October 2008

Article by Mark Cohen entitled, EAPs and Eating Disorders: Complex Opportunities and Challenges appeared in the October 2008 edition of the EAPA journal.

EAPs and Eating Disorders: Complex Opportunities and Challenges
By Mark Cohen, DSW, MPH and CEAP

EAP core technology describes numerous functions that make our profession unique.
One of them is the assessment and referral of employees into cost-effective treatment
settings and/or community-based resources. However, assisting workers in getting help
for eating disorders has been a missed opportunity in the services we provide to
corporate clients and their employees.
Historically, the number of eating disorder cases assessed and referred by EA
professionals has been extremely low. Occasional exceptions include an employee who
comes to the EAP with concerns about an anorexic child, a co-worker or supervisor who
expresses concern about “an employee who looks sickly” or a co-worker who hears an
employee vomiting in the bathroom.
If we added up all of these cases, the total would represent only a miniscule fraction
of all EA referrals in a given year – even though as many as 10 million females and 1
million males are fighting a deadly battle with anorexia or bulimia.
Compulsive overeating, binge eating, and yo-yo dieting have similarly not been
addressed by EA professionals to date. Those who suffer from these conditions rarely
come to the EAP, and when they do, it’s usually for a different problem such as a marital
concern. Like alcoholic employees, these individuals are nearly always in denial of their
problem.
And yet, America’s obesity crisis has an adverse impact on workers’ sick time,
accident rates, disability costs, workers’ compensation costs, presenteeism, and
productivity. Surveys indicate that approximately two-thirds of Americans are overweight,
more than half of which are obese or morbidly obese. Since most obese people are
employed, they collectively cost their employers large sums of money.
As a result, EAP’s ability to identify employees with eating disorders and motivate
them to get help – along with educating the workforce about the addictive nature of
eating disorders – offers a significant opportunity for EAPs to increase their usefulness
to corporate clients.
Obesity: An Addictive Disorder
Most Americans see obesity as a self-control issue. As a result, we are sometimes
critical of people who struggle with their waistlines. Similarly, few health-care
professionals view anorexia, bulimia, or morbid obesity as an addictive disorder with
physical, psychological, and spiritual characteristics. The term addiction is used to
describe a recurring compulsion by an individual to engage in some specific activity
despite harmful consequences to the individual’s health, mental health, and/or social life.
All eating disorders meet this definition.
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And yet, the majority of treatment facilities for eating disorders have traditionally
limited their treatment protocols to physical and psychological services. This grim reality
parallels the way we viewed and treated alcoholism 60 years ago! Although few studies
have examined the relapse rates for people with eating disorders, I submit that not
addressing eating disorders as an addictive disease contributes to the already difficult
challenge of remaining in recovery for those with eating disorders.
Addressing Eating Disorders
Health-care practitioners are expected to assess a wide range of pathologies, and
determining the existence of an eating disorder is no different. However, it is often a
tricky “diagnosis” to make since most clients are in denial and reluctant to talk about their
eating behaviors. This is especially true for EA professionals since we often see our
clients for only a few sessions.
Another problem in addressing eating disorders, as stated, is that employees rarely
go to their EAP for help with eating issues. Similarly, they rarely contact the EAP for
assistance with alcohol and/or drug concerns unless these problems pertain to someone
else. These are the unfortunate realities for EA professionals in addressing any addictive
disorder.
Comparing Alcohol and Eating
Consequently, the challenge and mandate for us as EA professionals is to engage in
conversations that allow us to secure the information necessary to make
recommendations to help our clients. If, in our professional judgment, we believe that an
eating disorder may exist but we can’t confirm a diagnosis, we have an obligation to
refer our client to a professional resource that can either confirm or refute our
suspicions. After all, EA professionals commonly provide this exact same service for
clients who we suspect have a drinking or drug problem.
When clients come to the EAP for help with relationship issues, mood swings,
problems with their boss or co-workers, or stress, we determine whether drinking is
contributing to the problem. If it is, we recommend treatment for alcohol abuse. But when
clients come to the EAP with the same issues, and they are significantly overweight,
obese, or shockingly underweight, do we explore whether these physical conditions (and
eating behaviors) are adding to their difficulties?
In this regard, isn’t the morbidly obese client “identical” to the client who smells from
alcohol use? And if so, don’t we need to discuss how obesity may be contributing to the
client’s problem?
As a result, talking about weight issues cannot continue to be “off limits” for EA
professionals. We need to become more comfortable and skilled in speaking about
eating disorders so that we are not depriving clients of our unique skills as a first source
of potential help.
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Intervention and Eating Disorders
Intervention techniques have been part of the “EAP Toolbox” ever since the early
days of our profession. These techniques work well for clients with eating disorders –
just as they do for clients with drug and/or alcohol problems. Recommending to a family
with a loved one with an eating disorder, that they seek help from an interventionist can
help everyone affected by the illness to begin the recovery process. EA professionals
will be extremely helpful to their clients when they think of eating disorders as an
addictive disease that can be best helped by using the techniques that work with other
addictive illnesses.
Helping the Corporate Client
Emerging corporate wellness programs have been recognizing and addressing the
interdependency of behavioral and physical health. EAPs can contribute to a company’s
wellness efforts by explaining the addictive nature of eating disorders, by distributing
literature, and by linking resources that clients are unaware of and/or do not have easy
access to. By working collaboratively with wellness departments, HR professionals, and
health-care practitioners, EAPs can be a vital resource in addressing obesity and other
eating disorders.
Summary
Eating disorders are increasingly prevalent, addictive, and they cost companies a
tremendous amount of money. Given EA professionals’ expertise in addiction, we can
play a unique role in addressing these problems. But in order to do so, we must change
the ways in which we approach clients, refine our skills in assessing and referring EA
clients, and we need to understand the resources that are available.
Dr. Mark Cohen is an interventionist at Addiction Intervention Resources (AIR), a national behavioral-health
consulting firm known for its success in recovery management. He has served as a consultant on addiction
issues to more than 100 workplace organizations and to hundreds of individuals and families. Dr. Cohen has
also directed several drug and alcohol treatment programs, and he created and directed the Employee
Assistance Program at American Express. For more information, visit www.AddictionIntervention.com. For a
list of references used in this article, contact the author at Mark@AddictionIntervention.com.
This article originally appeared in the October 2008 issue of the Employee Assistance Report. It is reprinted
with the permission of Impact Publications, Inc. For more information, visit: www.impact-publications.com