Anorexia Patients Denied Adequate Coverage

You're right that insurance coverage is inexcusably inadequate for mental health issues. Anorexia is something that should be covered more fully. But it's getting harder to get physical illnesses covered, too.

I'm 5'5" and I once dropped into the high 80s in weight and was stuck around 90 for years. But it wasn't due to anorexia; it was because of a physical illness.

I got saddled with enormous medical bills because of that, too. It seems the coverage is being cut for many things, both physical and mental health issues.

Beyond the mental health aspect of anorexia (which I don't fully understand), many people don't realize that it's physically difficult to gain weight once your body weight drops too far.

You can't just start eating everything in sight; your body rejects the attempts to gain weight. I didn't have a mental health issue. I desperately wanted to regain weight and my body wouldn't let me. It was a difficult problem to overcome. For me, I reached a plateau at 97 pounds that seemed almost impossible to overcome.

So it seems like there are plateaus both in losing and gaining weight.

I've dealt with both sides in my life and if I had to choose, I'd rather be overweight and have to diet to lose it.

Anyway, I'm glad you've recovered. Just one question if you don't mind me asking and I certainly don't mean to offend you with this:

But is anorexia an illness you can recover from completely or is it something you struggle with everyday even after you've regained the weight?

This is a sad truth about the entire healthcare/insurance industry: treat the symptoms, not the problem. Look at all the ads that are out lately for drugs: they all treat the symptoms, so you "feel" better, but the underlying problems still exist.

The medical community needs to start looking at the *whole person*, not just the part with the problem, and the insurance companies need to start rewarding wellness, and not illness. What do I mean by that? That ins. companies should include in their coverage discounts for things like health club membership *and* use, and encouragement for yearly wellness checks, including all necessary bloodwork. I bet that a lot of problems could be solved before they start if we had yearly bloodwork, because we'd have a baseline and history to compare.

As for weight issues, I've had similar trouble with insurance companies, except that I sought treatment for binge-eating disorder. They agreed to cover ten sessions with a family therapist (after denying me access to an eating-disorders specialist). The visits were a complete sham, with the doctor using his anorexic patients as GOOD examples for me!!! I gave up, and continue to struggle with the disorder today.

Once insurance companies starte seeing *people* instead of *profits*, things may change. Until then, I believe we are in for a lot more of the same. Higher prices and less and less coverage.

But is anorexia an illness you can recover from completely or is it something you struggle with everyday even after you've regained the weight?

It really depends on the patient. There are some people who make a 'full' recovery, and there are people who will struggle with it every single day of their lives. Even the people who can eat mostly normally may struggle with anorexic thoughts. It's not an easy thing to get over.
I've been trying for almost 10 years and I'm only 23. I have good days and bad days. Sometimes I'm afraid I'm one of the ones who won't ever get better.

The problem that is discussed here isn't a problem with the patients gaining weight. The problem is that once the patients get above a certain weight and heart rate, they are judged "healthy" and no longer in need of inpatient, even though their mental states may be still very ill. Then they are discharged, and of course relapse, etc, because only the physical problems were addressed, not the mental problems.

You're right about the insurance crisis in this country. I'm in the middle of a full-blown relapse and cannot get my insurance to cover counseling, let alone a nutritionist plus counseling. So I'm just trying to manage it on my own.

Oh well.

Debbie, To answer your question I think it's possible to get much better than you were, however, I don't think many people recover completely - most still have struggles (I do) on a daily basis or otherwise.

Sorry Nic I didn't see your comment.

Here's an alternative view to consider. NO health insurance! Pay for service. I believe that would drastically lower costs of all health care. Without the insurance industry allowing prices to be so high, health care could be much more affordable for everyone.

Claire S. said:
Sorry Nic I didn't see your comment. [...]

Thanks, Nic and Claire S., for answering my question. That's what I thought, but I wasn't sure. I think so much emphasis is put on issues of overweight that anorexia and other eating disorders are dismissed far too lightly.

Even though I've never had the problem, I think I'm going to do some research on it. I may even post about it on my blog (although I may be going off-topic for the people who read it).

But I think there's too much ignorance on this issue. Maybe if we work together, we can raise awareness and get the insurance industry to start taking this seriously.

I don't want to usurp your blog with this, so if you are interested or if you have any thoughts or suggestions for me, feel free to contact me via my blog.

