Impact of eating disorders on paid or unpaid work participation and performance: a systematic review

Abstract

Objective

Eating disorders (EDs), including binge eating disorders (BEDs), bulimia nervosa (BN) and anorexia nervosa (AN), can inflict adverse effects on well-being, daily functioning, and workplace performance, presenting significant occupational, social, and economic challenges. This systematic review seeks to explore the relationship between ED symptomatologies and their impacts on work performance.

Methods

This systematic review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analyses. Formal methods of critical appraisal for both qualitative and quantitative studies were utilized. Six studies were included.

Results

Participants across all studies (n = 20,367) exhibited heightened levels of presenteeism, absenteeism, work productivity impairment, and higher annual burden costs compared to their non-ED counterparts.

Conclusion

Impaired decision-making, cognitive inflexibility, and poor executive functioning significantly impact work participation and performance, underscoring the need for workplace policies that reduce stigma and stress, and calls for further research into how environmental factors and interventions affect ED recovery.

Level of evidence: Level I, systematic review.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40519-025-01783-8.

Introduction

Eating disorders (EDs) can have lasting negative physical and psychological impacts on one’s well-being, quality of life, and work performance [1, 2]. Common EDs include binge eating disorders (BED), bulimia nervosa (BN), and anorexia nervosa (AN) [2]. BED is characterized by recurrent episodes of binge eating and distress [3], affecting approximately 2.8 million adults in the United States [4]. BN involves episodes of binge eating with a lack of control over the amount and duration of eating, along with recurrent inappropriate behaviours compensating for bingeing (e.g. self-induced vomiting, using laxatives/diuretics, fasting, excessive exercising) [4]. Galmiche et al. [5] found that the lifetime prevalence rates of BN were 0.3–4.6% in females and 0.1–1.3% in males. Anorexia nervosa (AN) is defined by restricting energy intake relative to the requirements, low body weight, fear of gaining weight, and feeling disturbed by one’s body weight or shape [6]. AN prevalence rates range from 0.1–3.6% in females and 0–0.3% in males [5]. These disorders also coexist with increases in obesity rates, increasing from 30.5 to 41.9% from1999 to 20200 [7].

EDs can significantly affect the social and economic challenges faced by individuals recovering from and managing EDs and their symptoms worldwide [2]. Streatfeild et al. [8] highlighted the economic costs and losses associated with EDs. The losses were calculated as the loss of productivity in the workplace, defined as the decreases in task completion, attendance, and meeting job demands in the workplace. EDs significantly affect economic costs in the United States, with the total economic cost totalling around $64.7 billion in the fiscal year of 2018 to 2019 [8]. Around 30% of this cost was accounted for by BEDs, with a total of $19.4 billion. Indirect costs outside of the healthcare system added up to $60.2 billion, including individual productivity costs ($48.6 billion), cost of lost caregiver productivity ($6.7 billion), and overall efficiency losses ($4.8 billion) [8].

A similar study by Tannous et al. [2] based in South Australia found that the total annual economic cost of EDs in 2018 was approximately $84 billion, with $669 million in annual health care system costs. Individuals suffering from EDs face an annual loss of earnings totalling $1.6 billion. The study reported measures of two major factors of productivity loss known as absenteeism, losses caused by missed work, and presenteeism, losses caused by a lack of efficiency in the workplace [2]. Presenteeism accounted for 80% or $1.3 million of the lost earnings, nearly four times the total losses due to absenteeism. Individuals also suffered an annual loss of $324 million of out-of-pocket costs based on self-reported health expenditure. The total annual out-of-pocket costs for binge eating were estimated to be $560 million Out-of-pocket losses were calculated with self-reported expenditure on health services and healthcare service utilization (general practitioners' fees, specialist fees, psychologist fees, cost of purchasing medicine, surgical fees, cosmetic fees, and fees surrounding use of medical equipment) [2].

