Eating disorders are among the most deadly and pervasive behavioral conditions, afflicting an estimated 30 million Americans and twice as many people worldwide as they did back in 2000. The pandemic has only made things worse: Calls to eating disorder hotlines have surged since March of last year.
And as is true across the behavioral health industry at large, there just aren’t enough clinicians to keep up with demand. But there’s a growing push to change that with the help of coaches.
“Coaches are helping guide [people] in behavioral skills … to recover [from eating disorders],” Carolyn Costin — a Malibu, California-based psychotherapist and longtime eating disorder expert — told Behavioral Health Business. “Nobody up until now has really been filling that gap. You can have a lot of plans from your therapist and dieticians. But there’s only so much that they can do.”
Costin has been helping treat individuals with eating disorders since 1979. Having overcome anorexia nervosa as a young adult before becoming a psychotherapist, Costin launched Monte Nido & Affiliates in 1996. Today, the company operates over 30 eating disorder treatment clinics across 12 states.
Costin sold Monte Nido in 2016 and not long thereafter established the Carolyn Costin Institute (CCI), which virtually trains students to become certified eating disorder coaches, with an enrollment and tuition fee of $6,200. The goal is to grow the coaching workforce so there are more professionals to offer ongoing, lower-level support.
“Coaching for eating disorders is brand new,” Costin said. “When I decided to open this coaching course, I looked around to see if anyone was training eating disorder coaches. I found one [trainer] from my scan all over the country, … and her course was fairly short, maybe four weeks.”
Unlike therapists and dieticians who have strict schedules for when they meet with patients, coaches are more readily available and have more flexible schedules.
Eating disorder coaches do not provide therapy or dietary instruction — rather, they work within treatment plans laid out by therapists and dietitians. Coaches often make themselves available in-person, by phone or via text, providing support to individuals as they face the day-to-day challenges of recovery.
Costin said the support coaches offer patients is just as vital as the work higher level clinicians do, especially when therapists and dieticians are not around.
“Maybe there’s a ton of food in the house, maybe they’re binging or maybe they left laxatives in the house,” she said, using the example of a patient returning home after receiving residential treatment. “The coach goes in … [and] helps the person transition … back to their life. A coach will go to the grocery store, help them set up their kitchen, help them cook their first few meals … or even help [them] resist the urge to purge their food.”
Demand for CCI is high at the moment, Costin said, with prospective students waiting a month or two to begin coursework.
Costin said that many people question the efficacy of eating disorder coaches — but also noted that they have an important role to play in expanding the workforce and making the treatment more comprehensive.
“I think [the industry is] nervous about it,” she said. “These are complex illnesses. You have to know what you’re doing.”
The growth of behavioral health coaching
Eating disorders aren’t the only behavioral health conditions that can benefit from coaching. In fact, the practice is becoming more popular industry-wide, as stakeholders look for ways to tackle the behavioral health workforce shortage and improve access to services.
“There are just not enough providers out there,” Ginger CEO Russ Glass said during a recent webinar. “Reducing friction to access care is an incredibly important part of [fixing] the problem. [But] what you see is people don’t start in their mental health journey today until they’re pretty acute.”
And as behavioral health conditions become more acute, they also become harder to treat, as therapists and psychiatrists are in short supply and associated with higher costs of care. Meanwhile, coaching is less expensive and presents the opportunity to get ahead of behavioral health issues before they escalate into more serious problems.
“It really gets to the value equation of … making sure employees and audiences are able to access the right level of care, but not in a way that’s super expensive,” Glass told the webinar’s attendees.
Coaching can also help with treatment maintenance, especially in the eating disorder realm.
“Eating disorders often require a lot of treatment for someone to reach recovery,” Ilene Fishman, a therapist and board member of the National Eating Disorders Association, recently told the magazine Elle. “It’s expensive and hard for people to access the care they need — both quantity and quality.”
Lori Muller — an eating disorder coach in the Chicago suburb of Glencoe, Illinois — said coaching can be particularly valuable in times of crisis for patients, given that it costs less and is more immediate than higher levels of care.
“As a coach, I help the client in the ‘Here and Now’ and ‘In the Moment,’ when they are struggling, and support them to accomplish day to day behavior challenges necessary for recovery, serving as both a role model and guide,” Muller told BHB in an email. “I work as a team member and communicate directly with the therapist and dietician regarding the client and the work. I refer clients to both therapists and dieticians if they are currently in need of one.”
Casey Urban is also an eating disorder treatment coach. Based in West New York, New Jersey, she offers in-person support and often shares meals with clients, in addition to leading yoga classes and offering other wellness services.
“Millennials and younger people are more open to coaching,” Urban, who describes herself as “an elder millennial,” told BHB. “People that are more into the holistic field are [also] probably more into coaching.”
Urban said she’s seeing the eating disorder treatment industry steadily — if not unanimously — warming up to the idea of coaches as being a vital part of a patient’s care. Coaches like Muller, who work directly with therapists, feel the same way.
“It is still very new to therapists, but once they have worked with me, I end up with a lot of referrals from them,” Muller said, noting that coaching is generally not covered by insurance. “Because I am not a therapist, I am not restricted by licenses in states, so I am able to Zoom anywhere and take clients in every state, and I can find therapists in every state so my clients can see the therapist in person.”
As eating disorders continue to rise, demand is also poised to grow for coaching services, something Costin says she’s already witnessing.
“What’s happening is therapists who are working with coaches and having positive experiences with coaches are then calling most coaches back,” she said. “My coaches are out there [and] they’re getting a lot of work. I don’t even have enough coaches for the requests that I’m getting.”
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