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Eating Disorders in Kentucky

LOUISVILLE There is a growing concern about the increased prevalence of eating disorders and limited resources to treat these disorders in the state of Kentucky. Further, there are many misconceptions and myths about eating disorders.

Eating disorders (ED) are serious mental illnesses characterized by disturbances in behaviors, thoughts, and feelings towards body weight, shape, and/or food and eating that have a substantial impact on the well-being and quality of life of the person experiencing the eating disorder.

Currently, there are roughly 900,000 individuals, of which 29,000 are children, struggling with an eating disorder in Kentucky. In Louisville, there are approximately 200,000 individuals with ED. These individuals range as young as five years old up to 80 years old with all genders and sexual orientations, across all socioeconomic groups, and from different cultural backgrounds.

According to the Academy of Eating Disorders, nine percent of Kentuckians, approximately 393,345 people, will have an eating disorder in their lifetime. The yearly cost of ED to the economy and society in Kentucky is approximately $883.7 million, with a further breakdown into the cost of ED visits to be over $400 thousand and for inpatient hospitalizations to be $2.9 million. 1

These individuals require close monitoring due to serious medical complications that frequently result from disordered eating behaviors.

A National Problem

Statistics show that in the United States there are 10,200 deaths annually as a direct result from an eating disorder, which equates to one death every 52 minutes These numbers reflect the seriousness of these disorders.2, 3

There are significant gaps and barriers in Kentucky for treating eating disorders. There are very limited treatment options, currently only two IOPs and 1 PHP available for patients. There are no eating disorder psychiatric residential treatment facilities in the state. Individuals who are struggling with ED are required to travel out of town or state to receive treatment.

Another barrier to treatment in Kentucky is insurance. Individuals with Medicaid are limited to almost no options for higher level care outside of the state. There are no established aftercare programs or step-down care available in Kentucky. Many private insurances will cover a patient’s treatment based on BMI only. In addition, clinicians and practitioners are not fully aware of the commonality of ED. As a result, the limited practice of ED screenings can lead to prolonging the diagnosis, prompting more serious complications and risks for the individual.

Another misconception about eating disorders is the stereotypical image that someone with an ED must fit. It is misleading to believe that a person must look a certain way or be a certain size to have an eating disorder, or to rely solely on BMI for a diagnosis. In reality, we are seeing more atypical anorexic patients now compared to classic anorexia nervosa. Individuals with atypical anorexia have a normal or high BMI; they have a higher body weight and become preoccupied with their weight or shape. They will lose a considerable amount of weight, putting them at a risk for malnutrition and starvation. Their weight can drop from the 95th percentile to the 50th percentile, which may still be considered within the normal limit, but it causes severe malnutrition. This is why it is highly recommended to use other health metrics, along with BMI, when treating individuals with eating disorders

Recently, there have been increased discussions about glucagon-like peptide-1 receptor agonists (GLP-1As) being used as approved or as off-label treatments for weight loss. At the same time, concerns increase about the potential for GLP-1As to impact eating disorder symptomatology. Preliminary research on the use of GLP-1As to treat binge eating has been conducted; however, studies have design limitations and additional research is needed.4

Even with current limited evidence, it is very possible that the use or discontinuation of GLP-1A could exacerbate or contribute to the development of disordered eating behaviors and can negatively impact their treatment. It is extremely important to screen for a history of eating disorders, active eating disorders, and/or vulnerability for an eating disorder when prescribing these medications.

The Stigma of Eating Disorders

Despite increasing efforts to raise awareness for eating disorders, there remains a lack of knowledge and persisting misconceptions about its seriousness. Individuals who grapple with the devastating reality of an ED also face the additional stress and challenges of the serious stigma that presents with it. The stigma attached to these disorders can have significantly negative consequences for the lives of these individuals.

In many cases, social media promotes harmful behaviors and mindsets that can lead to an eating disorder. Research suggests that eating disorders attract more stigma compared to other mental health disorders, such as anxiety or depression. Negative attitudes towards eating disorders are pervasive among the general population, within employment and education institutions, within health services, and even among the friends and families of people experiencing eating disorders.5

It is important to create a weight-inclusive environment that is friendly and respectful to all individuals regardless of their weight, shape, or size. Further work needs to be done to remove the negative attitudes, beliefs, and discrimination against individuals with higher weights. This includes “the development of public campaigns and initiatives to raise

Zubi Suleman, MD

awareness of eating disorders, the development of guidelines for the reporting and portrayal of eating disorders in communication mediums, the establishment of advocacy groups and organizations, and the inclusion of lived experiences within policy development, service design and delivery and organizational governance.”6

Recovery from an eating disorder is a long term process, and it involves overcoming both physical and psychological problems related to it. Early interventions and prevention can play a vital role in significantly reducing the complications and aid in recovery. We all have a role to play in reducing the stigma and discrimination. We also need to strive to increase early screening, ask more questions about eating habits, and promote good health, without the focus of weight management. Together, these steps will aim to reduce medical complications and promote recovery for individuals with an eating disorder.