EDs also negatively affect workplace participation and performance, often resulting in decreased productivity, impairment in daily activities, and even unemployment [9, 10]. A study by Filipova and Stoffel [9] investigated the relationship between BED and work/classroom productivity and impairment. The study found that those suffering from mild or moderate BED were significantly more likely to experience classroom productivity impairment and overall and regular daily activity impairment. Classroom productivity impairment was measured using the Work Productivity and Activity Impairment Questionnaire (WPAI) and Classroom Impairment questions, including hours missed from class due to health issues, hours attended class, and the extent to which health issues affect classroom productivity while attending class. Additionally, results supported that BED contributes to impairment in social activities and social functioning (e.g. family, peer groups, romantic, and school atmospheres), emotional distress and help-seeking behaviour when compared to those without BED. Similarly, a longitudinal study by Wentz et al. [10] examined the outcomes on AN in people with teenage onset anorexia. This study found that 1 in 4 participants experienced unemployment as a result of ED and psychiatric disability following a diagnosis in adolescence.

Although there is research on the negative impacts of ED on general workplace employment, there is a lack of literature assessing the associations between specific EDs and work participation and performance. No existing knowledge synthesis has examined such a relationship, resulting in a lack of conclusive data to support the association and definition of workplace functioning. This study addresses the lack in literature surrounding possible reasons behind EDs’ negative impacts on workplace operations. This study’s objectives were to determine: (1) the association between ED symptomatologies and their impacts on work performance and (2) which specific ED symptoms present as most impactful on work performance and participation.

Materials and methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [11]. The registration number for this systematic review is [1] on PROSPERO, and the protocol has been published [1]. Medline (Ovid), Embase (Ovid), CINAHL (Ebsco), Web of Science, APA PsycINFO (Ovid), and Cochrane Library (Wiley) were the six databases searched for existing primary articles on EDs and their effects on work participation and performance. The Population, Intervention, Comparison, and Outcome (PICO) framework (Table 1) was employed to support, structure, and enhance the search strategy for the research question: what are the effects of eating disorders on work performance and participation?

Table 1.

Participants, intervention, comparison, outcome (PICO)

Participants	Employed (paid or unpaid) individuals, aged 15 + with ED
Intervention	Investigating the impact of ED on functioning in the workplace
Comparison	Employed individuals without ED diagnosis
Outcome	Impact of ED symptoms on work performance and participation, metrics and assessments that measure work performance and participation

The definitions for workplace functioning, unpaid work and work performance are provided in the search strategy and study selection section of the paper

Search strategy and study selection

The search strategy was developed by the research team and a health science librarian [1]. All articles included in the study were published in English. The selection of articles was retrieved on March 30th, 2025. The studies chosen for this review contain information regarding ED and its impact on work performance and participation. The full search strategy (including search syntax) can be found in the protocol [1] (see Appendix A, Table S1, for details).

The systematic review included studies with EDs using the diagnostic criteria from DSM-IV or DSM-5. The studies included males and females above 15 years of age. The cutoff of 15 years of age was chosen as it is the legal minimum age requirement as defined by the International Labour Organization [12] and the age at which ED symptoms are expected to emerge. Study participants were required to have a job or volunteer position in which they completed paid or unpaid work or training. The included studies reported associations between ED symptoms and work participation and performance, including but not limited to work productivity, absenteeism, presenteeism, workload completion, and quality of work. Since the work participation and performance definitions differed across studies, the concepts were defined using terminology by Lagerveld et al. [13], i.e. work participation is described as one’s presence in the workplace in relation to fulfilling their roles and responsibilities in paid and unpaid positions. Due to the comorbid nature of ED, the dual diagnosis of mental health disorders (e.g. anxiety, depression, bipolar disorder, personality, and substance use) was included. Meanwhile, work performance, also referred to as work functioning, is characterized as one’s ability to fully or partially complete their required tasks in paid and unpaid positions [13].

The exclusion criteria were as follows: studies with dual diagnoses including neurodevelopmental conditions (e.g. autism) and severe physical conditions/changes (e.g. cancer, stroke, female triad syndrome) were excluded to avoid influences of third variables on study outcomes. Other reasons for exclusion were studies with a sample younger than 15 years that did not report outcomes by splitting age groups; studies in which work is defined through means of satisfaction excluding participation and performance markers; treatment and intervention-focused studies; and studies that group leisure, school, and household activities as part of work. Book chapters, reviews, knowledge syntheses, primary articles, and primary articles that were not peer-reviewed or did not offer English translations (even after authors were contacted) were also excluded.