I really need to get educated about this.

Although I never had to go to inpatient treatment, I struggled with EDNOS for a long time and I desperately needed therapy to deal with a lot of my emotional issues. Unfortunately, I couldn't get into an eating disorder therapist unless a doctor referred me. Since I wasn't technically underweight enough to be "anorexic", I had a hard time with that as well. I ended up paying out of my pocket for therapy and I still struggle with eating/over exercising. My disorder was sort of a bulimia where I overexercised to rid myself of the foods...it was not fun or glamorous.

Dr. J--my husband would agree with you 100%. He believes people abuse health insurance because they can. He figures it should be more set up like car insurance...you pay for the maintenance stuff yourself but if your car gets totaled, then you can use insurance. Similarly, if people paid for things like physicals, medication, tests, etc., and only used health insurance for hospital visits, having a baby, etc., the price could probably be a lot more reasonable.

The whole health insurance industry is a sham. It needs to be completely dismantled and separated from government. I agree with an above poster, just pay for individual services like ANY other service.

It really depends on the patient. There are some people who make a 'full' recovery, and there are people who will struggle with it every single day of their lives. Even the people who can eat mostly normally may struggle with anorexic thoughts. It's not an easy thing to get over. I've been trying for almost 10 years and I'm only 23. I have good days and bad days. Sometimes I'm afraid I'm one of the ones who won't ever get better.

You and me both sistah! I even "made it" after traditional inpatient treatment (well after multiple attempts at inpatient treatment where I stayed until my insurance ran out). I finally made some headway when I was threatened with long term inpatient (my parents came into some money and suddenly it was a possibility). I started goign to daily intensive outpatient.

I had lost 2 years out of the 16 I had and I didn't want to go away to hospital for a long long time. I tried to comply with the program, maintain a weight outside the hospital.. I gave myself over to the program where the emphasis was it's ok to eat you have to eat. and I ate and I ate. But the reason I started restricting and purging in the first place was a fear of the obesity I felt was lurking within me (which I have since realized was intended for me by many commercial interests, from the food to the fashion to the diet industry. Intensive outpateint ended and I transitioned into support groups therapy and pharmacology. for a while treatment took up much of every week in addition to going to college (I wasn't able to accept a scholarship to the colellge of my choice and had to stay local to my treatment team.)
By the time I transitioned to bimonthly med checks with my doctor and meetings with a therapist every fortnight, I thought I wasb etter. I started eating like a "normal" American.

I ate my way from 94 to 176.5 pounds in three years. I had gone from a purging anorexic to a a compulsive overeater. I embraced the idea that I was too busy and had other goals besides what I ate... And I ate whatever was handy. At an all American college that is crap. suddenly I had 4.0 but I was overweight. I still felt a failure.

I joined what is typically known as a "pro-ana" website a few years ago. The community of active, uncertain, recovered and struggled ED sufferers (or ED believers depnding on who you are asking in the group) has helped me to find a balance between the two extremes, and I think this is the best I can have for now. But they saved me from running back into the arms of true anorexia, where I had no controland I was destroying my body and my mind so rapidly. the community I belong to generally stresses safety and health, but we are seen as harbingers of death, cheerleaders for mental illness. It's not true, at least for the community I belong to. We care baout each other, and can often offer advice we are too struggling to take. When you dont' want your friends to die it helps you not want to die. And now I have community of friends who understand what i'm working with. where my limits are. treatment was so forced, so commandeering, I didn't learnr how to do it on my own there. I did it with other anorectics, bulimics, ed-nos sufferes, compulsive over eaters and other real people living in the real world.

I don't know why I wrote all that, this ain't my blog! I just wonder if there is something to be learned from my story. I hhope so. I've been maintaining between 120-and 130 (the right weight for my height, even my therapist can't deny it) for eight months. I have between 5 and 13 pounds I can still lose and be healthy according to standard weight charts. Ok I 'll do that. I don't want to be sick, and I can't live inthis culture and be fat. It's ain't healthy and it ain't socially acceptable. that's why I got thin in the first place.

oniana said:
that's why I got thin in the first place.[...]

