Organizations Work to Improve Recognition, Treatment of Eating Disorders

With healthcare reform the topic of the day, eating disorders organizations across the country are working to increase overall awareness of the seriousness of eating disorders and to improve insurance coverage for treatment. The Academy for Eating Disorders recently published a position paper stressing that eating disorders are serious mental illnesses. The paper states, “anorexia nervosa and bulimia nervosa, along with their variants, are biologically based, serious mental illnesses that warrant the same level and breadth of health care coverage as conditions currently classified in this way, such as schizophrenia, bipolar disease, depression, and obsessive-compulsive disorder” (Int J Eat Disord 2009; 42:97).

The authors of the position paper, including Drs. Kelly L. Klump, Cynthia M. Bulik, Walter H. Kaye, Janet Treasure, and Edward Tyson, stress that, in the U.S., eating disorders should receive health care coverage and research funding equal to that of medical disorders as well as psychiatric conditions categorized as serious forms of mental illness. In other parts of the world, eating disorders should be recognized as serious forms of mental illness that deserve national recognition and funding. Changes in these designations here and around the world “will ensure equal access to treatment and resources for all forms of serious mental illnesses,” according to the authors.

Eating Disorders Coalition and the FREED ACT

An advocacy group has also been hard at work attempting to make treatment of eating disorders a public health priority. In mid-September, the Eating Disorders Coalition (EDC) hosted its second Lobby Day of 2009 in Washington, DC. The EDC (www.eatingdisorderscoalition.org) is made up of professional eating disorders groups and advocacy-based groups, with the goal of advancing recognition of eating disorders at the federal level. The group’s goal is building further momentum around the proposed FREED Act (Federal Response to Eliminate Eating Disorders Act, H.R. 1193). The legislation is the first eating disorders legislation to comprehensively promote research, treatment, education, and prevention programs. The EDC gained six new cosponsors for the FREED Act since their Lobby Day in Washington in April, and now have 18 co-sponsors of the bill.

What the FREED Bill Contains

The FREED bill, introduced on February 24, 2009, and now in subcommittee, amends the Public Health Service Act (PHSA) to require the Director of the National Institutes of Health (NIH) to take certain actions regarding eating disorder research, including:

1. implementing a scientifically justified budget for research on eating disorders;
2. coordinating and evaluating NIH research activities and programs;
3. expanding NIH research on eating disorders;
4. establishing a task force on eating disorder research; and
5. providing for centers of excellence for research on eating disorders.

The bill requires the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention (CDC):

1. to provide for the collection, analysis, and reporting of epidemiological data on eating disorders;
2. to establish a Center of Eating Disorders Epidemiology, to collect and analyze information on eating disorders; and
3. to establish a CDC clearinghouse for the collection and storage of data generated under the Act.

The bill also sets forth provisions providing for education and training on eating disorders, including requirements for:

1. developing and implementing a training program for health professionals on eating disorders;
2. establishing the Task Force on Eating Disorders Prevention in Educational Institutions to develop and provide training on eating disorders identification and prevention for students, faculty, coaches, and staff in schools; and
3. conducting public service announcements.

It amends the PHSA, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code, to require that a group health plan that provides medical and surgical benefits must also provide coverage for eating disorders. This would apply to coverage offered in the individual insurance market and under the Federal Employees Health Benefit Program. (Note: Some elements of ERISA have unintended consequences; for example, one provision in ERISA blocks lawsuits against many insurance companies, and has been used by some to avoid paying for eating disorders treatment.)

Bill Stresses the Seriousness of Eating Disorders

In a letter to Congressman Kennedy in May, the organization explained the overall importance of the act. They wrote, “The FREED Act is necessary for many reasons, but perhaps most importantly because thousands of Americans die each year as a result of an eating disorder. Eating disorders carry with them serious and often lethal health consequences, including cardiac arrhythmia, loss of brain mass, osteoporosis, diabetes, infertility, asthma, bowel paralysis, depression, and heart failure. In fact, anorexia nervosa has the highest death rate of all mental disorders.

The good news is that with early detection and adequate and appropriate treatment, eating disorders can be overcome. As with other mental illnesses, we know that eating disorders need not be hopeless, chronic, or deadly diseases–early diagnosis and treatment bring greater chances for survival and complete recovery. With the passing of the FREED Act more people have a chance of being diagnosed early and treated appropriately. The FREED Act offers hope to millions of Americans.”