For the first time in state history, the Colorado legislature last week passed measures to specifically address the issue of eating disorders.
If signed into law by the governor, Senate Bill 14 will create a statewide program to educate and maintain a resource bank on disordered eating research, prevention, intervention and treatments. Senate Bill 176 will prohibit insurance providers from denying coverage of eating disorder treatment due to weight standards, and restrict the sale of diet pills to minors.
In Colorado and nationwide, around one in 10 people will be diagnosed with an eating disorder in their lifetime, most commonly anorexia, bulimia and binge eating disorder. Eating disorders are the second-deadliest mental illness, beat only by opioid-related deaths.
“These bills are a strong first step toward better supporting Coloradans experiencing eating disorders,” said Sen. Dominick Moreno, D-Commerce City, who sponsored both bills. “It was the first time the legislature took up that issue in a meaningful way and we’ll be continuing that work in the future.”
While the passage of these bills is a historic move for Colorado, it didn’t come without concessions. Both bills were significantly changed from their original versions to reduce the price tag for the state.
In the end, SB 176 passed the Senate in a 23-12 vote and the House in a 51-13 vote. Only Republicans voted against the bill, though five Republicans supported it in the House and one — Rep. Brandi Bradley of Littleton — signed on as a sponsor.
SB 14 passed almost entirely along party lines, 23-12 in the Senate and 47-18 in the House. Only one Republican voted “yes” on the bill in either chamber: Rep. Rick Taggart of Grand Junction.
Opponents of the bills argued that eating disorders aren’t an issue lawmakers should be addressing, with some saying legislating medical treatments is not the proper role of government and others saying the government should instead focus on more prevalent causes of death.
“I worry the message we might be sending is that the actual leading causes of mortality and morbidity, the actual top 10 or top 20, are not being prioritized,” said Sen. Jim Smallwood, R-Parker, who voted against the bills. “We don’t have an Office of Unintentional Injuries Prevention, … an Office of Cancer Prevention, … an Office of Heart Disease Prevention.”
Proponents countered that eating disorders disproportionately impact Coloradans, warranting state action. Colorado is a national hub for eating disorder treatment and a 2015 report found that Colorado had the fifth-highest rate of eating disorders in the country among adolescents.
SB 14 initially sought to create a new state office to handle informing youth, parents, schools and primary care providers about preventing, recognizing and treating eating disorders. The Office of Disordered Eating Prevention would have also led a $200,000 grant program to fund research on the prevalence, causes and effects of eating disorders in the state.
In the final version of the bill, the funding for the grant program was removed and the office was downgraded to a program within the Department of Public Health and Environment, though it maintains the same responsibilities.
The changes to SB 176 were even greater. As originally drafted, the bill would have established numerous rules around care practices in eating disorder treatment facilities, all of which were stripped from the final bill to bring the state’s cost of implementation down from over $1.2 million through 2025, to $0.
“The removal of regulatory provisions from the bill reflects the state’s fiscal constraints and the power of corporate influence,” said Vincent Atchity, president and CEO of Mental Health Colorado, which developed SB 176. “Allowing the health of corporations to take precedence over human health and well-being is what we often do in the U.S. and should come as no surprise to anyone.”
Before the amendments, SB 176 would have, in part, required treatment facilities to provide private weigh-ins and medical exams for patients when requested, prohibited staff from being in a single bathroom stall with a patient, required appropriate bathroom accommodations for non-binary and transgender patients, and made bed-based care, room-based care and forced tube feeding a last resort.
Advocates said the bill was inspired by “traumatic” personal experiences of people who have worked at or stayed in eating disorder treatment facilities. The facilities pushed back against the bill, defending the practices as results of staffing shortages or necessities for the often life-or-death cases they are forced to address.
The final version of SB 176 would still prohibit insurance providers from using body mass index (BMI) or other weight standards to determine the level of care for a patient — though it could be considered for anorexia patients specifically in combination with the patient’s eating behaviors, needs for support or supervision, laboratory results and potential co-occurring disorders.
Proponents of the bill said eliminating BMI considerations is especially important as less than 6% of people with eating disorders are medically diagnosed as “underweight.” During public hearings on the bill, many witnesses spoke of being denied access to or kicked out of treatment facilities for regaining small amounts of weight, leading to relapses in their eating disorders as soon as they go home.
Lori Ventimiglia of Lakewood said her two daughters have both struggled with anorexia since they were 12 years old. They were hospitalized five times, during which Ventimiglia said they’d only stay for around 30 days before insurance declared them “weight restored” and they were discharged.
“I witnessed repeatedly how this set up a series of relapses and extreme anguish,” Ventimiglia said. “Insurance funding needs to cover patients through the healing of the whole person: physical, emotional and spiritual.”
The bill would also prohibit the sale of over-the-counter diet pills to Coloradans under the age of 18 without a prescription. This is narrowed from the originally-proposed ban of all dietary supplements.
Youth who use diet pills are six times more likely than non-users to be diagnosed with an eating disorder within three years, according to the National Alliance for Eating Disorders. A Harvard University study found that, in 2018, 490 people in Colorado visited emergency rooms due to adverse events linked with dietary supplements.
A hand-painted sign with a positive message hangs on the wall in the Evergreen Group Room at the Eating Recovery Center Denver on Monday, March 13, 2023, in Denver, Colo. (Timothy Hurst/Denver Gazette)
Timothy Hurst/Denver Gazette
Since 2019, the Eating Disorder Foundation in Denver said its average monthly sign-ups for support groups have increased 1,000%, which experts attribute to the mental health impacts caused by the COVID-19 pandemic. The Eating Recovery Center in Colorado similarly reported a “remarkable” uptick in patients in the last three years, particularly among teens and children.
Nationally, around 10,200 people die from eating disorders each year, amounting to around one death every 52 minutes.
Despite the many amendments made to the bills, proponents still celebrated their passage as a major step in the right direction for Colorado — and vowed to continue pushing for change.
“The effort to pass this bill, however reduced in its final form, served the important purpose of raising awareness,” Atchity said. “Mental Health Colorado will persist in our efforts to make human health and well-being the dominant priority for Colorado lawmakers. We will be back.”
Aimee Resnick, a teenager who developed SB 14 with the Colorado Youth Advisory Council, said she is “thrilled” with the bill’s passage. Even with the amendments, she said she is “content” and that the bill will enact the council’s original goals.
SB 14 was partly inspired by Resnick’s own experience with disordered eating.
Resnick said she was teased and bullied for being “bigger” than her peers throughout middle school and early high school, leading her to begin starving herself. Resnick was eventually diagnosed with anorexia and, in 2020 at 15 years old, she attempted suicide due to her eating disorder.
“Thinking about the bill’s passage brings me to tears,” Resnick, now 18, said. “I am so thankful for this opportunity to convert my experiences into action. This law will save lives.”
Gov. Jared Polis has until June 7 to sign or veto the bills.
