Skip to main content

WASHINGTON — When Robin Nelson sought treatment for her daughter’s severe eating disorder in 2019, she ran into a number of walls.

Her adult daughter had been discharged from a 72-hour psychiatric hospital but was unable to attend a treatment program near her home in San Francisco. The first available appointment was 32 days in advance.

Nelson instead found a program for his daughter at a food recovery center in Colorado – but his daughter’s insurer said he would be out of the network. She ended up taking it, using her retirement and pension money to pay for it.

“It’s something that absolutely needs to be covered, and if an insurance company doesn’t have the support or the availability and there’s no treatment available in a certain area, that there should be having flexibility or understanding that these are life-and-death situations,” said Nelson, a peer mentor and a recovered anorexic herself.

Lawmakers proposed at least four pieces of legislation that would address a problem that would have worsened during the pandemic for a multitude of reasons: anxiety, occasional food shortages, isolation from friends and family, less available in-person treatment, and a link between obesity and the most severe cases of COVID-19.

A bill has resulted from Facebook whistleblower Frances Haugen’s publication of documents last year showing that Instagram’s algorithms can lead to mental health problems and eating disorders in teenage girls. Facebook and Instagram are part of a company that has since renamed itself Meta Platforms Inc.

While the pandemic has compounded the problem and lawmakers are working on it, getting treatment remains just as difficult as it was for Robin Nelson. Previous congressional efforts have focused behavioral health legislation on other types of illnesses.

Eating disorders, or ED, are a group of mental illnesses that most commonly include anorexia nervosa, bulimia, and binge eating disorder. Contradicting a common misperception, around a third of sufferers are male, and the illnesses can affect young children and the elderly.

According to a 2020 report from the Harvard TH Chan School of Public Health, approximately 28.8 million Americans develop erectile dysfunction during their lifetime and 10,200 die each year. Johns Hopkins estimates that 95% of people with erectile dysfunction are between the ages of 12 and 25.

The National Eating Disorders Association said it saw a 107% increase in contact with its helpline from March 2020 to December 2021.

“Insurance companies really shouldn’t be the ones deciding ‘are you sick enough?’ because young people are dying,” said Elizabeth Thompson, CEO of NEDA, adding that there has been a national focus to come together on reducing substance use. “We need to do the same for eating disorders.”

Katrina Velasquez, chief executive of Center Road Solutions, said the pandemic is a perfect storm for eating disorders, which thrive in secrecy.

“The pandemic has really pushed a lot of people into an eating disorder or pushed them deeper,” said Velasquez, whose organization represents the Eating Disorders Coalition. “But now they have to do what they never had to do. They have to eat in public, which is really scary for someone with an eating disorder.

The increase in rates and diagnoses of these types of illnesses has not led to a greater emphasis on screening for eating disorders in primary care settings. Most medical schools do not offer elective disease training.

“We know that most people with eating disorders come to primary care first, but studies show that over 90% of primary care providers feel they have missed these diagnoses,” said Ellen Fitzsimmons-Craft, an assistant professor of psychiatry at Washington. University in St. Louis, whose research focuses on the use of technology to screen, prevent and treat eating disorders.

In a January report, the Departments of Labor, Treasury, and Health and Human Services showed gaps in treatment coverage. Two major plans covered nutritional counseling for conditions such as diabetes, but not for mental disorders such as anorexia nervosa or bulimia nervosa.

“The real issue at the heart of it all is enforcement: what can happen to get insurance companies to actually adhere to rules and regulations and if they don’t, what vehicle is there? ” said Cari M. Schwartz, a partner at Kantor & Kantor, which represents a separate class action related to mental health parity violations related to nutritional counseling in New York City.

Congressional Action

Advocates unite behind four bills they say could best improve prevention, treatment and research efforts. But a single bill would close the insurance coverage gap, and that would only involve those covered by Medicare.

Meaning. Amy Klobuchar, D-Minn., Shelley Moore Capito, RW.Va., Tammy Baldwin, D-Wis., and Thom Tillis, RN.C., proposed a bill that would authorize $5 million annually for fiscal years 2023 through 2027 for the Center of Excellence for Disorders diet continues training, intervention, and treatment initiatives established in 2016. Part of the University of North Carolina, the center is funded by HHS.

Velasquez said the bill could expand training to pediatric models and LGBTQ and minority populations.

Connecticut Democrat Richard Blumenthal and Tennessee Republican Marsha Blackburn, chair and ranking member of the Senate Consumer Protection, Product Safety and Data Security Subcommittee, are the sponsors of a measure that would require social media companies to give users under the age of 16 the option to protect their personal data. information and block certain addictive features.

It would also allow users to opt out of certain algorithmic recommendations and require annual audits of social media companies to monitor risk to young people and allow academic and advocacy groups to use certain company data for research on Security.

Thompson said social media algorithms can have negative consequences when someone is dealing with societal issues. The further down the rabbit hole you go, the more easily dieting can lead to dangerous outcomes like cutting, she said.

“It would make it much harder for the person to go through things,” she said, speaking out in favor of the bill. “I think there is a collective energy to achieve this. It should be a very easy lift.

The Commerce Senate did not plan to raise the Blumenthal-Blackburn bill.

Reps. Judy Chu, D-Calif., Jackie Walorski, R-Ind., and Lisa Blunt Rochester, D-Del., and Sens. Maggie Hassan, DN.H., Lisa Murkowski, R-Alaska, and Capito introduced a bill that would add Medical Nutrition Therapy, or MNT, as a covered benefit for people with an eating disorder under Medicare Part B. MNT provides a person with a diet plan and education from a dietitian, but Part B only covers it for diabetes patients.

Eating disorders in the elderly can be particularly dangerous due to an increased risk of other comorbidities.

“There are a lot of older people, not just in their 20s, who should have access to assessments and treatment modalities,” said Nelson, who is 68 and mentors a 60-year-old patient.

Meaning. Cynthia LummisR-Wyo., and Klobuchar and Reps. Kathy ManningDN.C., and Vicky Hartzler, R-Mo., are the leading sponsors of bipartisan bills that would update existing law for local school wellness programs to incorporate mental health resources, including the prevention of mental disorders. ‘feed. Schools that offer free or subsidized meals are currently only required to develop physical activity and nutrition goals.

Congress came to the eating disorders relatively recently. A 2016 law was the first to include eating disorder provisions. The provisions increased education and training related to emergency services and increased parity around treatment coverage.

The FY 2022 National Defense Authorization Act included language for an eating disorder recovery bill that would expand eligibility for treatment under TRICARE from 20 to 64 and provide training to military health providers to identify and provide referrals for these disorders. TRICARE is the healthcare program for active duty military personnel.

Compared to the general population, military personnel and veterans are more likely to use diuretics and laxatives or exercise excessively.

Anne Marie O’Melia, chief medical officer and clinical director of the Eating Recovery Center, a healthcare system focused on treating these conditions, said the biggest risk factor for developing an eating disorder is diet. .

“It used to be quite unusual to hear third graders talking about their body image,” said O’Melia, a pediatrician and child psychiatrist. Now, “you have third-graders accessing Instagram, and you know and have access to this glorified version of fitness and unrealistic goals when it comes to how they want their bodies to look.”

If you or someone you know has an eating disorder, please call the National Eating Disorders Association hotline at (800) 931-2237 or text “NEDA” to 741741 to be put in touch with a qualified volunteer in the event of a crisis.