Hidden Dangers
At least three out of every 100 American workers have eating disorders. Does HR know what to do?
By Carol Patton
For years, Chevese Turner hid a secret from her boss and co-workers. Since she was a highly productive employee, no one ever suspected anything was wrong.
About 15 years ago, Turner was diagnosed with binge-eating disorder, a psychiatric condition that affects up to 5 percent of the U.S. population, according to the National Eating Disorders Association. The condition is characterized by depression, anxiety, frequent episodes of eating large quantities of food in a short period of time -- up to 2,000 calories per binge -- and feeling ashamed or disgusted by the out-of-control behavior.
Turner recalls how she "ate mindlessly" at her desk at the beginning of each workday. Oftentimes, she consumed more than 1,000 calories before 9 a.m.
"You go into a food coma," says Turner, now a sales representative at Eisai Inc., a pharmaceutical company based in Woodcliff Lake, N.J. "Your sugar goes way up. You start to feel lethargic, tired and irritable, perhaps more anxious than when you started. You're also feeling depressed because you've eaten too much."
Binge eating is one of three eating disorders that plagues at least 5 million Americans, according to NEDA. The other two include anorexia nervosa, which is self-starvation, and bulimia nervosa, or bingeing and purging, which affect another 10 million women and 1 million men in the United States. NEDA estimates that the average direct medical costs for treating eating-disorder patients is $5 billion to $6 billion per year.
Since people with eating disorders represent at least 3 percent of the American workforce, HRE contacted more than 30 different employers and associations to find out how HR was helping employees with such conditions. Unfortunately, no one came forward except to mention employee assistance programs.
However, experts and practitioners agree HR can play an important role by generating awareness of these treatable disorders and coaching managers on how to approach and support employees who suffer from them.
Helping Hand
Just recently, for the first time since she was diagnosed, Turner decided to share her secret with her boss.
"My boss related to me on a very human level, saying that we all have our coping mechanisms to help us get through our days," says Turner. "She was and continues to be very supportive, knowing that this is something I'm struggling with and constantly working on."
Turner, who's also the founder and chief executive officer of the Binge Eating Disorder Association (www.bedaonline.com), says her boss -- who declined an interview -- understands her need to sometimes take a long walk or take a "Chevese day," a term the company made up for taking a day off to deal with high levels of anxiety or depression.
During such times, her boss asks key questions that help Turner get back on track: How can I help? What do we need to do to complete this project or task on time?
Overall, Turner says she feels a great deal of loyalty toward her boss and believes she's even more productive now because she no longer spends time searching for ways to hide her disorder.
Employees who are obese -- those who are at least 30 pounds overweight, according to the American Heart Association -- may have eating disorders. Because of this, Turner suggests HR make doubly sure specialized programs or assistance be made available to them.
"Try not to make judgments based on their size because there is often something much more going on [that] needs to be addressed," she says.
One such program, Overcoming Binge Eating by
HealthMedia
, is an online tool currently being used by more than 700 people through a health plan in the Northeastern United States, says Richard Bedrosian, a clinical psychologist and director of behavioral health at HealthMedia in Ann Arbor, Mich.
Launched initially in 2003, then revised in August, the program's first step requires employees to complete a baseline assessment that records health, eating or psychological problems, he says. It then uses the information to develop a tailored plan.
Program participants keep a daily food diary, identify triggers of bingeing and receive tips on how to change their eating behaviors, such as developing a consistent eating schedule, controlling the types of food brought into their home and shopping the outer perimeter of supermarkets, which contains produce and other fresh foods.
While it's too soon to assess the effectiveness of the program, Bedrosian says, participants using the initial one several years ago experienced a 40 percent reduction in binge eating.
"Binge eaters tend to be overweight and obese," he says. "Employers are pretty well versed at this point about the relationship between obesity and healthcare costs, but I don't know if they realize that it leads to productivity problems before health problems necessarily happen and, furthermore, [they] don't understand the relationship between binge eating and obesity."
