Anorexia and the Workplace

Last week I received an email from an employer who suspects that a woman he recently hired has anorexia. Let’s call him “Charlie.” Although he did not know her well, Charlie was concerned about his employee’s personal well-being but didn’t quite know how to go about offering her help. Aside from occasional sluggishness from sinus medication, the woman’s work performance was “great.”

This important topic cries out for more discussion and study. After exhaustive internet research, I found very little information. I do not know how many of the millions of women suffering from anorexia and other eating disorders hold jobs but suspect that the number is high.

That this state of affairs exists is understandable but not acceptable. An employer unfamiliar with eating disorders would usually feel uncomfortable approaching an employee about so personal a matter, while the employee would strive to keep her condition secret. But when people stand on social niceties, illnesses flourish. We will probably never know how many people could have been helped but lost their lives to venereal disease, AIDS, and cancer because these ailments were not topics for discussion in polite society.

True, it is a tough and delicate issue for both employer and employee. The rights of both parties must be respected. An employer has a right to a productive workforce and an employee should only be terminated for just cause. Joanne Larsen, M.S., a registered dietician at Millville Public Schools in Cumberland County, New Jersey, points out that an employer cannot fire someone merely because of a medical or psychological condition “as that would be discriminatory.”

Especially puzzling is the reticence of experts. I put this question to numerous employee assistance and related organizations via email. One did not feel “comortable having the discussion on the internet.” Most did not respond at all. Three, however, made constructive suggestions.

The Massachussetts Eating Disorders Association offered the following advice to people in Charlie’s position:

He should tell the person that he cares and is concerned about his/her wellbeing and encourage the person to talk to a counselor or therapist. The employer can educate himself/herself and should always remain positive because people do recover from eating disorders. Do not, however, focus on weight or food. These are only symptoms of whatever the real problem is. Do not give the person guilt, threaten, punish, bribe or preach. For more information, you can call our helpline at (617) 558-1881.
Karlynn Baker Scharlau, M.S., President of the Employee Assistance Program of Tucson (Arizona), Inc. says:

The first question I would ask is does he have any documentation or has he seen any changes in her workplace behavior, such as work performance, interpersonal relationships, etc? He does not need to make a suggestion of what the medical problem is but only point out how she may have changed. Has she been absent too much? Does she have any medical insurance that would pay for therapy?
Mary Tantillo, Ph.D., of the University of Rochester (New York) Medical Center, offers the following:

If her work performance is unaffected, you need to be very careful about what, or whether, you say anything. If her work performance is affected, you should consider discussing this, with clear communication about her behaviors that seem affected by weight loss. If there are no performance problems yet, I would ask Human Resources about whether you should approach her as a “concerned friend” and just give her your non-judgemental observations and concerns, or info re: resources– if she wants it. It may be hard for her and you, though, to really separate your employer and “friend” roles. You may have to wait (painfully) until her performance becomes affected.
Patients feel controlled, intruded upon, or ashamed when confronted about their eating disorder. A very caring, non-judgemental approach is necessary. You can validate their position while also stating yours. Their denial does not mean that your words were not effective. She will take them in and mull them over when she feels safe.

Is there anyone besides her employer/supervisor who could state his/her concerns? Someone the new employee trusts, respects or works closely with? Has anyone come to you with similar concerns about her? This might be less complicated because they do not have supervisory power over her.

I have a number of patients in the program here who were confronted gently about their perfomance, and that has been a good leverage for treatment with them. They have support at work to recover. Supervisors weren’t afraid to share concerns with them and design contingencies about what had to happen for them to remain in their jobs. There were clear performance issues discussed, and a great deal of support for the person.

Finally, go to the Eating Disorders Awareness and Prevention, Inc. website, or call them at 206-382-3587. The Mental Health Association here in Rochester also does workshops for employers. Their number is 716-325-3145.

Regarding insurance, a previous article on these pages has already noted the paucity of medical coverage available to anorexics. Under these circumstances, we either need legislation or private sector action to further define the relationship between anorexic employees, their employers, and the medical community. We also need more dialogue.

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