Behavioral Trade Association’s New Leader: We Need to Stop Compartmentalizing Eating Disorders

Despite the fact that eating disorders are one of the most deadly behavioral health conditions, treatment providers in the space rarely get the policy and payer support they need. Just ask Joel Jahraus.

By day, he is the chief medical officer at Monte Nido & Affiliates, a Miami-based eating disorder treatment provider that offers inpatient services and day programs out of more than 30 facilities across 12 states. Now, he’s taking on an additional role in the worldwide fight against eating disorders.

In January, Jahraus became the president of the International Association of Eating Disorders Professionals (iaedp) Board of Directors. An iaedp member for more than 20 years, Jahraus spent a year as iaedp’s president-elect before officially assuming the role of president on January 1 for a two-year term.

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To say that professionals and providers like Jahraus have their work cut out for them is an understatement. An estimated 30 million Americans are suffering from eating disorders, and numbers worldwide have doubled over the past couple of decades.

Research has shown that eating disorders are the second most deadly diagnosed behavioral health condition, just behind opioid use disorder (OUD). And the pandemic has only worsened the situation, with the National Eating Disorders Association reporting a 40% rise in calls to their hotline since March of last year.

Jahraus says he’s up for the challenge of heading up the industry’s leading organization for eating disorder treatment professionals while also balancing his day job at Monte Nido, which is owned by private equity firm Levine Leichtman Capital Partners and will celebrate its 25th anniversary in April.

Jahraus recently spoke to Behavioral Health Business to highlight his priorities at iaedp and his goals for Monte Nido, which include breaking down silos in eating disorder treatment, drumming up support for treatment providers, raising public awareness about eating disorders and more.

You can find BHB’s conversation with Jahraus below, edited for length and clarity.

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BHB: The new year kicked off on an active note for you, as you began your term as board president of iaedp. What are some of the near-term and long-term plans you have in mind for the organization?

Jahraus: The primary reason … for iaedp is educating professionals, connecting professionals and bringing them together as a team. I think we do a really outstanding job of that, but we’re extending our reach right now.

[We’re] moving into other countries, developing chapters in European countries, African countries [and] many in Latin America.

We also look at access to care as being an issue. [We’re] building tools through this educational process for non-eating disorder trained professionals to better recognize what eating disorders are.

Studies have shown a rise in eating disorders since the pandemic began. What might this mean for iaedp?

There’s more need for lowering the barriers to care, getting the word out and educating both [eating disorders] professionals and non-professionals.

The vast majority of individuals with eating disorders will make first contact with a primary care physician, nurse practitioner or other providers that may not know a lot about eating disorders. We’re trying to get the message out and help educate in all facets of the healthcare world as to what [providers] really need to be looking at and how these [issues] need to be taken care of.

When you look at anorexia, bulimia [and] binge eating disorder, they are very complex illnesses because they’re primary mental health diagnoses, but they’re one of the few [conditions] that really crosses that [medical] boundary. You get people that are very ill medically, and we have to help people understand it’s a combination of those factors.

It seems that when it comes to advocacy for eating disorder treatment, it tends to get less media coverage than mental health and addiction treatment. What’s the industry doing to bring more attention to the issue?

We have the Residential Eating Disorder Consortium trying to make inroads for residential treatment of eating disorders. And there’s also the Eating Disorders Coalition, the primary political organization that advocates for people with eating disorders.

I think it’s very hard for many people to understand that this illness does cross that gap between medical and mental health. Everybody tries to put things in a pure diagnosis… even the insurance companies. When you try and compartmentalize those things, people just don’t understand — and what they don’t understand gets pushed off to the side.

The other thing … is that … the absolute number of patients with eating disorders is [small] as recognized by the statistics out there. However, what [people are] not taking into account — [although] we know it as eating disorder treatment professionals — [is] there’s a huge number of our patients that have comorbid issues like substance abuse. In fact, almost 50% have these kinds of problems as well. So it’s not at all uncommon to see somebody with anorexia who also has troubles with alcohol or opiates. We’ve got to learn to look at the big package and not try and compartmentalize everything all the time.

Anorexia has the highest mortality rate of any mental health diagnosis … and yet it’s still pushed off to the side. I think we’re making inroads, but we’ve got a long way to go.

There’s never been a greater need for eating disorder treatment, and we want to be out there to meet the demand for that treatment. We’re expanding our footprint to all areas of the country and making sure that we’re out there providing services. We’re known very favorably for our innovative work in treating eating disorder patients.

How are you splitting your time between this new post with iaedp and your everyday responsibilities with Monte Nido?

The good news is that I’ve got a boss — [Monte Nido CEO Candy Henderson] — who recognizes the fact that it’s good to have individuals in leadership positions in professional organizations to help spread the word on eating disorders. Likewise, iaedp recognizes that I’ve got a primary job. I don’t have any problems with balancing the two because I’ve got great people that really understand.

Like you mentioned, growth is on the agenda for Monte Nido & Affiliates. It recently opened a new center in Portland, in addition to announcing the acquisition of Arizona-based Rosewood Centers. As Monte Nido’s chief medical officer, can you tell us more about the company’s 2021 goals?

Expanding our footprint in response to the incredible demand for eating disorder treatment services [is important].

We have a lot of requests specifically for Monte Nido programs because of our past history and recognition of what we do. The word needs to get out even more. We’re going to be out … in locations where we can meet that demand.

Monte Nido CEO Candy Henderson recently talked to BHB about the company’s services. Can you provide more insight into the services the company provides, as well as any additional services that might be coming down the pike?

Eating disorder treatment is not just one level of care. It’s multiple levels of care, because you can’t take a patient who has spent a couple of months in a residential or inpatient setting for eating disorder treatment services — which is 24/7 — and then suddenly expect them to go to weekly outpatient visits and do well. Rather, we step them down.

We have inpatient [services] in Arizona [at Rosewood]. We have residential services throughout the country. We have partial hospitalization programs, which are up to eight hours a day for treatment, but they go home at nighttime. Then we’ve got intensive outpatient services, which would be three hour periods three or four times a week that gradually steps this individual down.

We have some very innovative approaches that we’re taking on issues such as trauma. A huge number of patients have trauma issues that precipitate their eating disorder. It could be bullying, it could be sexual abuse [or] comments that people made about their height or their weight. Those are things that create this trauma, and it’s like peeling off the layers of an onion to get at the root cause of what it is. We’ve come up with some very innovative ways of doing that, and are utilizing… cognitive processing therapy where we’ve done a lot of the work looking into that [trauma] and the benefit of it [for] our patients.

How do you rate the eating disorder industry as far as making services available to people in need?

I think our industry has done a really good job of trying to adapt and develop the capacity to treat people. Now, it’s a matter of continuing to develop additional program capacity, which is obviously what we’re doing — and trying to do it quickly.

It seems like we’re rounding a corner with the coronavirus, now that vaccines are available and more people are getting them. Even after we put the pandemic behind us, what sort of work lays ahead for the eating disorder treatment industry?

The average treatment time for eating disorders is measured in years, not months or weeks.

COVID, with the trauma [and] the isolation associated with it … has simply increased the anxiety and depression that are comorbid illnesses most commonly associated with eating disorders. Those aren’t going away anytime soon.

Those individuals are going to be experiencing these things for a very long time.

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