Critical Care

For many anorexics, solving those problems at home would simply be impossible, no matter how supportive the parents. If treatment is to be effective, patients need constant support and multidisciplinary care, from physicians and social workers to dieticians and occupational therapists, say advocates for those with eating disorders. "You simply cannot get this type of integrated team work on an outpatient basis," says Cynthia Bulik, a clinical psychologist and the director of the disordered eating program at the University of North Carolina at Chapel Hill. "Given the number of deaths—and the number of lawsuits—it's hard to comprehend how these patients can get pushed to the bottom of the list."

If a patient does fall through the cracks or is discharged too early, relapse isn't the only fear. Ten percent of the nation's 8 million anorexics will die from their disease, according to NEDA. Federal parity law may not overhaul things, but Bulik is hopeful that other efforts might. The Eating Disorders Coalition, a nonprofit advocacy group, is drafting language for an eating disorder bill called the FREED Act, which would implement research and education initiatives, as well as require employers and insurers to cover eating disorder treatment the same way they cover physical disorders. In New Jersey, state Sen. Joseph Vitale has introduced two bills, one that would add eating disorders to New Jersey's list of covered mental illnesses, and another that would explicitly define them as biological.

For the moment, patients' best bet may be getting insurance companies or employers to realize that parity doesn't cost as much as they think. In a Congressional Budget Office report on an earlier version of the House bill (which aimed to include coverage for every illness listed in the Diagnostic Statistical Manual of the American Psychological Association), it was estimated that premiums for group health insurance would increase by an average of just four-tenths of a percent, and some of the cost could be passed on to workers.

Meanwhile, as Bulik points out, treating anorexia early is the best way to prevent future health ailments. The lasting effects of anorexia range from osteoporosis to severe gastrointestinal problems. "If insurance companies would help families when their children are beginning to show signs of disordered eating," they could save money and perhaps even prevent a full-blown eating disorder, says Grefe of the NEDA. Not to mention a whole lot of anguish.

© 2008