What Are Eating Disorders?

Eating disorders are mental illnesses that involve abnormal food intake (e.g., severely restricting the amount or type of food eaten, eating unusually large amounts of food), usually due to extreme fear of weight gain. Eating disorders can be life-threatening and are often difficult to treat.¹

Three main types of eating disorders are recognized in the Diagnostic and Statistical Manual of Mental Disorders, Text Revision. The American Psychiatric Association (APA) defines the 3 types of eating disorders as follows:²

• Anorexia nervosa is characterized by distorted body image and excessive dieting that leads to severe weight loss.
• Binge-eating disorder (BED) is defined as recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, called a binge. A binge is not the same as overeating, which is a normal phenomenon that most people engage in periodically, such as during the holidays or at special social gatherings. Rather, during a binge, a person feels their eating is out of control like they cannot stop even though they want to, or that they feel compelled to keep eating even though they are uncomfortably full.
• Bulimia nervosa is characterized by frequent episodes of binge eating followed by harmful behaviors to avoid weight gain, such as self-induced vomiting, use of laxatives, or excessive exercise.

Symptoms of eating disorders vary based on the specific disorder and its severity. However, most eating disorders involve some combination of the following:^1,2

• Having an overly negative opinion of one’s body size, weight, and/or shape
• Having an extreme fear of weight gain
• Engaging in unhealthy, harmful behaviors to avoid weight gain, such as self-induced vomiting, abusing laxatives or diuretics, or over-exercising
• Engaging in unhealthy, harmful dieting to avoid weight gain (e.g., eating an excessively low amount of calories, restricting entire food groups for weight loss purposes)
• Having a significantly lower body weight than is healthy for one’s age and developmental stage
• Engaging in binge-eating behaviors

Eating disorder symptoms are persistent and occur for at least 3 months.²

How Eating Disorders Affect Employees and Employers

Knowing whether an employee or colleague might have an eating disorder is important because these conditions are very serious and can even lead to death if untreated. The faster someone with an eating disorder can receive appropriate diagnosis and treatment, the sooner they can begin regaining their health and well-being.

Physical Effects

Eating disorders can have numerous harmful effects on the body, such as:¹

• Low blood pressure, arrythmias, and other cardiovascular disturbances
• Electrolyte imbalances (e.g., low potassium)
• Damage to major organs, including the heart and brain
• Infertility
• Anemia
• Osteoporosis
• Severe constipation
• Gastrointestinal problems

Psychiatric and Functional Effects

Eating disorders are also associated with a wide range of emotional difficulties—the most serious of which is suicide risk. People with anorexia are 18 times more likely to die by suicide, and those with bulimia are 7 times more likely to die by suicide compared to their peers without eating disorders.³ A meta-analysis of 52 studies found the prevalence of suicide attempt among people with anorexia or bulimia was 22%.⁴ The prevalence of having suicidal thoughts was more than double, at 51%.⁸

Other burdens associated with eating disorders related to emotional health and functioning include:^5,5

• An increased risk of co-occurring mental disorders, such as depressive disorders, trauma-related disorders, personality disorders, and substance use disorders
• Lower quality of life
• Difficulty participating in work/school and social activities
• Difficulty maintaining healthy interpersonal relationships

Work-Related Effects

In addition to the physical and emotional toll, eating disorders can negatively affect a person’s ability to perform their job effectively or to be present at work. Consider the following work-related outcomes associated with eating disorders:

• Presenteeism — People with anorexia, bulimia, or BED have higher rates of presenteeism, with approximately 10% lower work output than workers without eating disorders.^6,7 This results in a cost of $18.2 billion.^11,12
• Absenteeism — Individuals with anorexia or bulimia are absent an estimated 27.3 more days from work than employees without these disorders; for BED, absenteeism is estimated at an additional 4.2 days. These absences result in a cost of $6.4 billion.¹¹
• Work productivity loss — Eating disorders cost approximately $48 billion in productivity losses, or $8,874 per person.¹²
• Cost to employers — In 2018–19, eating disorders cost employers $16.3 billion.¹²

How Are Eating Disorders Treated?

