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About Eating Disorders
A significant number of men and women experience a eating disorders at some time during their lives. Many cases are probably not reported. Many more people may not meet the criteria for an eating disorder diagnosis, but have difficulty around dissatisfaction with their bodies and distorted beliefs and behaviors about eating. Eating disorders are characterized by a continual disturbance of eating or eating-related behavior that results in changes in eating patterns that significantly impairs physical and mental health. Although there are many eating disorders, JAN hears about those that are most prevalent:
- Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by restriction of energy intake (food consumption) and excessive weight loss. Symptoms include resistance to maintaining body weight at or above a minimally normal weight for age and height; intense fear of weight gain; disturbance in the experience of body weight or shape; undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight; and loss of menstrual periods in girls and women post-puberty. Anorexia nervosa typically appears in early to mid-adolescence and it has one of the highest death rates of any mental health condition.
- Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors designed to undo or compensate for the effects of binge eating. Its presence is indicated by regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior; regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise; and extreme concern with body weight and shape. Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.
- Binge eating disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating. It is characterized by frequent episodes of eating large quantities of food in short periods of time; feeling out of control over eating behavior during the episode; and feeling depressed, guilty, or disgusted by the behavior. Behavioral indicators of BED include eating when not hungry, eating alone because of embarrassment over quantities consumed and eating until uncomfortably full. BED is often associated with symptoms of depression.
JAN's Accommodation Solutions: Executive Functioning Deficits is a publication detailing accommodations for individuals with limitations related to executive functioning. These ideas may be helpful in determining accommodations.
Eating Disorders and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Eating Disorders
People with eating disorders may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with eating disorders will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Key Accommodations:
Malnutrition: For individuals with eating disorders, having accommodations to help manage malnutrition can be helpful.
Accommodation Ideas:
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A nineteen-year-old grocery store worker who mainly completed on floor tasks, such as pricing and packaging, had been complaining of feeling very exhausted from standing and walking all day long.
She disclosed to her employer that she was seeing a counselor for an eating disorder and the counselor suggested that she request an accommodation to help with her fatigue while she addressed her health needs. She requested to work as a cashier and to be allowed to sit while working. Because one of the grocery store's cashiers recently resigned, the employer was able to reassign her to this position and allowed her to sit while she worked.
A customer service representative for a physician's office is currently undergoing treatment for an eating disorder.
One of his therapeutic tasks is to integrate many small meals into his daily routine. His office has a strictly-enforced policy that employees can only eat in the break room, out of sight from the patients. In order to keep from disrupting his production level and to aid in his recovery, his supervisor modified the workplace policy and allowed the employee to eat snacks at his desk.
A bank branch manager started receiving complaints from multiple employees that one of the company's bank tellers was taking excessive bathroom breaks and rarely requested backup.
On certain days, she left multiple customers waiting for over 15 minutes while other tellers were waiting on customers. After witnessing her behavior himself, he decided to give her a warning for inappropriate use of time. Upon receiving the warning, the employee disclosed that she has experienced bulimia for over a year and wanted to start seeing a counselor. She requested an accommodation of a modified work schedule in order to see a counselor two times per week. Although the employer did not have to lift the warning, the employer granted the accommodation so the employee could comply with company policies in the future.