Robbing Peter to Pay Paul
Thoughts on eating disorders treatment options
A few weeks ago, I received an email from a reader asking if I had any advice about eating disorders treatment for her teenage daughter. After all my time researching, writing about, and lobbying for improved mental healthcare treatment, I was stumped. I had no idea where individuals suffering from an eating disorder go for treatment today. I quickly discovered yet another gap in our treatment system.
The National Eating Disorders Association reports:
9% of the US population, or 28.8 million Americans will have an eating disorder in their lifetime.
The overall lifetime prevalence of eating disorders is estimated to be 8.60% among females and 4.07% among males.
Every 52 minutes 1 person dies as a direct consequence of an eating disorder.
As I started digging around and talking to colleagues for information, it got me thinking about my own long history of dealing with eating disorders in different capacities.
I’ve never personally suffered from an eating disorder, but several people close to me have dating back to my adolescence. I’m a Gen X child of the 80s, and I remember first hearing the term “anorexia” when Karen Carpenter, the lead singer of the group The Carpenters (one of my mom’s favorites) shockingly died from the effects of self-starvation, binging and purging. I vividly recall later watching The Karen Carpenter Story on network television, a cheesy made-for-tv-movie, and being riveted by it.
At that point in my young life I’d never known anyone who’d suffered from an eating disorder like anorexia or bulimia, but that would change as soon as I started high school.
At the end of my freshman year, my closest friend at the time told me she wanted to “lose a little weight over the summer.” She was a pretty girl with a strong, athletic body, and certainly didn’t need to lose any weight, but I didn’t think much of it. I don’t remember trying to talk her out of it, or giving her any affirmations about her appearance being healthy just the way it was.
By the time our sophomore year started she had lost a seriously concerning amount of weight, and within months, her parents admitted her to the eating disorders unit at Iowa Lutheran Hospital in Des Moines. She completed the difficult treatment program and returned home at a healthier weight, but had several relapses in young adulthood. Over the years, I knew at least a half dozen other young women who went to eating disorders treatment centers, including Iowa Lutheran before the unit eventually closed.
After the close at Iowa Lutheran, there was only one eating disorders clinic left in the state, at the University of Iowa Hospitals and Clinics, and it closed in 2022. Before the closure though, if a patient couldn’t get a bed in the U of Iowa unit and didn’t feel like the general psychiatric units in the other Des Moines-area hospitals were the right fit, the only other choice was to go out of state and pay out of pocket. Again, in the last decade I’ve known multiple families who had to make this expensive, long distance choice to get treatment, including my own.
In 2012, my then-11-year-old son spent a summer in a pediatric eating disorders clinic at the University of Nebraska Medical Center’s Munroe-Meyer Institute (MMI) in Omaha for disordered eating caused by severe food allergies. It took me months to find any clinics in the United States that treated pediatric cases (there are maybe a dozen?) and there were only two at the time in the Midwest, with the MMI the closest. It was an incredibly stressful time for our family as my husband and I traded weeks living in a Ronald McDonald house near the hospital, while the other parent stayed home to care for our two younger children.
It took eight intensive weeks to undo nearly ten years of his disordered eating, both physically, mentally, and emotionally. But the team at the hospital knew what they were doing, and within two weeks they had him eating food groups we, his loving and attentive parents, had never been able to get him to even try without crying, retching, and vomiting.
More than the treatment, though, I remember the string of medical doctors, specialists, psychiatrists, and occupational therapists we saw, none of whom could get our son to eat more than oatmeal, pudding, and yogurt. By the time he was 11, he was underweight for his age, and had nearly stopped growing. The day he was unable to run across a soccer field without stopping because he was too tired and had no energy was my breaking point. I went home that afternoon and started researching every corner of the internet for treatment centers.
Once I found the MMI, I worked diligently with our pediatrician to get him accepted as a patient, and then spent another six months battling my insurance company to cover some portion of the incredibly expensive program.
But, as I said, he got better. He started eating a nutritious diet, put on weight, and even went on to be a varsity cross country and track runner in high school. Something totally unimaginable when he was eleven and existing off pudding cups.
This is what I thought of when I read the email from the Iowa mother asking for eating disorder advice for her daughter. She just wants to see her child healthy, and just wants someone, anyone to help. But here in Iowa, those treatment center no longer exist. Eating disorders are part of the mental health spectrum, but also the medical spectrum, and require unique and specialized treatments. General psychiatric units aren’t always the right fit.
It disheartens me that our medical community keeps forcing families to “rob Peter to pay Paul,” as the saying goes by taking away some types of psych beds to create others, even though what we really need is both. Because essentially all we end up doing is just filling one hole and creating a gap somewhere else.
If you or someone you love is struggling with an eating disorder, start with the National Eating Disorders Association for a free screening, to find an eating disorder treatment provider in your area or online, to find nutrition counseling, and more.
Here in Iowa, you can also find support and advice through the Eating Disorders Coalition of Iowa Facebook Group and website.
Legislative Updates
I’m happy to report HF124, an act relating to responsible discharge of involuntary committed person from a treating facility, is heading to Senate subcommittee by April 4. Progress!
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