Opinion: Eating disorders are still widely misunderstood, even within medicine

In Colorado and across the country, people are becoming increasingly aware that many are struggling with their mental health, and that care for mental health is often inaccessible or inadequate.

Awareness around eating disorders, however, is far behind, even though the mortality rate of those with eating disorders is among the highest associated with any mental illness. They’re also incredibly common – an estimated 30 million Americans will experience an eating disorder in their lifetime. Making matters worse, the barriers to care for eating disorders can cause even further distress to those who are doing their best to recover.

I know from firsthand experience how eating disorder treatment is lacking in compassion and common sense. I recently spent time in a recovery program where I was partially hospitalized for anorexia nervosa. During that time, I was subjected to punitive practices that made the experience even more traumatic, in addition to outdated and illogical medical criteria that stood in the way of my healing. Thankfully, lawmakers have the opportunity this year to improve eating disorder treatment in Colorado with Senate Bill 176.

Even though medical professionals increasingly view Body Mass Index as an inaccurate, unscientific, and culturally inappropriate way to measure health, the BMI is often still used as a determining factor in what kind of treatment a person receives for an eating disorder. As a result, weight can be a serious barrier for people with eating disorders, making it impossible to access appropriate levels of acute and ongoing care. 

Those with bulimia nervosa, binge eating disorder, or the many other eating disorders that exist may need treatment just as much as those with anorexia, but may be prematurely released from treatment, or not admitted at all, because they don’t display a low BMI. In fact, only a small portion – just 6% – of people with eating disorders are considered medically underweight. 

Someone with a severe eating disorder can be at risk of a cardiac event and yet be released from treatment simply because they are considered a “healthy weight” by this outdated standard. When I was in treatment for my eating disorder, the doctors eventually told me that my BMI was not low enough for them to consider me in need of residential treatment anymore and cut my stay short despite the ongoing risks to my health.

The fact that we tell people with eating disorders that they don’t need treatment because they’re “not underweight enough” is illogical, dangerous, discriminatory, and just plain wrong. 

In addition to limiting the use of the BMI, Senate Bill 176 would make care more compassionate, provide basic protections for patients, and limit the use of certain punitive restrictions. When I was in treatment, I often felt like I was being punished, not cared for. For example, on multiple occasions I was prohibited from going outside for up to a week at a time. Feeling so trapped not only made the experience more traumatic, but caused me severe anxiety that I still carry with me today. 

Relapse rates for those with eating disorders are extraordinarily high. I personally required multiple stays in a treatment facility for my eating disorder – something I’m not sure I would have needed had my first stay provided me with the compassionate and competent support I needed to heal. 

In order to fix this broken system and save lives, we need lawmakers, medical professionals, insurance companies, and the public to understand that eating disorders come in all shapes and sizes, that every experience is unique, and that health looks different for everyone. With Senate Bill 176, I have hope that we are finally arriving at a better understanding of eating disorders and treating those who experience them with the support and compassion they deserve.

Elizabeth Earhart, of Denver, is an EMT and advocate for eating disorders and mental health issues.