HealthMedia recently surveyed the program's 700 participants. The results indicated that binge eaters were significantly more impaired than the rest of the employee population. Likewise, the more overweight they were, the higher their level of impairment was.
For example, Bedrosian says, employees who didn't binge eat and managed their weight were unproductive at work about 8 percent of the time. Those who did binge eat but managed their weight averaged 15 percent in lost productivity. But the most impaired were obese employees who were also binge eaters -- they usually lost 25 percent in work productivity.
Ironically, employees with binge-eating disorders only averaged more than three sick days a year, according to Bedrosian. But they also experienced psychological distress such as anxiety and depression. Hand in hand with anxiety and depression come guilt, mood swings or negative feelings about themselves, which, he says, may negatively impact their creative ability to solve problems or meet deadlines.
"[HR] should work on trying to include some recognition of binge eating in their existing services of obesity," says Bedrosian. "Don't neglect the binge eating part of obesity. Among obese people, it's the binge eaters who are costing you the most."
Consider the facts, he adds. Based on several studies, such as the National Comorbidity Survey Replication, which surveyed more than 9,000 people in the United States about their mental health, results indicate that binge-eating can lead to reduced functioning and much higher levels of disability and health problems ranging from diabetes and heart disease to high blood pressure and stroke, Bedrosian says.
Cover Your Bases
Sometimes, employees will share concerns about peers they believe are exhibiting eating-disorder symptoms with their manager. But not every manager knows what to do with the information, says David Yonkin, senior consultant at Harris, Rothenberg International, a New York-based EAP.
For example, how many would contact HR? How many would try to handle the situation themselves? How many would simply ignore it?
HR can be a big help by explaining do's and don'ts of responding to such concerns, says Yonkin. For example, he says, managers should first inform HR when they hear about someone's problematic behavior or possible symptoms. They should then document dates and times when employees approached them.
When approached, they should ask them why they're reporting it to ensure there's no hidden agenda or issue between the employees. They should also ensure that the troubled worker is not harassed or called embarrassing nicknames by peers; then, they should ensure that the worker becomes very familiar with the company's health benefits, EAP and medical leave.
What's more, managers must also be familiar with process-related steps. For example, they should schedule meetings with the employee after hours -- or when the least amount of staff is on-site -- to avoid workplace gossip, they should avoid mentioning the name of the employee(s) who came forward with a concern and they should set up a conference call during the meeting with an EAP counselor, since employees with eating disorders typically are in flat denial or become defensive or emotional when approached about concerns over their behavior.
Yonkin says the key is that all conversations must focus on the employee's deteriorating job performance, such as "Bob is frequently absent and away from his desk" or "Sheryl comes in late and misses deadlines."
HR professionals need to remember that they aren't trained clinicians and should never diagnose; otherwise, they could cross into dangerous territory since employees with eating disorders may be protected under the Americans with Disabilities Act, he adds.
Likewise, conversations should start and end on a positive note. After complimenting the employee on recent achievements or efforts, break the ice with phrases like, "You don't seem to be yourself," "You seem to have lost (or gained) a great deal of weight," "I don't want these issues to get in the way of your career opportunities," or "I've noticed a pattern where you constantly ask to be excused from attending client luncheons or meetings where food is served."
Sometimes, HR professionals or managers neglect to ask how they can help or ask the employee for suggestions, such as establishing a consistent time for lunch, which would prevent the employee from delaying or never eating lunch. But in all cases, job expectations should be clearly defined and a follow-up meeting to check on the employee's progress should be scheduled.
"Make it a business issue first, rather than a personal one," Yonkin says. "It will be less likely your presentation will be seen as a personal attack."
Female employees usually feel more comfortable speaking to a female manager or HR representative, he says.
However, HR doesn't have to sit in on the conversation, he adds. What matters is that the conversation occurs and is documented.
"This is a timely topic because of [the recession]," Yonkin says. "A lot of people have a lot of anxiety and are going to turn to ways of dealing with it. They'll start to increase their eating or decrease their eating. They don't necessarily have an eating disorder. Managers have to look out for that; not let the person off their radar."
July 1, 2009 Copyright 2009© LRP Publications
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