This is the sixth installment of December's countdown of Quizzify's Greatest Hits.
You've heard about the Consolidated Appropriations Act requiring employers to assume fiduciary responsibility with regards to their health benefit. One such responsibility is not harming employees with eating disorders by paying employees to lose weight (or fining them if they don't) within the context of the health benefit.
What follows are the first-person stories of employees who were harmed by employer weight-loss programs.
Imagine if you were a recovering alcoholic. You hadn’t taken a drink in quite some time, attended AA meetings conscientiously, and were getting on with your life. Then your employer had a drinking contest and told you that you weren’t drinking enough. Further, if you failed to drink more, you would be fined. So you need to start drinking again…or else!
Preposterous? Yes—but that is exactly what people with eating disorders (ED) are forced to endure in many wellness programs. They are urged to eat less, and docked points or money if they don’t. Most importantly, they are shamed into relapses by vendors who have no idea the harm they’re causing—and who have no desire to spend money to train their employees to avoid them.
Yet, eating disorders have the highest mortality rate of any mental illness not involving substance abuse, killing one victim every 62 minutes. You will see from the four stories below that workplace wellness can actually exacerbate the problem, causing eating disorder relapses, and sometimes hospital admissions. (As a percentage of total admissions, hospital admissions for anorexia in the commercially insured population have climbed 17% since 2000, despite the vast increase in outpatient and residential treatment options.) While it has been proven that wellness programs have had no impact nationally on admissions for diabetes and heart attacks, it is apparent that the same can’t be said for anorexia nervosa.
Here are 4 testimonials from wellness program participants with a history of eating disorders. In all cases, non-participation would have resulted in fines or forfeitures up to $2470, which explains why these folks felt compelled to participate in these “voluntary” programs.
(Special thanks to Chevese Turner and her colleagues for her assistance, and guidance in understanding eating disorders, and to Jennifer Mathis for helping these individuals organize their stories and describe the impact that their wellness programs had on their lives. Testimonials are edited for content and full versions can be found here.)
Jane
My dietitian wrote a letter urging that I not be weighed or have my body mass index measured by the program, as that would be detrimental to the progress that I had made under her care.
The wellness program nurse read the letter but proceeded to weigh me and—despite my stepping on the scale backward so I would not see my weight—she announced how much I weighed and what my body mass index was. She remarked that “it wouldn’t hurt you to enroll in our healthy eating program.” This is precisely the type of trigger that my treatment—and the treatment of people with similar eating disorders—is designed to avoid. She was telling me I was fat—exactly what I needed to hear to stop eating again.
After this incident, I stopped eating for two weeks and ultimately ended up in an intensive outpatient treatment program.
Mary
I had taken a leave of absence after a suicide attempt and inpatient treatment for chronic depression and anorexia nervosa. I had gained a few pounds and my depression had stabilized, and I was looking forward to returning to work I found meaningful.
But when I walked in the door, I was inundated with signs about our workplace weight loss contest—a “Biggest Loser”-style competition. For someone who was struggling desperately to gain weight, this was nothing less than an affront. Signs told me that “Nothing tastes as good as skinny feels.”
Then, flooding in my inbox were the emails encouraging us to only eat half our lunch, and to try to sneak in an extra workout during our lunch break. Never mind that these behaviors were exactly what had landed me in the hospital.
I had to quit my job.
Sue
Like the screenings, the health questionnaire inappropriately suggests that thinner is always better. Based on my answers, the wellness program assumes that I have unhealthy eating habits, but it does not account for the fact that my diet is carefully prescribed by my treating doctor in response to a multitude of food allergies. I am allergic to all grains, and as a consequence, in 2013 I switched to a natural fat, unprocessed, grain-free diet. My health markers began to improve at that time. The wellness program, however, identified my eating as unhealthy because of the fats included in my diet. As a result, I was docked “health points” and was given recommendations such as “eat less,” “unsupersize your meals,” and “go Mediterranean to transform your health and your weight,” and attend Weight Watchers. After receiving these messages that suggested I was overweight and eating poorly, I began experiencing greater symptoms of my eating disorder and began purging.
Joan
The whole experience was a nightmare. They conducted the screenings in the music room at school, with different tables and stations set up. About 10 or 12 teachers and staff members were in the room at one time, so there was little privacy.
When we got to the end, a wellness “counselor” went over our results. The lady saw my triglycerides number and immediately asked, “Does diabetes run in your family?” “Is obesity an issue in your family?” I asked why. [Editor’s note: it is illegal to ask about family history.] She said that a high level of triglycerides means that the body has “too many fat cells” and that I am at an “increased risk.”
To someone who has struggled with an eating disorder ("ED"), as I have, this was tantamount to saying “Because of your high triglycerides, you are fat. You are obese.”
Being weighed is always a humiliating and shameful experience for me, as it is for many people with eating disorders, and it can trigger exacerbations of my disorder. To have to be weighed in front of my peers made that experience even worse.
This biometric screening triggered my disorder. I was in tears by the time I got to the last “counselor” and had a very hard time controlling my feelings.
Your Liability
These are not isolated incidents. The practice of unintentionally (or even intentionally, in the case of outcomes-based wellness programs) abusing vulnerable employees is widespread. Yet, awareness of the abuse changes the game. From this point on, no vendor can claim ignorance as an excuse. Any vendor, any employer, even any employee involved with these programs (including you), can be liable if their disregard of employees with EDs causes harm.
Now that you know about this risk, you must take steps to avoid it. Mistakes can be made, setting you up for liability. Fortunately, there is a solution. Find a vendor who will provide an intervention that (1) is ED-compatible and (2) indemnifies you against liability for employees with eating disorders in your employ.
Quizzify’s ED-compatible health literacy/consumerism curriculum eschews weighing and nutrition “coaching” altogether, and, as a founding supporter of the Employee Health and Wellness Program Code of Conduct (which has been amended to specifically address employees with EDs), only partners with vendors who have trained screeners/coaches.
Stories...harms...liability. Contact us today and we can get your program headed in the right direction.