The full inclusion and exclusion criteria can be found in the [1]. Two reviewers examined, collected, and critically appraised the data from each article. Conflicts were resolved through a deliberation process. If there was disagreement, it was brought back to the research team for resolution. Additional details surrounding the selection of articles can be found in the protocol [1].

Critical appraisal of included studies

The Critical Appraisal Skills Programme (CASP) review checklist and the Joanna Briggs Institute (JBI) checklist were used by two reviewers to assess all the included qualitative studies to evaluate their relevance, validity, and quality against 10 questions [14, 15]. Additionally, the Newcastle–Ottawa Scale (NOS) was employed by two reviewers to assess all cross-sectional studies [16]. The risk of bias for observational studies was examined using NOS, appraising studies across three domains (selection, comparability, and outcome). All the included studies were stored in Covidence, a review management software used to maintain the quality assurance and organization of the data screening, collection, and analysis processes [17].

Meta-analysis rationale

A meta-analysis was not conducted due to insufficient data and methodological heterogeneity between the studies. Of the six included studies, only three cross-sectional studies reported statistical data analyses. However, these studies did not include raw data scores in their publications or provide individual participant data files when authors were contacted regarding their reported data. A large majority of the data were reported as percentages due to the WPAI scoring system. The studies by Ling et al. [18] and Pawaskar et al. [19] reported using the WPAI questionnaire as a measure of work productivity, absenteeism, presenteeism, and work and activity impairment over the past 7 days. In contrast, the study by Striegel et al. [20] utilized a modified WPAI questionnaire that focused on reducing the effects of transient sicknesses’ influence on work productivity and measured work productivity over the past 4 weeks. The differences between the studies’ measures, methods, and design introduced methodological heterogeneity, mainly due to the modified questions and time differences (7 days vs 4 weeks), which may lead to inaccurate conclusions and misleading interpretation of data if a meta-analysis was performed [20]. As a result, a meta-analysis was not performed to avoid the possibility of causing biases, imprecision in the analyses, and misleading conclusions [21, 22].

Results

The search strategy identified 35,556 studies. Of those, 22,602 studies were screened after removing duplicates. Six studies were selected for analysis, of which three studies were qualitative (Table 2) and three were cross-sectional studies (Table 3). Risk-of-bias of included studies was assessed as mentioned above (see “Critical appraisal of included studies” section). The results of all included studies were summarized, and common themes were generated from the qualitative studies for analysis. Thirty-eight full-text studies were assessed while 22,564 articles were excluded for being reviews, case reports, etc. (see Fig. 1).

Table 2.

Qualitative study characteristics and critical appraisal

Author, year, country	Sample size	Sample gender	Sample ethnicity	Sample age (mean)	Sample diagnosis	Outcomes	CASP grade	JBI grade
Siegel et al., 2019, USA	n = 70	Female (69 cisgender, 1 transgender)	62 White, 1 Latina/white, 1 Native American, 2 Asian, 2 Black	34.5	Diagnosis of AN, BN, and/or BED	Individual characteristics, identity, stigma, and stress management techniques, workplaces stressors, personal and organizational outcomes	8	9
Siegel et al., 2020, USA/Canada	n = 14	Males	White	27.8	Clinically diagnosed ED (AN, BN, BED, or Combination)	Fear of stigma and (non)disclosure, emotional reactions, coping strategies, and impaired work performance	10	10
Lyons et al., 2019, Europe	n = 7	Males	White	28.29	diagnosed with AN	Lived experiences of men who have, or have had, an ED	8	9

Table 3.