I completely agree with the comments about paying for many of the things one needs yourself rather than relying on insurance. As a generality, I have heard so many comments from 'well, I would LOVE to change over to alternative medicine, but the insurance doesn't cover it' (this from someone with a minor problem unwilling to pay a fee that some people pay for a normal lunch with wine over here) to 'well, I know such and such is a much better therapist with an excellent track record, but I'll just stay with the one I have. I don't much like him but the insurance pays.' They wouldn't dream of passing up a vacation or cutting down on booze and cigarettes to help finance their own health.

I know so many Brits used to national health system that the concept of paying themselves is utterly foreign to them...so they'd rather wait months for an appointment etc etc. 'Months'?? when you may have a serious health problem??

We prefer to pay for our own blood/urine etc lab results (that we have a local private docter order). Obligatorily, we show him the results then bring them to our alternative medicine specialists. Thru him we have healthy results.

But I've gotten away from this topic. Not knowing much about anorexia, I recognize that the mental aspect is what causes it in the first place...media and fashion being the possible triggers. But we ourselves can work ourselves into an unhealthy 'mental state'.

I see it as something that starts voluntarily self imposed (as in over eating leading to obesity). To me it seems to fit into the same category as any self imposed habit that is harmful and leads elsewhere...alcoholism (now conveniently dubbed a 'disease') or heavy smoking. In the later two, no one forces one to start excessive drinking or smoking - no one forces one to make wrong nutritional choices - especially in view of ALL the information available on so many areas. These are all addictions that started out of carelessness that then got out of control.

I would like enlightenment in this area about anorexia.

Please, lets not go the path of 'but its in my genes' hence I am predestined to whatever. Sorry, we ALL have various health tendencies...MOST of which WE trigger off due to poor choices only we make. (I refer to here 'my mother was fat/alcoholic so its in my genes - people can also 'inherit' eating/drinking and living a certain way too etc...THAT is changeable and within our control.

So is anorexia a result of becoming obessed with the 'catwalk look' and the 'Hollywood Gaunt Look'/media pressures or what? If not this, then why is anorexia classified a relatively 'new' disorder?

I certainly don't mean to offend anyone, but the media seem to point the finger at becoming obsessed with looking like a fashion model is what 'can' get one into that anorexic downward spiral - a path chosen to follow.

In answer to Patricia(Spain):

Anorexia is not simply a response to images in the media and fashion models. Some anorexics don't even pay attention to or care about fashion and models. Anorexia is a coping method, albeit a very, very flawed and dangerous one, in response to the feeling that one's life is out of control. Extreme caloric restriction or over-exercising gives the anorexic a feeling of control in a life which has presented circumstances that produce anxiety, fear, or distress. As I said, it's a flawed and dangerous method that spirals into mental illness and an addiction to a negative image of oneself.

So why choose it? Is it chosen? I don't believe in blaming one's genes, but I don't believe anyone wakes up one morning and says, "Ok, I'll be anorexic." it's not as simple as reaching for a cigarette. No, the state of mind and thoughts that lead to anorexia gather over time and can be triggered--not by media images, but by trauma, difficult circumstance, and unhappy family situations. Anorexics often come from background where they are not taught emotional intelligence, which is the ability to cope with stress and/or trauma in healthy, life-affirming ways. Treatment and therapy, then, are not simply a matter of gaining weight--ideally it's the process of re-parenting through the guidance of a therapist to learn how to cope better. And it can take a while.

Dr.J said:
Here's an alternative view to consider. NO health insurance! Pay for service. I believe that would drastically lower costs of all health care. Without the insurance industry allowing prices to be so high, health care could be much more affordable for everyone.[...]

Amen.

I would say in my case, I didn't "choose" to become eating disordered but the circumstances leading me into it were ones that are probably common for a lot of ED patients. I went off to college overweight and I gained 30 lbs in 3 months. I felt VERY out of control, especially when I realized I was outgrowing my clothes faster than I ever thought possible. I had a lot of very skinny friends that seemed to have it all together. I decided to get healthier and I stopped eating junk food. I lost weight initially very quickly and I felt absolutely invincible. Having that kind of determination and control in that area of my life made me feel good about myself. I kept on eating right and exercising and it wasn't actually a problem until I got to the point where I was eating only certain foods and working out WAY too much just to burn them off. Even though I wasn't healthy and I knew it, I somehow still felt good about being so thin and being different from everyone else. Being the skinniest person in the room made me feel really virtuous and being able to turn down dessert and fatty foods when others just HAD to have that chocolate brownie really made me feel like I was somehow superior. And that feeling is what kept me going, even when I didn't feel like working out or eating right. I don't know if that's the way it is for anorectics, but that was how it was for me.