Fortunately, safe and effective evidence-based treatments for eating disorders exist.¹ These typically include psychotherapy—often cognitive–behavioral therapy or interpersonal therapy—to help patients change their thought patterns about weight loss, eating, body image, weight gain, and more.

For some individuals, such as those with severely low body weight, medical treatment, and inpatient psychiatric treatment may be needed until they are restored to a healthy weight and their health is stabilized.¹ Even in people whose eating disorder is not severe, medical treatment and dietary counseling is often needed to help the person resolve any physical ailments, address nutrition deficiencies, and develop healthier eating patterns.¹

Eating disorders are complex conditions and can be difficult to treat. However, the sooner a person has access to and engages in treatment, the sooner they can start to recover. Although eating disorders tend to be chronic, lifelong illnesses, treatment can help people regain their health and wellness and decrease their chances of serious outcomes, such as suicide.

Tips for Employers: How You Can Help Employees with Eating Disorders

Managers and supervisors are not expected to be able to identify an employee with an eating disorder. However, there are some warning signs they should be aware of, as these may indicate a person in need of help. Many people with eating disorders feel great shame and embarrassment about their illness and are hesitant to ask for help.⁸ Knowing the warning signs can aid employers in potentially intervening and connecting the person with needed treatment.

According to the National Eating Disorders Association, these warning signs can include:⁹

• Clear indications that the person is preoccupied with diet, weight, weight loss, or their own body shape or size (e.g., constantly talking about dieting or exercise)
• Leaving evidence of binge eating (e.g., an unusually large number of food wrappers and containers in the waste basket)
• Consistently taking trips to the bathroom soon after eating
• Leaving wrappers for diuretics or laxatives in the waste basket
• Avoiding workplace events that involve food

Other tips to help employers concerned about eating disorders in the workplace include the following:

• Pay attention to messages about weight, eating habits, and exercise: Many employers are focusing on weight loss due to the medical and productivity implications of obesity. Workplace health and wellness programs and messages should focus on healthy eating and exercise practices rather than weight loss.
• Consider awareness programs: Participate in awareness activities such as Annual National Eating Disorders Awareness Week at the end of February, and make materials available to your employees through wellness programming and communications.
• Examine the design of your benefit plan to ensure appropriate coverage of eating disorders. Due to their serious nature, eating disorders can require intensive interventions. Medically necessary services may include inpatient hospitalization, residential treatment, partial hospitalization, or intensive outpatient treatment. Review benefits coverage to ensure it conforms to legal requirements, including state and federal mental health parity laws.
• Provide convenient and confidential access to mental and physical health benefits and related resources: Ensure your employees know how to access services. Eliminate barriers so that once someone reaches out for/accepts help for an eating disorder, they can easily access services. The EAP may be a familiar entry point for mental health services in many organizations. An EAP counselor can be a valuable resource for information and referrals. Talk with your EAP and mental health vendor partners to understand how they respond to employees and family members who call with concerns about eating disorders to ensure that they receive appropriate care intervention.

Resources

Managers, supervisors, and other employers can learn more about eating disorders in the workplace through the following resources.

• National Eating Disorders Association’s Eating Disorders in the Workplace (.pdf) is a toolkit that includes facts about eating disorders and what organizations can do to make the workplace supportive of and responsive to the needs of employees with eating disorders.
• The Society for Human Resource Management offers guidance about how to talk with an employee about a suspected eating disorder and how to implement workplace accommodations.

Resources for the general public can be found below.

• National Eating Disorders Awareness Week is an annual campaign to bring public attention to the critical needs of people with eating disorders and their families, hosted by the National Eating Disorder Association.
• National Eating Disorders Association offers programs and services to give families the support they need to find answers for these life-threatening illnesses.