Anyone with any experience – personal or professional – of eating disorders will know the lengths individuals or families often have to go to get proper treatment. I speak on a daily basis to families battling insurance companies and/or employers (in the cases of “self-funded” in insurance plans). And even if some coverage for treatment is forthcoming, maintaining adequate treatment until remission is gained is often more difficult. Despite all the talk about “preventive care” the fact is insurance companies usually want things to get worse before they contemplate shelling out for preventive treatment. It never ceases to amaze me how willing insurance companies are to pay for medical hospitalization when a good day treatment program has been demonstrated to curb the need for hospitalization, at a fraction of the cost. They don’t even seem to understand their own bottom line! But that’s for another blog.

So when I was recently handed a primer on the issue of securing effective care for eating disorders from the helpful folks at NEDA I felt this was something we should share with our readers.

The primer is called Securing Eating Disorders Treatment: Ammunition for Arguments with Third Parties, and was compiled and written by Margo Maine, Ph. D.. It takes the form of ten arguments to make in favor of comprehensive treatment. A PDF version of this document, with a compete list of all studies cited, can be found here.

Argument #1: A full course of treatment is cost effective for eating disorders.

Several studies have shown this to be the case, including one by Baron et al. in 1995 that reported a 55% reduction in re-hospitalization rates of 14 patients who were allowed to remain in treatment until they reached 96% of their minimum weight for health (aka “ideal body weight” or IBW, but at Kartini we shy away from such terminology, for obvious reasons).

Argument #2: Specialized treatment for eating disorders is preferable and cost effective

In our clinical experience, specialized treatment saves time and helps to achieve better, lasting treatment outcomes. Generalized treatment in an outpatient setting, especially for children, is an invitation to disaster.

Argument #3: Recovery takes place over a long period of time.

Cutting off treatment because of momentary weight gain simply means treatment gains are not secured, all progress will be lost, and another round of treatment required. Meanwhile, in the case of children, precious developmental time is lost, never to be regained.

Argument #4: Treatment of bulimia is effective.

Studies suggest that early treatment provides for a better prognosis. The longer symptoms go untreated the worse the prognosis becomes. In our opinion, the same can be said for anorexia and food phobia.

Argument #5: Even successful treatment can have an uneven course.

As any parent or provider can tell you, eating disorders, especially anorexia, is a disease of remission and exacerbation. There simply is no cure for anorexia and certain other eating disorders, and relapses can and do happen with some frequency. But that is emphatically not the same as saying treatment does not work.

Argument #6: Eating disorders are serious and lethal.

It is well documented that eating disorders are highly lethal over a prolonged period of time, to say nothing of the untold misery of those unfortunate enough to suffer from one, or the anguish felt by parents and loved ones. These are terrible illnesses that need to be taken seriously.

Argument #7: The mortality rate increases with the duration of symptoms.

This is only logical. The longer the illness goes untreated the worse it becomes. Very few patients recover without proper treatment, and even if they do it is usually at the cost of preventable medical conditions. The American Psychological Association reported in 2000 that the mortality rate for anorexia was 5% within 5 years but increases dramatically to 20% at 20 years, without proper treatment. Suicide is a major cause of death and one not always attributed directly to the eating disorder.

Argument #8: Comprehensive, long-term treatment does “pay off.”

Several outcome studies demonstrate that mortality rates can be reduced through sustained, clinically appropriate treatment. In our clinical experience at Kartini Clinic this includes at least some form of intensive treatment such as day treatment. Serious eating disorders are usually not successfully treated in a standard outpatient setting.

Argument #9: Younger patients require intense and aggressive treatment.

To quote the Society for Adolescent Medicine (1995), “because of the potentially irreversible effects of an eating disorder on physical and emotional growth and development… the threshold for intervention in adolescents should be lower than in adults.”

At Kartini Clinic, we could not agree more. As pediatric and adolescent program we stress in no uncertain terms that a delay in treatment can cause irreversible developmental damage to young children. There are certain developmental “windows” which are open for a specific time. Once they close they can never be reopened and, even in the event of eventual recovery, permanent damage such as growth stunting and/or cognitive impairment will result. It is heartbreaking to witness children who have been permanently damaged by an unnecessary delay in treatment.

Argument #10: Utilization of mental health benefits may offset high medical costs associated with eating disorders.

As I mentioned earlier, insurance companies seem willing to spend enormous amounts of money on medical hospitalization when lower intensity, “mental health” interventions can achieve the same result. In the end it’s whether treatment works that counts, not where it takes place.