Reese Chism had marks on her wrists from the restraints used to pin her down for blood draws.
She still has nightmares about being forced to stand naked in front of other girls for weigh-ins. The teenager said she threw up because staff made her drink milk and eat cheese, even though she told them she was lactose intolerant.
Chism, now 16, attended a day program at an eating disorder treatment center in Colorado for just three days last summer before her parents yanked her out, concerned that it was hurting her more than helping. “They started noticing something wasn’t right,” she said. “My parents were in classes at the facility and they basically train your parents not to believe you.”
The Denver teen is now among those asking Colorado to regulate eating disorder clinics, ensuring they provide so-called trauma-informed care. That includes not watching patients as they shower or forcing them to eat foods they are ethically opposed to eating, including meat, according to legislation under consideration at the state Capitol.
Chism does not want to name the facility where she received treatment. Her parents enrolled her in the day program after Chism’s eating disorder had gotten so dire that she had lost 40 pounds and was eating just 800 calories per day — the amount recommended for a toddler.
At the center, she said two male staff members held her down and told her she would get a feeding tube if she didn’t eat the rest of her meal. “I was sobbing and I was really scared,” Chism told The Sun. “They thought I was going to fight back against them.
“I was 15 years old and 5-foot-1.”
While Colorado is a national hub for eating disorder treatment, the state does not regulate centers’ treatment plans or clinical practices. The clinics are regulated only by the Colorado Department of Public Health and Environment, which performs safety inspections and investigates complaints. The legislation from state Sens. Lisa Cutter and Faith Winter, both Democrats, would put the clinics under the purview of the state Behavioral Health Administration, which oversees mental health hospitals.
Eating disorders are the second-deadliest mental health condition, after opioid abuse. From 2018 to 2022, health insurance claims for eating disorders rose 65% nationally, with the largest increase in those ages 14-18.
“Yet there are few laws and regulations in place to address this type of treatment and protections people would expect while receiving care here in Colorado,” Cutter said during a hearing on the legislation, which passed out of a Senate committee 6-3. “This bill would recognize that people with eating disorders have a mental health condition and should be in facilities regulated by agencies with expertise in mental health.”
Cutter tried to pass a similar bill last year, but the legislation was stripped of the regulation requirement for budgetary reasons. This year’s bill calls for $460,533 next year to set up the program.
Instead, the legislature passed a bill in 2023 that prohibited insurance companies and treatment facilities from using a person’s BMI, or body mass index, to determine whether to cover eating disorder treatment. It also prohibited the sale of some diet pills to minors.
Should Colorado ban doctors from forcing vegans to eat animal products?
A huge point of controversy in this year’s proposal — and one that divided the Senate Committee on Health and Human Services — is whether eating disorder treatment facilities should be allowed to force patients to eat certain foods.
Former patients of eating disorder centers said they had been forced to eat dairy products and eggs even though they are vegan.
“I believe that ignoring deeply held personal convictions, and dietary restrictions, could have a significant impact on someone’s mental health,” said Cutter, of Jefferson County. “We all have different things that we hold deeply. Am I to tell any of you that your religious conviction doesn’t matter?”
Sen. Kyle Mullica, a Federal Heights Democrat and an emergency room nurse, disagreed with the ethical diet clause in the bill, as did several medical and behavioral health staff who work with patients with eating disorders. They argued that it’s sometimes necessary to require people to eat all kinds of foods so they don’t die.
“The goal of these providers is to save lives — it’s not to try to traumatize by any means,” Mullica said. “We need to be really careful when it comes to not allowing physicians and providers to be able to do the job that they have been trained for years, and sometimes decades, to do.”
Several clinicians from the Eating Recovery Center, which receives 85% of its patients from out of state, said it’s difficult to untangle the reasons why patients won’t eat certain foods. Often, it’s part of the disorder.
Anne Marie O’Melia, chief clinical officer for the Eating Recovery Center, said the center tries to accommodate dietary requests when it’s safe. The problem is that some of the same foods that help people gain weight, such as dairy products and eggs, are the ones patients say they will not eat, which makes it difficult to accommodate veganism, she said.
“The Eating Recovery Center maintains a philosophy that all foods are good foods,” she said. Adolescent patients are offered vegetarian diets, if their parents support that option, O’Melia said.
Doctors take “careful history” to find out how long a teen patient has been following a vegan or vegetarian or gluten-free or dairy-free diet, said Dr. Jennifer Hagman, medical director of the eating disorder program at Children’s Hospital Colorado.
“Changes in dietary rules that an individual makes for themselves are often the core of the problem,” she said. “There are certainly situations where a highly restrictive diet has developed in the context of the eating disorder and continuing it really doesn’t help the recovery process.”
Sen. Jim Smallwood, a Parker Republican, wanted to amend the legislation to give doctors the discretion to determine what patients should eat. He argued that the term “dietary ethics” in the bill is too broad. The bill was amended by the committee, but the ethical food issue is expected to be a huge part of the debate going forward.
“If we were to list out the dietary ethics choices that Americans choose today, I mean, we could be talking about environmental veganism, for example,” he said. “Anything that the patient would feel, hypothetically, might damage the environment. Industrial farming, for example.”
The details of such a restriction could get difficult considering that even some of the medications used to treat eating disorders have been tested on animals or contain animal derivatives, such as gelatin or fish oil, said Elizabeth Wassenaar, an adolescent psychiatrist with the Eating Recovery Center.
“In the pursuit of nutritional restoration and brain rescue, it is often necessary to request a temporary pause on vegan practices,” she said. “This is not meant to dismiss or diminish any philosophy but to prioritize medical and psychiatric stabilization.”
No privacy, strip searches and solitary confinement
The bill requires the Behavioral Health Administration to create specific rules that eating disorder centers would have to follow, including about weigh-ins, privacy in the bathroom, dietary accommodations and accommodations for people who are LGBTQ.
“I believe extremely strongly that treating a patient is treating the whole person,” said Sen. Winter, of Westminster. “And to only be looking at the eating disorder, without their morals or ethics or values, their mental health, any other problems they have, we are actually pushing them away from treatment.”
The legislation comes at a time not only when adolescent eating disorders are on the rise after the COVID pandemic, but as treatment facilities have faced harsh accusations.
A state health department investigation last year found that two Eating Recovery Center patients, ages 11 and 14, tried to kill themselves multiple times, including by strangling themselves to unconsciousness. A doctor told staff to ignore their behavior, according to the state report.
Erin Harrop, an eating disorder therapist and University of Denver professor, said they witnessed several nightmare-inducing situations during their years in treatment for anorexia. Harrop wouldn’t go to the bathroom to avoid using the toilet with staff watching. A friend was forced to eat cheese against her will. Patients were strip-searched and placed in solitary confinement.
“One of my most poignant memories of treatment is standing in shorts and a tank top, deeply ashamed of my body, while medical staff measured every inch of my body with calipers to determine my body fat percentage,” said Harrop, asking lawmakers to regulate eating disorder treatment.
“When you are starving, your brain changes. Your thinking gets rigid, distorted, obsessed, paranoid and hopeless. This leads to multiple traumatizing procedures aimed at protecting critically ill patients from themselves.”
The legislation, Senate Bill 117, next needs approval from the Senate Appropriations Committee before going to the full Senate. It has the support of Mental Health Colorado and the Eating Disorder Foundation.