Clinics that treat eating disorders are evolving, nationally and in Colorado, to deal with yet another disturbing result of the pandemic — people with anorexia or bulimia are now far sicker by the time they seek help.
Experts blame the isolation of the pandemic for the delay in care and the overall stress of living through such uncertain times for the reason many people relapsed or developed eating disorders as a coping mechanism.
“People are reaching out for help but they are a lot more ill than what they have been in the past,” said Brenda Velissaris, clinical director at the eating disorder treatment center EDCare. “This has required higher-level-of-care facilities to really take a look at our programs.”
EDCare, which already has an outpatient program and a day-treatment program for adults and adolescents in Denver, is now opening a residential program. It is the first residential treatment program in the state that will accept Medicaid, the government insurance program for people with low incomes.
The expansion also comes as Colorado is trying to do a better job of regulating eating disorder treatment after lawmakers heard horror-story testimony from former patients of Colorado clinics who said they were subjected to naked weigh-ins and forced to eat meat against their will.
By January 2026, eating disorder facilities that provide intensive outpatient, partial-hospital programs or residential programs will have to obtain a designation from the state’s Behavioral Health Administration that specifies what services they are qualified to provide. The state agency will conduct site reviews and oversee treatment centers’ policies on patients rights and quality of care, as well as investigate complaints. The new oversight is the result of a state law passed last year.
As of now, the state isn’t even sure how many eating disorder clinics exist in Colorado, because it has only been required to regulate the three programs that provide the highest level of care — involuntary hospitalization. Those are two units at the Eating Recovery Center and one inside Denver Health Medical Center.
Research presented to the legislature last year tallied at least 27 clinics across the state that are currently unregulated by behavioral health authorities.
New residential center opened with a waitlist
The new residential program at EDCare, which opened this week, has room for 12 adults and already has a waitlist.
The company added the residential program because it was turning away people who were seeking help when they were already too ill for the center’s other programs. The partial-hospitalization program, or day treatment, keeps patients for six to eight hours per day, and the intensive outpatient program lasts for three to four hours per day.
Those options aren’t enough for people who already have severe medical complications because of the disease, Velissaris said. More patients are showing up for treatment with extremely low blood sugar, dangerously low calorie intake and a heart condition called bradycardia, which occurs when a person’s heart rate is so low they are at risk of heart attack. Patients who are that ill need 24-hour monitoring, she said.
EDCare opened in Denver in 2000 and expanded to locations in Nebraska and Kansas. In Denver, it added partial-hospitalization and outpatient programs for adolescents ages 13-18 in 2023.
About 80% of patients are female, while 20% are male.
The new residential program in Denver is structured on routine to help patients model daily life. Patients receive weekly psychiatric evaluations and 24/7 nursing care.
Pandemic obsessions about “healthy” lifestyle changes triggered eating disorders
The pandemic exacerbated eating disorders in part because the diet, weight-loss and exercise industries promoted the isolation era as a time to focus on body transformation and lifestyle changes, said Velissaris, who is also a certified eating disorder specialist consultant. People became obsessed with new hobbies and habits, for better or worse.
“Health and wellness took a life of its own,” she said.
“I think we are seeing an influx of individuals with eating disorders because during COVID they had a lack of access to care and they were also really isolated. People ended up coping with the life change that was thrust upon us with eating disorders. Everybody was trying to figure out how to cope with this strange thing we were going through.”
Eating disorders develop for biological, psychological and social reasons, Velissaris said. Some people are genetically predisposed, and a stressor or life-altering event — like a pandemic — sets the biological factors in motion.
EDCare’s day programs, as well as the non-residential programs at its Denver competitor, Eating Recovery Center, take private insurance as well as Medicaid. Between 50% and 60% of EDCare’s patients have Medicaid. But EDCare’s residential program is the first in Colorado that accepts Medicaid for 24-hour care, which is a game-changer because access to residential programs historically has been limited only to people who have the financial means to pay for care.
“Access to eating disorder treatment is really tied to people that have money,” Velissaris said. “But eating disorders do not discriminate. They don’t care what kind of financial background that you have.”
Eating Recovery Center said it is “working on” plans to accept Medicaid in its residential program this year, public relations director Meg Mulcahy said.
The cost of residential treatment ranges from $1,000 to $2,500 per day nationally, and depends heavily on the contracts negotiated between eating disorder centers and insurance companies. The average length of stay for patients is four to eight weeks, until they are healthy enough to step down to a nonresidential program.
While affordable eating disorder treatment is in high demand, facilities still have to work to restore some of the public trust that was lost after the exposure of mistreatment in Colorado.
“EDCare is an empowerment program. We provide individualized care to the person,” Velissaris said, noting that patients are not forced to eat meat or any other food that is against their moral or religious principles. “We are also an unlocked unit that respects patients rights. A person is free to come to our program and they are free to leave the program.”
When the new law takes effect in a year, it will affect only facility-based treatment, not individual clinicians who offer counseling or other outpatient care. That means the Behavioral Health Administration will not maintain licensing records or have oversight of independent clinicians treating eating disorders.