Cross-sectional study characteristics and critical appraisal

Author, year, country	Sample size	Sample gender	Sample ethnicity	Sample age (mean)	Sample diagnosis	Comorbidities	Outcomes	NOS grade
Ling et al., 2017, USA	n = 344	Females and males	White (n = 286), Black (n = 32), other (n = 26)	46.0	Diagnosis of BED	ADHD*, ADD**, depression	Work productivity loss, healthcare resource utilization, direct and indirect costs	8
Pawaskar et al., 2017, USA	n = 344	Females and Males	White (n = 286), Black (n = 32), other (n = 26)	46.01	Diagnosis of BED	Depression, psychological impairment	Functional impairment and productivity—work/school impairment, social life/leisure activities impairment, family life/home responsibilities impairment, presenteeism, absenteeism, work productivity loss	9
Striegel et al., 2012, USA	n = 19,690	Females and males	Majority White: 88.2%	Mean age was not reported	Binge eating or obesity	Anxiety, ADHD*, ADD**, bipolar disorder, major depressive disorder, OCD***, panic disorder	Work Productivity and non-work activity impairment	9

^*Attention deficit hyperactivity disorder (ADHD), ** attention deficit disorder (ADD), *** obsessive compulsive disorder

Fig. 1.

PRISMA flowchart of included and excluded studies

The six identified articles were reviewed and consisted of studies across the United States [18–20, 23, 24], Canada [19] and Europe [25]. Half of the included studies were qualitative reviews that focused on stress management in the workplace, the stigma surrounding illness disclosure, coping strategies, and lived experience [23–25]. Meanwhile, the other half consisted of cross-sectional studies and had common themes of productivity, work productivity loss, and non-work-related functional impairments [18–20]. The quality of critical appraisal was determined using CASP scorings for the qualitative papers, with an average CASP scoring being 8.67, and scores ranging between 8 and 10. The JBI scores were also determined for the qualitative papers, showing an average score of 9.33 and scores between 9 and 10. The CASP and JBI scores indicate a low risk of bias, high/good quality, and high reliability. The critical appraisal scores of the three cross-sectional studies were determined using NOS scores. An average score of 8.67 (“good” quality) was calculated, with scores ranging from 8 to 9. NOS scores greater than 7 are considered “good”, scores between 2 and 6 points are considered “fair”, and scores ranging less than one are considered “poor’ quality [26].

The EDs assessed across the six identified articles included BED (n = 5), AN (n = 3), BN (n = 2) and obesity (n = 1). Participants in each of the studies were either clinically diagnosed with an ED (n = 2), categorized as having an ED using a survey measure reflecting DSM-5 characteristics (n = 2), completed an online health risk assessment and psychosocial questionnaire (n = 1), or self-reported as having an ED (n = 1). In the three cross-sectional studies that reported comorbidities, the most common comorbidities found in ED participants were depression (n = 3), anxiety (n = 2), attention deficit hyperactivity disorder (ADHD/ADD) (n = 2), and bipolar disorder (n = 1) [18–20]. Additionally, few selected studies focused either solely on women (n = 1) or men (n = 2), while the majority examined both men and women (n = 3).

Participants in all six studies (n = 6) reported experiencing negative effects on their workplace performance or participation while attempting to manage EDs in their workplace [18–20, 23–25]. Common themes across three studies revealed that the management of EDs in the workplace often associates with emotional strain, challenges in recovery, exhaustion, emotional distress, impaired workplace functioning, physical/cognitive symptoms, and decreases in job performance because of physical or mental decline [23–25]. Although a healthy routine is vital in promoting ED recovery, participants reported not being provided a stable and predictable daily schedule by their workplace to accommodate meals and appointments essential to their recovery [24]. Consequently, participants’ professional lives took priority over their recovery, increasing their chances of relapsing or engaging in ED behaviours to cope [24]. Participants’ reports of physical symptoms stalling work, cognitive symptoms stalling progress in the workplace, and negative impacts on errors or mistakes on work performance [24].

Workplace stressors and demands often triggered participants and resulted in the use of unhealthy coping strategies such as covert ED behaviours [23]. Two major workplace stressors for ED participants were categorized by Siegel and Sawyer [24] as organizational stressors (e.g. food-related work events, health-focused work environments, schedule conflicts, and triggering occupations) or interpersonal stressors (e.g. leader intolerance and co-worker insensitivity), both bringing different challenges in ED recoveries. ED behaviours such as obsessively thinking about food/body weight and leaving one’s desk to engage in disordered eating often led to reduced work productivity, performance, and cognitive ramifications (e.g. lack of focus on tasks and work errors) [23, 24]. Some participants reported leaving their place of employment due to their inability to cope with the stress and effects of EDs; participants who got treatment gained confidence and those who did not seek treatment faced the same issues in their new workplaces [23, 25]. Many coping mechanisms reported in the studies were negative and included blending in, covert ED behaviour, humour, isolation and evasion, differential disclosure, avoidance, and prioritizing professionalism [23, 24]. However, Siegel and Sawyer [24] reported a positive coping method used by ED participants that felt secure and comfortable with their recovery process. This coping technique was recovery-centric behaviour, including creating social supports, requesting accommodation, using mindfulness strategies, and forming healthy routines.

