Coinciding with National Eating Disorder Awareness Week, Sen. Shelley Moore Capito, R-W.Va., toured the state’s most comprehensive eating disorder treatment facility on Monday.
The West Virginia University Disordered Eating Center of Charleston not only provides evidence-based, outpatient treatment for individuals, but also consults and trains providers across the state to increase treatment availability for rural populations.
But with no existing inpatient treatment centers in the state — and a 54 percent increase in Medicaid enrollment over the last two years — West Virginians with limited means have a lower chance of receiving the help they need.
“Some patients aren’t even able to come [for treatment] every week because they have to save up their gas money,” said Dr. Jessica Luzier, the center’s clinical director.
Out-of-state treatment for those individuals, she added, “is just not an option.” Medicaid often doesn’t pay for out-of-state eating disorder treatment.
When Sen. Amy Klobuchar, D-Minn., asked if Capito would co-sponsor the Anna Westin Act, Capito agreed. The legislation is named for a young woman whose insurance company wouldn’t cover intensive treatment for her anorexia nervosa because it claimed such treatment wasn’t “medically necessary.” Westin committed suicide in 2000 — the second leading cause of death among people with anorexia.
If passed, the act would provide training to healthcare providers and school faculty to identify early warning signs of an eating disorder and how to intervene. It would also clarify existing law to ensure patients are able to receive full health insurance coverage for eating disorder treatment, including residential treatment.
Capito said the bill would encourage states to include such treatment in their Medicaid coverage — something she hopes to see in West Virginia.
“It’s going to cost more money [to not expand coverage] because it’s going to result in higher hospitalizations and more intense medical care,” she said.
The health complications stemming from eating disorders are myriad and often permanent, said Dr. Stephen Sondike, the center’s medical director. The leading cause of death among anorexia patients is heart disease, though other major organs usually shrink and begin to shut down over time.
“Anorexia nervosa has the highest risk for long-term mortality, [while] people with bulimia may have a higher risk of something happening right away because of the electrolyte disturbance that goes along with vomiting or abusing laxatives,” Sondike said.
A person’s cognition and bone density can also suffer lasting effects.
“Some of our 17-year-olds have bone densities consistent with 70-year-old women,” he added. “You don’t build it back.”
In the Mountain State, which is ranked second in the country for obesity and first for type two diabetes, eating disorder awareness often is overlooked by the public and healthcare providers, Sondike said.
“We’re seeing younger and younger kids with eating issues because they’re constantly getting negative nutrition messages,” Sondike said. “Everybody’s wringing their hands over obesity and not thinking about the consequences of constantly telling kids, ‘Go on a diet, restrict your fats, restrict your sugars.’ ”
Nationally, the rate of hospitalizations for eating disorders among children under 12 increased by more than 70 percent between 1999 and 2009, according to a study by the Agency for Healthcare Research and Quality.
In fact, obesity and disordered eating often go hand in hand. Many patients Sondike sees for weight management will skip meals, purge or use laxatives; and they’re just as likely to end up hospitalized as those who are underweight.
“To separate obesity from eating disorders is folly . . . it’s all encompassing,” he said.
The center also has begun tracking patients’ accessibility to food in their communities to see if there’s a connection between disordered eating and food deserts — or areas with no grocery stores or produce markets nearby. So far, the results haven’t shown much variety, Luzier said, because most patients who can get to the center for treatment also have access to nutritious foods.
“We simply can’t reach the folks who can only make it to the convenience store once a week to get food,” Luzier said.
But she also sees a few “unique” eating patterns among patients.
“Sometimes we see folks who go all day without eating, and then they eat what’s available, which is Taco Bell or McDonalds,” she said.
While the center has provided specialized care for disordered eating patients since 2010, its main goal is giving outreach assistance to other healthcare providers in the state through an eating disorder network. First started three years ago, that network has grown to include more than 200 providers across West Virginia.
And yes, the center, located at Charleston Area Medical Center’s Memorial Hospital, does accept Medicaid.
“We’re lucky here. If someone can’t afford treatment with us, we can still find a way to get them [help] because we have WVU and CAMC resources,” Luzier said. “But that’s not the case in a lot of other places.”
Commons signs of eating disorders include drastic weight loss, preoccupation with counting calories, the need to weigh oneself multiple times a day, excessive exercise, binge eating, purging, avoiding meals and taking laxatives or diuretics often. For more information on WVU-DECC, visit www.hsc.wvu .edu/decc/home.