Any report card on eating disorders has to give higher marks to public awareness these days.
“The public is much more aware of these conditions than years back,” said Dr. Michael Strober, the Resnick chair in eating disorders and a professor of psychiatry at University of California, Los Angeles, in a recent phone interview. “There’s a dialogue that didn’t exist 20 years ago.”
Fashion World Responds
In 2015, France passed a bill to prevent models with an unhealthy body mass index (BMI) from working in the field. It also requires commercial images to have a disclosure when models have been altered.
U.S. lingerie retailer Aerie, based in Pittsburgh, launched an ongoing campaign in 2014 featuring only unretouched models, while Ashley Graham recently became the first plus-size model to cover Sports Illustrated’s famous swimsuit issue.
Treatment has taken a step forward. Ohio-based psychiatrist Dr. Angie Stergiou points out the growing inclusion of psychoeducation and family therapy. “Everybody is playing a role to get this patient well, including educating the family in terms of their own dynamic,” she said.
Roughly one-fourth of anorexia patients fully recover in the United States with treatment, while half are “markedly improved,” according to the text Kaplan and Sadock’s Synopsis of Psychiatry. The rest have a 7 percent mortality rate.
Stergiou said patient facilities are beneficial, especially for those with anorexia who are on the verge of death. But, she argued, there are setbacks since it’s only treatment.
“If an inpatient hospitalization provided a cure, insurance companies would easily pay for the stay,” she said. “Insurance companies pay for inpatient stay when the patient’s weight drops to a potentially life threatening level. Many times patients have to be forced into treatment at that point.”
Across Different Groups
More attention is now paid to the different ethnic and racial groups, and age groups, being treated for eating disorders, a condition once only associated with young, affluent white women.
For instance, binge eating or vomiting was just as likely to occur in black women as in white women, found a 2000 study published in Archives of Family Medicine.
“Eating disorders do not discriminate by race or ethnicity or social economic status,” said Dr. Ovidio Bermudez, chief clinical officer at Denver’s Eating Recovery Center, one of over 100 recommended facilities in the country offering various levels of treatment 24 hours a day.
Children under 12 years old getting hospitalized for eating disorders more than doubled between 1999 and 2006, according to statistics from the Agency for Healthcare Research and Quality. There was also a 37 percent increase in male patients and a 48 percent increase in those between the ages of 45 to 64.
“More women in middle and later life are coming for treatment who have had the problem for five, 10, 15 or more years,” said Dr. Kathryn Zerbe, a psychiatrist based in Portland, Oregon, who has been treating patients with eating disorders for over three decades.
Strober, at University of California, Los Angeles, said recent statistics regarding eating disorders do not necessarily mean more people are being affected now than they were decades ago. “It’s one thing for a treatment center to be seeing more people than in years past,” he said, “whether that’s an increase in incidence or increase in access to treatment, is not clear.”
As the director of the UCLA Eating Disorders Program at the Resnick Neuropsychiatric Hospital in Los Angeles, Strober has also noticed a shift in his center in the past decade, but said the increase of racial and ethnic minorities is still low compared to Caucasian patients.
What’s remained constant, however, is the danger of eating disorders.
Anorexia nervosa (critical low body weight) is still the deadliest of all mental disorders; the death rate for females between 15 and 24 suffering from the disorder is 12 times higher than any other disease. But treatment gives patients a chance, especially when they are treated early.
“Eating disorders are treatable as long they are recognized and appropriate care is sought in a timely basis,” said Bermudez, at Denver’s Eating Recovery Center. “I cannot think of a person that I will say, ‘This is so bad that I give up on them.’ I can’t think of that scenario.”
Insurance coverage, particularly for inpatient treatment centers, however, can be inadequate.
“Most patients that come to our programs are fairly ill and their insurance offers some degree of coverage, sometimes not as long as we would like or not as long as the patient would like,” Bermudez said in a recent phone interview.
The levels of care needed and expenses for the recovery process depend on each individual patient, Bermudez added.
Check our archives for more coverage of eating disorders.
At times, Bermudez said, insurance companies don’t agree on the levels of care that he might want for a patient, either at the beginning of treatment or later on.
In 2006, Women’s eNews covered the gaps in coverage for inpatient eating disorder centers and the extent to which they can create financial barriers for patients.
Two years later, in 2008, Congress passed the Mental Health Parity and Addiction Equity Act, which pushes insurance companies that offer mental health benefits to create parity with other conditions.
However, Zerbe, the psychiatrist in Oregon, said in-patient treatment is still prohibitively expensive for many patients who would benefit.
“The subspecialty of eating disorders has made inroads with Congress but it is still difficult to get insurance companies to recognize the importance of mental health treatment, whether it’s eating disorders or any other form,” said Zerbe, who is also a professor of psychiatry at Oregon Health and Science University.
The biggest problem is not so much outpatient care, Zerbe added, “it’s when somebody is [really] sick and they need to go to residential or inpatient. “. . . Inpatient is much more expensive.”