By the time Christina Andrews realized her daughter was struggling with food and body image, she was already in the throes of an eating disorder that would upend the next 17 months of the family’s life.
At just 12 years old, the preteen began restricting her food and lost 25 pounds in a matter of weeks. The added pressures of social media, paired with comparing herself to friends with different body types, created an unhealthy obsession with her weight that quickly spiraled into dangerous habits. While Andrews immediately tried to help her daughter, getting doctors to understand their dire situation — and then finding the right treatment — was a constant battle from the start.
“She stopped eating, she was restricting, and she lost 25 pounds in three weeks. So we knew something bad was happening,” Andrews says. “Our primary care doctor was like, ‘Oh, she’s fine,’ because she was still at, I guess, what was considered an average weight.”
After several more doctor and therapy visits, one medical professional even advised the pre-teen to manage her weight with “two meals a day and a lot of water,” Andrews says. They eventually found a therapist and Andrews’ daughter attended sessions for six months, with little improvement. She had also started purging her food, something Andrews says was “a blow to all of us.”
“She was throwing her lunches away. There were so many tears, meals would last for hours. There was screaming and crying because she was so angry,” she says. “It was traumatizing for her siblings. It was ugly.”
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After private therapy, doctors encouraged her to enter an intensive inpatient treatment center that would have sent her hundreds of miles away from the rest of the family, in a facility with mostly adult patients. Doctors continued to push this as the only option, but Andrews knew there had to be something else that worked for not just her daughter, but the entire family, too.
“I quit my full time job and pulled her out of school. And we went to intensive outpatient here seven days a week,” she says. “I was able to supervise her 24/7. She did 10 weeks but she was not weight-restored and she was still having major eating disorder thoughts.”
A challenge to treat
Eating disorders like anorexia, bulimia and binge eating disorder are notoriously hard to diagnose and treat — of the nearly 30 million people who have eating disorders, 80% of cases will go undetected or not receive treatment, according to the American Psychiatric Nurses Association. Of those who seek inpatient treatment for anorexia or bulimia, only 30-40% fully recover, according to the National Association of Anorexia Nervosa and Associated Disorders, and the relapse rate for these disorders is between 9-65%, according to research published by The University of Toronto.
Like many other mental health services, treatment for eating disorders can be prohibitively expensive, and not always fully covered by insurance. A one-month stay at an inpatient residential treatment center can cost up to $30,000 per month, and average treatment time is 83 days, according to the International Journal of Eating Disorders.
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For Andrews, finding treatment for her daughter became her full-time job, with much of the expense coming out-of-pocket. Leaving her role as a teacher mid-year added financial strain for her family of five, and paying for therapy and outpatient services that were doing little to help her daughter left Andrews feeling stuck.
“I just thought, well, you know, she’s in therapy, maybe things will get better. Maybe things will click, but it didn’t,” she says. “Caregiver burnout is very real. I felt like I was dropping my career, and that was selfish. It was hard for me to deal with.”
Eventually, a recommendation through a Facebook support group led Andrews to Equip, a telehealth platform for eating disorder treatment. Her daughter was enrolled in a yearlong program that matched her and her family with a care team that included a therapist, nutritionist and peer mentors. Finally, Andrews says her daughter began to make progress toward her recovery.
“Within the first four months, she was weight restored, and it was very gradual, but her eating disorder thoughts started to be put aside and she finally recognized she could do this,” Andrews says. “I was told eating disorders have a 30% recovery rate, and that wasn’t good enough for me. I needed her to get better, and Equip really played a huge role in that.”
A virtual care approach to recovery
At Equip, the platform provides treatment for children, teens and adults of all ages. Equip president, Nikia Bergan, says it’s vital that eating disorder treatment meets patients where they are to avoid major life disruptions that could prevent them from seeking care from the start. A virtual model makes this possible.
“The mission of Equip is to provide eating disorder treatment that works for everyone who needs it,” Bergan says. “Virtual treatment really allows patients to live their lives while they’re in treatment, versus having to leave their lives to enter treatment. The treatment team goes with you.”
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Equip provides patients with a five-person care team, and the yearlong program can be done from home. This is essential for supporting not just patients, but working parents managing the stress of an eating disorder in the family, a burden that is quickly felt within the workplace.
“Eating disorders can have a huge negative impact on employers — it costs billions of dollars in productivity losses annually, and there are parents who quit work because of their child’s behavioral health needs,” Bergan says. “That has implications on what they can afford to pay for care, and what kind of care is covered. The benefit of a virtual model that works is that it allows people to be in care without sacrificing all those other elements of their lives.”
The need for pediatric mental health support is on the rise: 54% of employees have sought out behavioral health resources for their children, according to advocacy group On Our Sleeves. Since 2020, employer-spending on pediatric mental health has increased 26%, according to data from the RAND Corporation, a nonprofit thinktank.
But finding the right healthcare solution, especially amid a sea of other telehealth options, is increasingly challenging for employers who are committed to helping their parent populations, says Kristen Weeks, VP of strategy and corporate development at healthcare delivery and navigation platform Accolade. They’ve added Equip to their Trusted Partner Ecosystem, which vets healthcare vendors so employers can more easily offer quality solutions in their benefit plans for more specific and expensive healthcare needs.
“We’re generally trying to make it easier for our employer customers to select best in class solutions in categories that are consequential to them because spending in them is high,” says Weeks. “What we had heard consistently from our employers is that they were overwhelmed by the number of digital health point solutions. For each of our trusted partners, customers are able to trust that they are selecting a solution that has been thoroughly vetted.”
Expanding their services to include eating disorder treatment was a necessary addition, as rates of diagnoses rose during the pandemic and employer requests for solutions became more frequent, Weeks says. Equip’s approach addresses the challenges of traditional eating disorder care, while involving the entire family into their treatment model.
“The clip at which eating disorder diagnoses were growing over the past few years was kind of mind-boggling to our team. But the residential treatment process, which is the standard, can have a lot of unintended negative consequences, like cost and uprooting someone from their home base,” Weeks says. “Figuring out a way for people to recover in the environment that they’re going to need to survive and thrive in was what the Equip team was designing for. And they built on evidence-based family therapy, so you’re going through treatment as a collective unit.”
Navigating the road to recovery
Andrews says she paid around $2,000 out-of-pocket for Equip’s services, and received therapy, coaching and training herself to learn more about what her daughter was going through and how to talk about.
“I utilized all their services that I could. I had a family mentor that I could talk to, who went through it and understood. I did the group support to hear other people talk,” Andrews says. “I needed that support to know that what I was doing was right and that there is a light at the end of the tunnel.”
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Today, Andrews considers her daughter “fully recovered,” and she herself has returned to work and is now pursuing a master’s degree. While Andrews had an empathetic boss who understood what she was going through, continuing to combat stigma around these issues is still an uphill battle, Bergan says.
“The biggest impact on employers is people who are having to take leave for their children or themselves to go away for care. It’s lost time, lost hours, lost productivity, and it has a long-term impact on a family’s ability to stay in the workforce,” Bergan says. “We accept as a society that medical conditions happen to people, but we don’t have that yet for behavioral health. It’s important for companies to make this OK to talk about so we move to get people into treatment more quickly.”
Andrews’ daughter is now a freshman in high school, and while she still has hangups around food and body image, she’s now in her “comeback year” and has a supportive group of friends. Andrews says while the experience was a challenge, it’s made their family stronger.
“She can now look back and say, ‘Mom, even though those times were so ugly, I think they brought us closer.’ She realizes now, ‘I’m so glad you did this for me,'” Andrews says. “Looking back on it, there were ugly times. But it brought us closer because we did that together.”