Thank you both, Peace Cat and Spectra. Very interesting answers to ponder over. I value your insights. :>)

Spectra said:
you pay for the maintenance stuff yourself but if your car gets totaled, then you can use insurance. [...]

I read an interview with an eating disorder specialist in Time or Newsweek a while ago who said (paraphrase): "The eating disorder patient is usually born with the seeds of the disorder, but the culture loads the gun." There are many many issues that contribute, and culture is one of them, but so is brain chemistry and genetics.
Even if someone doesn't care about fashion or models (which I never did at 15 when I developed my ED), the culture of America and most of the Western world is so screwy right now in terms of women and weight and fat that I don't think I've ever met a woman who eats "normally". Even if they eat healthfully or in adequate amounts, their thoughts about food are not entirely healthy. At least this is my experience.

it's just so so bloddy unfair! I was in an inpaitent for anorexia for about 3 weeks about 3 years ago...I was better for about 4 weeks out of there and the relasped hard. I'm obviously not sure if stying IP would have helped...I'm still sick now, even though I've managed to keep my weight near normal. I'm still so desperatly sick and scared.

Laura said:
[...]The visits were a complete sham, with the doctor using his anorexic patients as GOOD examples for me!!! I gave up, and continue to struggle with the disorder today.

I honestly hope you reported him. He cannot be allowed to be a therapist.

As for health insurance, it is very different here in Brazil. First of all, we do have socialized medicine, and if you get private health insurance, you get a tax cut (since you are not using the governmental system). Second, a lot of things are regulated by law, like the fact they do have to cover all preexisting conditions that are not pregnancy (in that case, they have to cover health care for the mother, but not pay for the delivery). And medications are only covered if they are administered to you in a hospital, otherwise we pay for them (or get them at the public hospital). My insurance is a lot more like car insurance. I have emergency room visits and tests covered, and 1 test and 1 doctor's visit that are non-emergencies a month. It is more than enough to do all kinds of checkups and follow-up on chronic illnesses, and even to fit in a few dermatologist visits to be checked for moles. If you want a 2nd office visit in the same month, you pay 50% of the value, to discourage people from abusing it.

So, I checked my mother-in-law's insurance statement last year (we have the same company) and she'd had 8 *extra* doctor visits in a month, and 5 *extra* tests. Her bill was triple what it would usually be. This seems to work well to discourage hypochondriacs like her.

Jan said:
As for health insurance, it is very different here in Brazil. First of all, we do have socialized medicine, and if you get private health insurance, you get a tax cut (since you are not using the governmental system). Second, a lot of things are regulated by law, like the fact they do have to cover all preexisting conditions that are not pregnancy [...]

Similar story in Australia with the health insurance. We also have socialised medicine, with a tax cut for the privately insured. I've never heard of anyone getting kicked out of treatment.

Wish I'd had power for the last several days, so I could have been more of a participant here...

I agree completely with those who say that the insurance "system" needs a drastic overhaul. Personally, I like the idea of Health Savings Accounts... you still pay monthly premiums, but the money goes into an account and you pay-as-you-go out of that account. In addition, you have a high-deductible "catastrophic" policy that can cover things like broken bones, heart attacks, etc. I believe they can be expanded for pregnancy/delivery coverage, as well.

This would cause people to actually LOOK at what they pay for healthcare. It makes me sick to hear people complain that they have to fork out a whole $10 or $20 for a copay!

To bring this back to the topic at hand - mental health - I think it would open up mental health care, as well... YOU decide when you need to see a psychiatrist, YOU decide if you need a specialst, and your catastrophic policy might just cover that in-patient care.

Stellar said:
Similar story in Australia with the health insurance. We also have socialised medicine, with a tax cut for the privately insured. I've never heard of anyone getting kicked out of treatment.
[...]

Yes! It makes me wonder why insurance is as unregulated as it is in America, and they can do whatever they want. Other than cosmetic surgery (not plastic surgery to repair scars from accidents etc.), everything is covered here and in Australia. The US doesn't adopt similar policies because it doesn't want to.