The shameful disease

Is it just me – or are eating disorders becoming more prevalent? I think so. And I have never heard an occupational health and safety practitioner discuss this topic. Why not?

I imagine that eating disorders are often swept under the boardroom table because of the associated embarrassment. For some unknown reason these diseases – primarily anorexia nervosa, bulimia nervosa and binge eating – are frowned upon and considered shameful; a bit like drinking yourself into an early grave. (People whisper about it … but they don’t advertise the fact widely.)

One of the reasons why these disorders are hidden is because they are classified as mental health problems – to put it bluntly, sufferers are worried that their friends and colleagues will think that they have gone loopy. But exactly the opposite is true: according to Beat (an organisation that wants to see eating disorders being beaten), eating disorders are symptoms of underlying psychological or emotional distress and develop when a person is unable to communicate their extreme despair and unhappiness, or when they cannot resolve, or even think about, the situations which are causing the despair.

“Food is used as a way of coping in an environment in which the person with an eating disorder feels out of control. The underlying psychological causes are usually well concealed and will be different for each individual,” the organisation points out.

So yes, the disease and its causes are often kept secret. However, based on my personal experiences, I believe that eating disorders are becoming more and more prevalent here in South Africa. During the last week alone, I have encountered two South Africans who suffer from acute bulimia, and, quite frankly, I would never have guessed. They both look healthy!

I have not been able to establish accurate figures pertaining to eating disorders in South Africa. However, in the United States, some six percent of people suffer from anorexia nervosa, one percent are bulimic, and 2,8 percent deal with some form of a binge eating illness. That is downright scary!

As we all know, eating disorders, if not treated, can be deadly. According to Beat, anorexia nervosa is especially dangerous. In fact, it has one of the highest death rates of all psychiatric illnesses, with an estimated 20 percent of all those affected dying either from the effects of starvation or from suicide. Just one person who succumbed to this dreadful disease is that wonderful musician, Karen Carpenter, who died at the age of 32 from cardiac arrest due to anorexia …

Incidentally, Carpenter is not the only celebrity known to have suffered from an eating disorder. The list of celebs, who have come out of the eating disorder closet, includes: Victoria Beckham, Paula Abdul, Kate Beckinsale, Kelly Clarkson, Princess Diana, Sally Field, Lady Gaga, Geri Halliwell, Audrey Hepburn, Wynonna Judd, Joan Rivers, Kate Winslet and Oprah Winfrey.

As this list demonstrates, eating disorders are almost exclusively the domain of members of the fairer sex; the only two male celebs who have reported an eating disorder (of which I am aware) are Elton John and Ashley Hamilton, son of actor George Hamilton.

Of course eating disorders certainly aren’t limited to celebrities (although the rich and famous are more likely to talk about them). Beat reports that, in the working population, eating disorders are most likely to be found in the 16 to 30-year age range; although it is possible to have an eating disorder for many years, even for life, so older employees may also be affected. The average age of onset for an eating disorder is in mid-to-late adolescence, so employees with children may also be affected. About 90 percent of sufferers are female.

Eating disorders are more likely to be found in a predominantly young female workforce, Beat reveals, as the incidence is higher in this group – however, anyone can be affected. There are also certain occupations that tend to attract people who are vulnerable to eating disorders, such as jobs in the food industries, sport, fashion, nursing and the caring professions.

Some employees with eating disorders will never allow the disease to compromise their ability to work. As Beat aptly notes: “Whatever difficulties they have, they will make strenuous efforts to keep to themselves to avoid their disorder being noticed at work.

An eating disorder is not a barrier to success. Indeed, people with an eating disorder are probably some of the most effective, hard working and loyal members of a workforce.”

But others will suffer from ailments that may include anything from mood swings to fainting – some requiring hospitalisation.

Some companies have recognised this, and are dealing with the matter. Boeing, for instance, has issued a staff directive entitled “Eating Disorders in the Workplace: Tips for Supervisors”. It makes fascinating reading: the company notes that up to 24 million people suffer from eating disorders in the United States. “The shame and stigma surrounding eating disorders keep some from seeking treatment or disclosing their illnesses to employers. In fact, only one in 10 people with eating disorders get treatment. Left untreated, eating disorders compromise a person’s ability to function at work and at home and result in irreversible physical damage to the body or even death,” it warns.

With treatment, employees can certainly return to a normal, fulfilling and productive life. But, of course, given our ridiculous obsession with looking good, it’s sometimes difficult to know when an eating disorder exists. Plus, people with eating disorders often are very secretive about their condition, hiding the most obvious warning signs, such as self-starvation or binging and purging. But, according to the Boeing directive, clues do exist.

These include excessive weight loss; being preoccupied with food; skipping meals, taking only tiny portions, eating in ritualistic ways or eating strange combinations of food; offering excuses for not eating, such as not being hungry, feeling ill or having just eaten; abusing laxatives, diuretics or diet pills; and displaying mood swings, compulsive behaviour, self-doubt or signs of depression.

Pay extra attention to employees who always wear baggy clothes, those who exercise compulsively, constantly complain of being fat, perform poorly on the job or frequently miss work.

Other telltale signs include being overly competitive or perfectionistic with an “all-or-nothing” attitude, employees who have difficulty concentrating and people who withdraw from others.

By being aware of the signs and symptoms of eating disorders and addressing your concerns, you may be able to prompt an employee to seek professional help early, when treatment outcomes are much more favourable. “Be careful, however, not to allege that an employee has an eating disorder. Instead, point out job performance problems or behavioural instances that indicate that you should be concerned for your employee’s health,” the Boeing company directive warns.

There are many superb medical professionals and clinics within South Africa, which can provide treatment to people with eating disorders. But we need to learn about these diseases, we need to understand their causes, and, above all, we need to end the stigma associated with eating disorders.

The message is clear: let’s stop pretending that these diseases don’t exist. Occupational health and safety practitioners need to tackle this scourge head on!