Participants with EDs exhibited higher levels of presenteeism, absenteeism, activity impairment (non-work related), and work productivity loss/impairment compared to participants without EDs [18–20]. Daily activity impairment was nearly double in BED participants compared to non-BED participants [18]. Binge eating status showed significant relationships with both work and non-work-related activity impairment [20]. This relationship persisted even when using low thresholds of binge eating status (e.g. one episode in the past month), suggesting that even low-frequency binge eating is correlated with activity impairment [20]. Participants with BED reported significantly more lost days and unproductive days than non-BED participants [19]. Moreover, BED participants also reported significantly increased work hours missed due to health problems and decreased total hours worked [19]. Ling et al. [18] calculated the total healthcare resource utilization and cost of burden between BED and non-BED participants. Results displayed that BED respondents had higher healthcare utilization across all resources, including the number of surgeries, emergency room visits, and physician/healthcare provider visits. Similarly, BED participants had a greater annual cost burden for both direct and indirect costs. The average adjusted direct costs for BED participants were $20,194; in contrast, non-BED direct costs totalled $14,465. Likewise, the average adjusted indirect cost (calculated based on work productivity loss) for BED participants was $19,327 compared to $9,032 for non-BED participants. Overall, the total costs (direct and indirect) for BED respondents were nearly 1.5 times higher than the costs for non-BED respondents, totalling approximately $35,519 for BED participants and $19,598 for non-BED participants.

ED symptomologies were shown to have adverse effects on work participation by impacting workplace relationships, social connectedness, and networking opportunities (n = 3). For example, Siegel and Sawyer reported that women either skipped social work events to avoid public eating or attended social events only to engage in purging or bingeing before and/or after the fact [24]. Furthermore, it was found that because of avoiding workplace social events, women found it difficult to form social connections, causing strain on workplace relationships.

Participants suffering from EDs also expressed fear of stigma because of their condition (n = 3) or facing discrimination based on their gender (n = 2) [23–25]. Another source of stress came from leader intolerance, where women reported that disclosing their ED conditions resulted in leaders in their workplace raising questions about their competency [24]. Female participants reported experiencing stigma because of their size, with co-workers commenting on their body image and mental health trivialization [24]. Certain industries focused excessively on women’s appearances (e.g. dancers, waitresses, fitness instructors, actors, bartenders, etc.), posing additional challenges for recovery. Women expressed feeling pressured to remain a certain size in sexually objectifying work environments, often facing ridicule and questioning about their size from staff members. Women did not report experiencing stigma or discrimination because of their ethnicity.

Men feared experiencing stigma for contradicting masculinity norms, having mental illnesses in the workplace, and stigma surrounding ethnicity and gender since EDs are known to mainly affect teenage girls who are middle class and white [23, 25]. Both men and women had trouble facing co-workers’ insensitivity and unawareness towards their EDs and feeling unable to talk to them about their feelings or struggles [23–25]. However, only women reported that successful management of their EDs resulted in relationship authenticity as co-workers offered emotional support and accommodation. Despite both genders facing inequality and stigma in the workplace, it was found that both men and women face similar outcomes of activity impairment, with participants with obesity and BED in both genders having increased impairment and presenteeism [20].

