ANRED: Suggestions for employers

First, know that we appreciate that you are in a difficult situation. Good employees are hard to find, and chances are the person you are worried about is a good, or even excellent, worker. S/he would be hard to replace, and you are tempted to look the other way.

Moreover, you probably find confrontation uncomfortable, one of the most distressing parts of your job. You may be friends with this employee. Maybe you are not completely sure s/he has an eating disorder, and you would hate to say something and then find out you are wrong. Nevertheless, be aware that people with eating disorders can be productive, charming, endearing and likeable, all the while using their workplace people skills to hide their problem.

In spite of your desire to avoid distress for both you and your employee, you must deal with the situation. You are probably sincerely concerned about her/his health and safety, and remember that legally the company, the boss and the supervisor all can be held liable if something happens to her that you could have prevented, or if he injures someone else while in your employ because of physical weakness or emotional impairment related to an eating disorder. If you allow the person to continue working for you without challenging the disorder, you are implying that s/he is healthy enough to work safely, without causing harm to her/himself or others. You might want to talk over this situation with your company's attorney. You and the company have certain rights and responsibilities, and so does your employee. Make sure you cover all bases before you take action.

So what might that action look like? In general, it can be broken down into six steps.

Observe: ask who, what, when and where

Be objective. Don't rely solely on what you hear from other employees, although you may be hearing quite a lot. Watch the employee's behaviors. Is s/he painfully thin and still losing weight? Does she work through coffee and lunch breaks? Does she keep a stash of snack food nearby and nibble her way through the day? Does s/he make frequent trips to the rest room and return with a red or blotchy face and sour breath? Or smelling of breath freshener? Is the quality of her work declining? Does he often seem spacey, distracted or in another world?

Listen to what the employee says. Does s/he make frequent comments about being too fat? Does s/he always have an excuse why s/he cannot eat with others employees? Does she talk about feeling depressed, anxious, hopeless or overwhelmed? Yes, there are problems other than disordered eating that produce these kinds of behaviors and statements, but look for the overall pattern. For a detailed list of behaviors that should signal alarm, visit our Warning Signs page.

Document: make a written record of your observations

Create a record or diary of the behaviors and situations you witness that lead you to take action. It will help you deal with the employee's denial when you finally confront her/him, and it may protect you and the company should s/he attempt legal retaliation.

Record dates, times, locations, who was involved, what happened (who said what; who did what) and the outcome. Avoid subjective words like "stubborn," "irrational," and "passively defiant." Instead, choose words that you might use if you were narrating incidents for TV news: e.g., "On October 25, 2006, Ms. Jamison returned from lunch break, stated she had not had enough time to eat, but that she had run for 50 minutes on the athletic club track. At 1:50 pm, she fainted by the photocopy machine."

Prepare: gather facts and rehearse

Make sure you are familiar with company policy regarding EAP referrals and grounds for termination. Review your documentation and mark salient parts for quick reference should you need them in the confrontation. Rehearse what you will say, preferable with a colleague but at least into a voice recorder. Anticipate the employee's reactions, and prepare yourself for tears, anger and denial. Plan a response for each of those scenarios. Now is a good time for another consultation with the company's attorney.

Before you meet with the employee, decide what you want her/him to do. Some possibilities: (1) S/he must visit an EAP counselor who will send you a statement of her fitness to continue her employment , (2) the employee must visit a community-based therapist who will send you a statement of his fitness to continue his employment , or (3) the employee must be evaluated and examined by a physician who will send you a statement of her fitness to continue her employment. If any of these resource people find the employee is impaired, then (4) s/he must enter and remain in appropriate treatment until s/he is judged by a clinician to be mentally and physically healthy and able to resume her/his duties. Any evaluations or statements you receive from medical or psychological profressionals should be kept in the employee's permanent file. Check with the company attorney about how best to present your bottom line. An "either/or" ultimatum is usually not in anyone's best interests.

Note: Avoid weight gain as a goal. You can't control that, and if the employee truly does have an eating disorder, s/he can't control it either.

Take action: speak directly to the employee

Arrange a meeting. Do it privately, out of hearing range of other employees and supervisors. Have your documentation ready should you be challenged or should the employee deny that anything is wrong.

Be gentle and polite, but firm. Tell the employee that you are concerned about her/his health (and performance if that is part of the problem). Describe in some detail what you have observed, and conclude by stating what must happen, usually one of the options listed above in the "Prepare" section. Set a deadline for compliance and a date and time for a follow-up meeting.

Note: In extreme cases an employer may want to terminate an employee with an eating disorder. Be careful. In some cases eating disorders may qualify as disabilities under the Americans With Disabilities Act. If you are considering termination, you should talk to your company's attorney first.

Consider your approach: maintain a calm, fair and objective attitude

To be effective, be fair but firm. For the good of the employee and the company, the observed behaviors cannot continue. S/he may become emotional, either teary or angry. Neither one should derail the meeting or your purpose in calling it. Remain calm. Don't let her/his emotions drag you into a less than rational state. Keep the focus on her/his documented behaviors, not the reasons behind them, and make the employee responsible for her/his behaviors. S/he should also be held responsible for improvement.

Express concern, but be very clear about your expectations. Specify consequences if there is no change, and set a deadline for compliance and improvement.

Follow up and review: don't let the issue slide

For many employers, once the confrontation is over, the natural tendency is to assume that everything will be well, and the file is put on the back burner. Don't do that. Avoiding follow-up will enable the employee to continue unhealthy ways and escape consequences, leaving both her/him and you vulnerable to crisis and disaster.

Continue to document observable behaviors. Watch for improvement and note it -- or the lack of it. Arrange a follow-up meeting. If the medical and psychological recommendations have not appeared on your desk, ask for them. Review the situation. Acknowledge progress and confront lack of it. Your goal in follow-up meetings is to clearly state that the employee must choose -- and in fact no one but her/him can make that choice -- to either change or risk termination of employment as allowed by law.

In conclusion

We appreciate that you are in a most difficult situation. However, ignoring the problem is not an option. For your own good, and the good of your company, and ultimately the good of your employee, you must take action. Do so with concern and fairness, but be firm. No one will benefit if an eating disorder is ignored.

And remember, a conversation with your company's attorney will help you refine the above outline so that no one's right are violated in the process.

Please Note: ANRED information is not a substitute for medical or psychological evaluation and treatment. For help with the physical and emotional problems associated with eating disorders, talk to your physician and a mental health professional.

Page updated April 30, 2008