Why Eating Disorders Matter to Employers
The Center for Workplace Mental Health and Mental Health Works are dedicated to responding to our readers’ interests. One way to do so is through coverage of topics that readers have identified as particularly important. This article, which highlights key reasons eating disorders matter to employers and what can be done to address these disorders, was prepared in response to readers’ requests.
Eating disorders are serious illnesses that can be life-threatening and are often difficult to treat. The good news is that treatment is available, and people with eating disorders can recover and successfully manage their illness. Employers can take steps to ensure that their employees are directed to the care they need.
Three main types of eating disorders are recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard classification used by mental health and other health professionals for diagnostic and research purposes.
The American Psychiatric Association (APA, 2013) defines the three types of eating disorders as follows:
Anorexia nervosa is characterized by distorted body image and excessive dieting that leads to severe weight loss. (p. 1)
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, with episodes marked by feelings of lack of control. Someone with binge eating disorder may eat too quickly, even when he or she is not hungry. The person may have feelings of guilt, embarrassment, or disgust and may binge eat alone to hide the behavior. This disorder is associated with marked distress and occurs, on average, at least once a week over three months. (p. 1)
Bulimia nervosa is characterized by frequent episodes of binge eating followed by inappropriate behaviors such as self-induced vomiting to avoid weight gain. (p. 2) [Note: BED was approved for inclusion in DSM-5 as its own category of eating disorder.]
Symptoms of eating disorders vary based on the specific disorder and its severity, but they can include serious physical problems such as low blood pressure, damage to major organs including the heart and brain, infertility, anemia, osteoporosis, severe constipation, and gastrointestinal problems (National Institute of Mental Health [NIMH], 2011). Moreover, individuals with anorexia nervosa have a risk of dying that is 18 times higher than the risk for people of similar age (NIMH, 2011). Eating disorders often have comorbidity with other psychiatric disorders, which can complicate treatment and recovery.
The following examples were cited by the National Eating Disorders Association (NEDA, n.d.a):
Alcohol and other substance use disorders are four times more common among persons with eating disorders than in the general population (Harrop & Marlatt, 2010).
Depression and other mood disorders co-occur quite frequently with eating disorders (Mangweth et al., 2003; McElroy, Kotwal, & Keck, 2006).
There is a markedly elevated risk for obsessive-compulsive disorder among persons with eating disorders (Altman & Shankman, 2009)
The Impact of Eating Disorders on Business
All of the above mentioned symptoms and comorbidities may affect individuals who have an eating disorder and may have an impact on their ability to perform work effectively or to be present at work. The direct medical and behavioral health costs associated with the treatment of eating disorders largely depend on the kind of treatment required. In general, early intervention can result in cost savings associated with avoidance of more intensive and costly treatments. According to the Eating Disorders Coalition (2009), cost for treatment of an eating disorder “…ranges from $500 per day to $2,000 per day. Outpatient treatment, including therapy and medical monitoring, can cost $100,000 or more” (p. 1). In more extreme cases, some patients will require three or more months of residential treatment.
Coverage for treatment greatly varies based on benefit plan design and plan networks. While employers incur direct costs associated with treatment of employees and/or beneficiaries covered through their employer-sponsored health plans, there is limited reported evidence about the full economic burden associated with eating disorders which would include absenteeism, presenteeism, and productivity losses (Simon, Schmidt, & Pilling, 2005).
Treatment for Eating Disorders Understanding how eating disorders are treated can help employers understand utilization of health benefits and inform discussions with brokers and/or health plan representatives. People with eating disorders require treatment, and early intervention increases the chance for successful outcomes.
According to NEDA (n.d. b):
People with bulimia nervosa demonstrate a better recovery rate if they receive treatment early in their illness. If treated within the first five years, the bulimia nervosa recovery rate is 80%. If not treated until after 15 years of symptoms, the bulimia nervosa recovery rate falls to 20% (Argument #5 section, para. 2).
Individuals with eating disorders are often unlikely to reach out for help and may resist accepting treatment, making the condition more difficult to treat. Only one in ten people with an eating disorder receives treatment (Eating Disorders Coalition, 2009). The delay in receiving treatment allows the disorder to worsen, leading to the need for more intensive treatment interventions.
For those who do receive help, treatment plans are based on the individual’s specific medical and mental health needs, the severity and duration of the disorder, and the presence of comorbid medical and/or mental disorders. Treatment can include individual, group, and/or family psychotherapy, medical treatment and monitoring, nutritional counseling, and medications. Because of the serious nature of eating disorders, some individuals require hospitalization and intensive programs in safe environments that ensure the provision of proper monitoring and care (NIMH, 2011).
Eating disorders reflect the strong connection between emotional and physical health, and treatment addresses multiple levels (APA, n.d.). First, treatment addresses the immediate physical concern to obtain a healthy weight and stop unhealthy eating behaviors. Second, the emotional challenges that led to the unhealthy behaviors must be addressed to sustain healthy behavior. Psychotherapy can help those with eating disorders address the underlying thoughts, feelings, and behaviors that lead to unhealthy habits. Third, medication can be effective to some in their treatment.
Given the physical conditions associated with eating disorders, it is important that treatment include general medical attention, along with nutritional counseling. Integrating all three levels of treatment creates a comprehensive approach that improves the likelihood of returning working individuals to emotional and physical health.
Tips for Employers
Remember that while a human resources manager or a supervisor is not expected nor encouraged to identify the nature of a health problem in an employee, it is always a good idea to recognize that eating disorders or other behavioral problems may be contributing to performance or attendance declines. Consider the following suggestions as you think of your existing programs, and take note of other ideas that may also help those affected by eating disorders in your organization.
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 being overweight. It is important that weight-related messages focus on healthy eating and exercise practices rather than simply emphasize weight reduction.
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 focused on health. The American Psychiatric Association (APA), APA Healthy Minds Blog, the National Eating Disorders Association, and the National Institute on Mental Health are good sources for information about eating disorders.
Examine the design of your benefit plan to ensure there is appropriate coverage of eating disorders: Eating disorders can require intensive interventions due to their serious nature. 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. Ask your broker or plan representative for information about specific limitations, exclusions, or management techniques that may affect coverage for eating disorders.
Provide convenient and confidential access to mental and physical health benefits and related resources: Make sure 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. In many organizations, the employee assistance program (EAP) may be a familiar entry point for mental health services. The EAP can be a helpful first step for both the employee and the employee’s supervisor or human resources manager. 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. For example, find out how they triage in order to ensure the caller receives appropriate care intervention.
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 (NEDA) provides programs and services to give families the support they need to find answers for these life-threatening illnesses.
American Psychiatric Association (APA) Find answers to your questions written by leading psychiatrists, stories from people living with mental illness and links to additional resources.
National Institute on Mental Health (NIMH) offers authoritative information about mental health disorders well as information on a range of mental health topics and the latest mental health research.