Participants expressed fear and hesitation surrounding disclosing their condition to their workplace and co-workers [23–25]. This fear stemmed from concerns of being fired for their condition, social ramifications, intensive reactions, judgement, stereotyping, and organizational backlash for disclosure in the workplace. Women suffering from AN had a higher rate of disclosure compared to women with BED, BN, or multiple EDs, expressing that the fear of insensitivity was the reason behind choosing non-disclosure [24]. Another factor that impacted a woman’s decisions to disclose was the prevalence of workplace stressors, as women facing interpersonal and organizational stressors had a lower rate of disclosure. In contrast, the studies reviewed showed that men were unlikely to disclose their condition and often only saw disclosure as an option when it was a necessity [23]. The main reasons for non-disclosure included avoiding being labelled as “weak”, feeling emasculated, and fear of insensitive reactions. Men who disclosed their condition reported receiving varying reactions from work colleagues [25].

Discussion

The multitude of impacts that EDs in the workplace can have on one’s absenteeism, presenteeism, work productivity, and activity impairment were identified in this systematic review. Considering the lack of literature investigating the negative effects of EDs in the workplace, this review aims to address the gap by investigating the association between ED symptoms and their effects on workplace performance and participation. Given the challenges faced by individuals managing EDs in the workplace, understanding the relationship between work performance, work participation, and ED symptomologies is imperative to help address the stigma surrounding EDs. Furthermore, it is essential to implement workplace accommodations, foster supportive work environments, and minimize workplace stressors for working individuals with EDs. Specific ED symptoms are most impactful when examining the relationship between EDs and work participation and performance. Specifically, the results of this systematic review demonstrated that emotional strain, exhaustion, emotional stress, physical/cognitive symptoms, physical or mental decline, presenteeism and absenteeism were found to most affect the work of those diagnosed with an ED.

Although specific ED symptomologies and how they affect work participation or performance were not a focus in the included studies, some articles stated that the physical, mental, emotional and cognitive decline symptoms all affected impairment [23–25]. A previous study conducted by Miranda-Olivos et al. [27] showed that ED participants including those with binge spectrum disorder (BSD) such as BN/BED, anorexia nervosa-restrictive (AN-R), and anorexia nervosa—binge/purge subtype (AN-BP) exhibited decreases in decision-making skills and cognitive flexibility in comparison to healthy control groups. Additionally, participants with BSD showed significant executive functioning deficits. In contrast to healthy controls, ED participants displayed impaired performance in decision-making (66% of BSD, 48.1% of AN-R, and 40.7% of AN-BP participants), cognitive flexibility deficits (33% of BSD, 33% of AN-BP, and 18.6% of AN-R participants), and deficits relating to inhibitory controls (33% of BSD, 22% of AN-BP, and 18.6% of AN-R participants).

The duration of EDs played a role in impairment in decision-making, inhibitory control, executive dysfunction, and cognitive flexibility. Similarly, the findings of Iceta et al. proposed that individuals suffering from BED and food addictions displayed decreased performance when completing cognitive tasks [28]. Furthermore, results showed that participants with BED performed significantly worse in inhibitory control tasks, cognitive flexibility, attention tasks, planning, and memory tasks than in control groups. Yang et al. reported that adults with obesity displayed extensive deficits in their cognitive flexibility, inhibition, executive functioning, working memory, decision-making, fluency, and planning [29]. In comparison, overweight individuals (no ED) only displayed impairment in working memory and inhibition. These studies show the range of effects that EDs can have on workers’ cognitive and mental functioning. These impacts can potentially play a role in the decline of their work performance and work participation, making it difficult to manage ED symptoms while also meeting their job demands.

Prevalent comorbidities were found in ED participants across all six studies, including depression, anxiety, ADHD/ADD and bipolar disorder. Lydecker and Grilo [30] found that adult participants with BED had a 41% prevalence rate of also presenting with a psychiatric comorbidity, as 22% of participants had mood disorders and 20% presented with anxiety disorders. The presence of such psychological comorbidities may also be a major contributor to the decline in work performance and work participation faced by individuals with ED. This is supported by findings from Roca et al. showing that young adults (aged 12–25) suffering from depression displayed similar neuropsychological impairments, including deficits in executive functioning, visual memory, working memory, verbal fluency, overall processing and psychomotor speed [31]. When examining the effects of anxiety and depression on work performance, Deady et al. [32] concluded that individuals with comorbidity exhibited increased severity of symptoms, decreased work performance, and more work missed/absences due to sickness. Absenteeism and presenteeism rates were increased for those with depression or anxiety, suggesting that these comorbidities may play a role in the decline in work performance and participation of individuals managing EDs in the workplace.

