Eating disorder services remained in high demand in 2023. As a result, there were several major investments. But it wasn’t all smooth sailing for the industry. In late 2023, two large PE-backed behavioral health providers scaled back eating disorder services.
Eating disorder providers will have to tackle increasingly complex, higher acuity cases in 2024, industry insiders told Behavioral Health Business. The new year could also bring opportunities to improve efficiency and tailor care models to meet changing needs. Cutting-edge technology and medical advances may also spur more eating disorders or further increase severity.
Additionally, providers anticipate that less invasive treatment options, including outpatient and virtual therapies, will become increasingly popular.
Behavioral Health Business connected with four eating disorder experts to reflect on 2023 and predict challenges, trends and opportunities for the industry in 2024.
Patient demographics, severity of cases will change
Eating disorder treatment providers will continue to see increased rates of younger, more diverse patients with more severe cases, providers predict.
“With the uptick just generally in mental health challenges that we’re seeing, particularly in teens, we’re going to see more eating disorders show up in those individuals, especially since COVID,” Dori Steinberg, Equip’s vice president of research, told BHB. “We’re going to see more of that. It’s great because we know they’ve been there and hidden in plain sight, but now we’ll hopefully be a bit more aware since we’re emphasizing mental health.”
Virtual eating disorder provider Equip operates in all 50 states and offers patients a full care team, including therapists, dietitians, physicians and mentors. The San Diego, California-based company received a $20 million cash infusion in 2023 and expanded to treat adults as well as adolescents.
Equip’s patient base has trended towards younger, more diverse patients. Patients between ages 14 and 18, and some even younger, have increasingly sought eating disorder treatment.
“Eating disorders don’t just affect white affluent, thin people,” Angela Celio Doyle, Equip’s vice president of behavioral health care, said. “It really affects people of all races, gender identities and socio-economic levels. We’re also seeing more males seeking treatment for eating disorders. We always have known that they are out there, and need help and treatment, but for them to actually reach out and seek treatment has been a really welcome change.”
Patients have increasingly presented with higher acuity and more complex cases, a trend that providers say may continue into 2024.
Comorbidities, including depression, anxiety, OCD and PTSD have become more common, as have cases of ED-DMT1, also known as “diabulimia.”
Diabulimia impacts people with diabetes who are insulin-dependent. People with this condition manipulate their insulin dosages to spur weight loss, but can experience imbalances in blood sugar levels. To care for patients with diabulimia, doctors determine insulin-to-carb ratios, implement regular blood sugar checks and work with patients to meet their nutritional needs.
To meet increasing demand for diabulimia treatment, eating disorder provider Alsana has expanded its geographic footprint into more states.
“I don’t know exactly what the contributing factors are but people are coming into treatment more acute, having more medical complications,” Jessica Harris, chief operating officer of Alsana, told BHB. “One of the potential reasons is that people are potentially waiting longer to seek care, so by the time that they get to us, they’re sicker. I think the economy has something to do with that, and individuals’ ability to pay for treatment.”
Alsana offers residential, partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) in Alabama, California and Missouri, along with virtual offerings across the U.S. The Westlake Village, California-based provider specializes in a compassion-focused approach to eating disorder treatment and cares for a broad spectrum of eating, feeding, and co-occurring mental health conditions.
Ozempic may lead to more instances of eating disorders
Weight loss drug Ozempic has become a “blockbuster” diet drug, but eating disorder providers predict that the popular drug will impact patients in more ways than weight loss.
Some providers have increasingly heard clients mention the drug, and predict that more patients’ interest will only increase in 2024.
“The market for it is enormous, and it glorifies what ends up being eating disorder behaviors to lose weight,” Doyle said. “I do think, at worst, it can set off or retrigger an eating disorder. Of people seeking Ozempic, there are quite a number who are at high risk for the development of an eating disorder if they don’t already have one. So it’s a really vulnerable population.”
Research on Ozempic and other semaglutide injection-based drugs suggests that weight lost will return as soon as patients stop taking the drug, meaning that length of use as well as side effects may be lifelong.
Jillian Lampert, chief strategy officer of eating disorder provider Accanto Health, compared the drug to the “fen-phen” (fenfluramine/phentermine) weight loss craze of the 1990s.
“We saw then what I think we’ll see now, where people with eating disorders who also desire to lose weight will try the medications and find that perhaps that’s not the answer to their eating disorder,” Lampert said.
St. Paul, Minnesota-based Accanto is the parent company for eating disorder treatment providers the Emily Program, Veritas Collaborative and Gather Behavioral Health. The companies offer a full continuum of care for eating disorders with an individualized approach.
While Ozempic may spur weight loss, it fails to resolve the deeper pathology of disordered eating, providers said. There could also be room for abusing the medications.
“We know that eating sores are neurobiologically-based illnesses that are often triggered by somebody changing their eating or activity patterns,” Lampert said. “So a medication that leads you to do that might be a trajectory into an eating disorder.”
The double-edged sword of AI
AI technology, which is likely to impact all sectors of the behavioral health space, will be a double-edged sword for eating disorder providers.
Like other segments of the behavioral health industry, eating disorder providers can take advantage of the technology to improve efficiency.
“If it’s used well, AI can triage folks and connect them with the right services they need,” Doyle said. “ It’s so wonderful because it can align limited resources with those who need them. People could be routed more quickly to what they need.”
“In treating eating disorders, every word counts,” Doyle said. “That means that we have to be very thoughtful about how we talk to people who have eating disorders. So, to rely on AI to take the place of a person when delivering treatment is concerning, especially because AI draws from so many sources that are infected by misunderstandings about eating disorders. You can imagine how that could pollute the information AI could provide.”
While providers told BHB that the full impact of AI remains to be seen, the technology’s capabilities are certainly of concern.
“These tools are only going to lead to harmful content being generated,” Steinberg said.
In 2024, patients with eating disorders, especially younger patients and their families, will increasingly seek treatment that is the least disruptive to their lives, providers told BHB. These treatment options will include telehealth appointments and, potentially, an increase in outpatient treatment.
“Families are looking for options that are least disruptive to their child’s education,” Lampert said. “I’m a parent myself. It’s understandable that parents would be loath to interrupt their child’s high school career with something as intensive as eating disorder treatments. So we’re seeing families looking for options that are less intensive.”
While virtual appointments can make treatment more accessible, getting specialized treatment at the right degree of acuity is crucial.
“We’re seeing families who opt for virtual therapy once a week,” Lampert said. They think, ‘That will be enough.’ Then we hear from families a little bit further down the road who say, ‘Oh, that wasn’t enough.’ And how could it be enough if it wasn’t specialty care for an illness that needs specialty care.”
Outpatient treatment has experienced significantly higher levels of demand, with similar goals of minimally impacting patients’ lives. It can also allow providers to reach more patients without being limited to a set number of beds.
“Outpatient is only going to increase because it’s allowing someone to get better in the context of their actual life,” Steinberg said. “If you send some away to a special place where they are sheltered from their actual life, they are going to get better, but they’re more likely to relapse. Hopefully, this movement will lead to longer-lasting recovery and less of a relapse likelihood.”