital to be thin or fit.
It’s also perhaps no surprise that, according to the NHS, the isolation and anxiety caused by the pandemic is thought to have increased eating disorder GP referrals by 20% during that time.
Eating disorders explained
While many people will have heard of Anorexia and Bulimia, there are other conditions – some involve eating more, others too little.
- Anorexia nervosa: Perhaps the most well-known and often referred to as ‘anorexia’. It is an eating disorder which is diagnosed as a serious mental health condition which doesn’t have a single cause, rather it is a combination of different factors. This can stem from things that have happened in the individuals past or present and has also found to be due to biological reasons. An individual with anorexia will try to keep their weight as low as possible with a fear of gaining or maintaining their weight. They often will use different modalities to keep their weight low including excessive exercise, insufficient food intake and not eating meals, the use of laxatives, or making themselves physically sick. It sadly carries the highest mortality rate of any mental health condition and has severe long term health risks due to the lack of nutrients. But recovery is possible, with treatments and resources available to support the individual through therapy, nutritional psychology and medication. It can take several years for recovery due to the severity of the disorder and the underlying mental health causes.
- Bulimia nervosa: This type of eating disorder is when individuals go through periods of binging and purging. This means they will eat a lot of food in a very short amount of time due to differing reasons such as distorted body image views, trying to gain control, depression or feeling negative towards their self. They will then follow this with a period of purging using laxatives, vomiting, diuretics or excessive exercise to expel the food from their body to try to stop themselves gaining weight or in a response to possible shame or guilt from the binge.
- Binge eating: This is recognised as a disorder in its own right and where people feel compelled to overeat on a regular basis. Often carried out alone, those suffering will eat a lot of food in a short time, unable to stop when full or eating without thinking or acknowledging the foods they have consumed. Individuals with this disorder will often hide what they are eating from others, eating in secret and often eat less nutritional health foods. It often causes those who binge to feel guilty or ashamed.
- Avoidant/restrictive food intake disorder (ARFID): This less well-known condition is one of the focal points for this year’s awareness week. This is when certain foods or types of foods are avoided with restricted intake or inclusion. It’s usually unrelated to concerns about weight with varying reasons as to why someone may develop this disorder. The restriction or avoidance of food can occur through sensory sensitivities, a bad experience with food or having concerns over the consequences of foods. If left untreated, this can have serious consequences for their health.
- Other specified feeding or eating disorder (OSFED): The ‘other’ describes what this is. An umbrella term for those conditions that don’t fit the recognised symptoms or criteria to be diagnosed as one of the more common conditions. This category includes night eating syndrome and other disruptive eating habits.
Longer term consequences
Eating disorders affect far more than the weight of the affected individual and have the ability to damage a person’s vital organs, cognitive processes, skin and bone health, menstrual cycles, the ability to bear a child and the management of long-term mental health conditions.
Looking for the signs at work – symptoms and risks
As with many approaches to managing a mental health condition, actually spotting the signs can be hard. While those with anorexia nervosa will look severely underweight, many other forms of eating disorders are difficult to identify.
For example, people suffering from bulimia may be within the normal weight range or may be overweight, while those with a binge eating disorder are often overweight. And increases in working from home and hybrid patterns now mean employees are out of sight for longer, making it easier for them to turn to food to manage anxieties. The challenge for employers is that how someone looks in many cases isn’t going to reveal an eating disorder.
The shame that many associate with eating disorders makes coming forward and perhaps confiding in a colleague or sympathetic line manager unlikely. It’s more realistic to identify potential eating disorders by being aware of changes in the individual, which include:
- Physical: Weight loss/gain/fluctuations, clothes not fitting, faint or dizzy episodes, digestive issues and signs of self-harm.
- Psychological: Increased stress levels, irritability, low self- esteem, mood swings, anxiety, fixations and having difficulty concentrating.
- Behavioural: Declining to eat with colleagues, eating a single item for lunch, constant worrying and discussing of weight, fixating on food and calorie counting, restrictive eating habits, taking a long time to eat food when present with others, leaving the dinner table straight after eating, overeating, declining any social interactions and ‘layering’ clothes or wearing bulky/loose clothing to hide their appearance.
Supporting someone with an eating disorder / getting the conversation started
As with any mental health condition, opening a conversation can be a delicate process. It’s not helped by the fact that many with an eating disorder will be trying hard to disguise it so may not want to engage in conversation. Indeed, many may not even recognise that they have an eating disorder.
Cordell Health have produced a guide on Eating Order Awareness For Organisations. In it we cover how to set the scene for a safe conversation. As a line manager, you’ll need to approach any discussion with empathy, consider who the person may feel most safe with, how to prepare for the conversation, the privacy needed and how to set up the environment so they’ll feel most comfortable. This guide is available to members of our wellbeing subscription service. If you are not signed up to this service and would like to find out more, please contact us on wellbeing@cordel.247developments.com.
Why a supportive culture matters
Fortunately many organisations are now developing a more open culture around mental health and discussing it. However, eating disorders are particularly sensitive and all colleagues need to be aware of any negative behaviours that could make an issue worse – and do what they can to manage them.
In the worst cases, such as incidences of fat shaming and associated bullying due to weight, these need to be called out and addressed with a robust policy. There are also steps you can take to create a culture that boosts self-esteem – including being thoughtful on conversation topics around food, not always making food central to team social events and even discouraging bad food habits such as eating during meetings and eliminating vending machines. Allowing flexible working will enable those that need to have time off for medical appointments or counselling to do so discreetly.
Self-esteem can also be boosted by feeling more valued by others. A powerful message to promote is that weight does not dictate someone’s value. Research indicates that this will make those with eating disorders more likely to respond positively to offers of help if they are struggling with any weight, body image or self-worth issues.
In conclusion
Eating disorders aren’t just about weight loss. It’s very hard to tell if someone has a weight loss condition and they’ll usually try very hard to disguise the fact. This presents challenges for employers who may want to help but don’t know where to start. Line managers need to be aware of behaviour patterns as well as any physical signs. Organisations can help reduce the feelings of low self-esteem that can trigger eating disorders by fostering a more supportive culture where people are valued for their whole self, not their appearance and weight.
Additional reading
Beat Eating Disorders – the website behind the organisers of Eating Disorders Awareness Week https://edaw.beateatingdisorders.org.uk/