What is already known on this subject?

Research on the negative impacts of EDs is well established in current literature. EDs present substantial economic and societal burdens, primarily driven by indirect factors such as lost productivity, caregiver burden, and workplace inefficiency. EDs were also found to impair educational and occupational functioning as individuals who experienced BED faced classroom productivity impairment, emotional distress, and reduced social functioning compared to non-affected peers.

What this study adds?

This study is the first to systematically examine the associations between ED and work participation and performance. It directly addresses gaps in the literature and looks beyond general workplace employment and the negative impacts of ED. Additionally, by looking at specific ED symptoms impacting work participation and performance, study findings can help create awareness for the less apparent effects of EDs in the workplace, such as emotional strain, exhaustion, emotional stress, physical/cognitive symptoms, physical or mental decline, presenteeism and absenteeism, and inform the development of resources that will help support affected individuals. For example, occupational therapy resources can help individuals manage their ED in the workplace, while workplace mental health policies, such as flexible hours, can help accommodate the time needed to access these resources.

Strengths and limitations

The inclusion of both qualitative and cross-sectional studies allowed for in-depth thematic inferences to be made. The use of a systematic review also allowed for specificity in the research question, reproducibility, and an exhaustive approach to investigating EDs in an occupational environment. Nevertheless, the study may pose risks of selection bias surrounding the subset of studies chosen for the systematic review. Furthermore, due to the lack of relevant and current research articles on this topic, the articles chosen for this review may be subject to publication bias as they all presented similar negative findings. The chosen articles did not report information that may influence job performance such as workplace characteristics, job task descriptions, and the impacts of workplace settings. Another limitation of this study is the lack of comprehensive analysis due to the inability to perform a meta-analysis on the six identified articles. This was because not all studies included statistical data analysis, instead providing thematic analysis of ED trends. However, the inclusion of both qualitative and cross-sectional studies allowed for in-depth thematic inferences to be made.

Conclusion

This systematic review aimed to address the research gap related to managing EDs in the workplace and explore the connection between ED symptoms and work performance participation. The findings from this review can contribute to breaking the stigma associated with EDs by fostering worker education, offering interventions, providing resources for employees with EDs, and striving to minimize workplace stressors that impede ED recovery. Future research may consider exploring the relationship between ED and its common comorbidities (e.g. anxiety, depression, ADHD, etc.) on individuals’ work lives. Researchers may be interested in exploring the role of work addiction as an overlooked commodity. Future studies may also want to explore further the specific workplace mental health outcomes, including their impact on functioning; moreover, examining environmental factors affecting recovery, as well as work intervention measures and their effectiveness. Supporting workplace mental health policies and promoting awareness about EDs and occupational therapy resources would help workers effectively manage their EDs in the workplace. Furthermore, supporting the diverse experiences of individuals with EDs by ensuring equal representation, avoiding stereotyping, and providing equal support opportunities for both genders would also be effective.

Implications of the results

This systematic review aims to examine the research addressing work performance and participation among workers with ED. The review findings highlight the need to destigmatize EDs and raise awareness to implement intervention and support methods for individuals with EDs. The study findings suggest that EDs can impact individuals’ work performance, participation, and be seemingly difficult to manage in the workplace, resulting in personal and financial losses. Appropriate resources must be implemented in occupational settings to address the stigmatization of those suffering from EDs. Additionally, workplace settings should include accommodations to limit workplace stressors, offer interventions, and provide support in hopes to encourage ED recovery.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

Author BNK conceptualized the study. Authors SU and BNK contributed to the study design and conceptualization of the study. Authors SU, AB-F, and AH assisted in writing the first draft of the manuscript. Authors FS and AA conducted the search strategy, including the systematic identification and retrieval of relevant studies from Covidence. Authors SU, BNK and AB-F performed the extraction, synthesis of data from the included studies, and the interpretations of the findings. All authors made significant revisions to the manuscript. Author BNK provided supervision throughout the development of this project.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.