On November 6, 2019, the Academy for Eating Disorders (“AED”) in conjunction with the Strategic Training Initiative for the Prevention of Eating Disorders: A Public Health Incubator (“STRIPED”) a research and training program based at the Harvard T.H. Chan School of Public Health and Boston Children’s Hospital, announced they have teamed up to collaborate with economic consulting firm Deloitte Access Economics to develop the most comprehensive report to date on the social and economic costs of eating disorders in the United States.
Although garnering very little media attention in the United States, this Report could result in tremendous breakthroughs in the treatment of eating disorders in the United States. Its importance cannot be understated.
According to the November 6 release, “A national advisory steering committee of members bringing expertise in psychology, medicine, epidemiology, economics, decision sciences, policy, and lived experience with eating disorders will oversee the project. Most of the advisors are members of AED with some additional advisors from outside the field to bring unique perspectives to the work. The Deloitte team will have responsibility for the technical economic modeling and for writing a final scientific paper for publication and a full report to release to policymakers, healthcare provider, and community advocates to inform resource allocation decisions related to research funding and health services.”
So, what does this mean? Isn’t there a significant likelihood that this Report, like many reports before it will simply fall into “the gap” and be disregarded? And what possible impact could it have in the eating disorder industry?
The answers to these questions can be derived from a similar study conducted in Australia, the results of which were released in 2012.
South to Australia
The Australian Deloitte Access Economics report, commissioned by the non-profit Butterfly Foundation for Eating Disorders, studied the economic and social impact of eating disorders including anorexia, bulimia, obesity and binge-eating disorder.
The Australian Report found that 913,000 Australian citizens were living with an eating disorder. This figure dramatically contrasted with the last official estimate released in 2003 by the Australian Institute for Health and Welfare. (“AIHW”) That report estimated the number of people suffering from this disease at 23,464.
The Australian Report also estimated the costs to society in terms of costs of care, productivity cost and deadweight loss defined as “foregone productive opportunities to society associated with higher taxes due to illness.” This estimated “costs to society” was $69 billion in 2012 alone. The costs of treatment alone for eating disorders was found to pose a substantial economic burden. For example, in the Australian private hospital sector, the treatment of an episode of Anorexia was estimated to come second to the cost of cardiac artery bypass surgery.
With regard to the standard mortality rate, the Australian Report, using the then latest meta-analysis of epidemiological studies from the published literature (the so-called gold standard of health research) indicated that mortality rates are almost twice as high for people with eating disorders and 5.86 times higher for people with Anorexia Nervosa compared to those without the conditions.
The Australian Report estimated the productivity impact of eating disorders at $15.1 billion in 2012, similar to the productivity impacts of anxiety and depression which were $17.9 billion in 2010. Of this cost, $2.0 billion was due to lost lifetime earnings for young people who die. Eating disorders also had lengthy duration – an average of around 15 years in survey respondents – which can mean long lasting productivity impacts for those living with eating disorders, such as lower employment participation (costing $6.0 billion) and greater absenteeism ($1.8 billion) and presenteeism ($5.3 billion). Productivity costs were borne largely by individuals, but also by the Australian Federal Government (in the form of less taxation revenue) and by employers (sick leave and lower productivity from presenteeism).
Finally, the Australian Report estimated that for every $1 spent in proactive, preventive care, it saved approximately $4 on reactive treatment care on the back end.
A well-known advocate in Australia opined that the impact of the 2012 Deloitte Study had been MAJOR. That its impact was ongoing. It presented facts, it separated facts from the emotions surrounding the disease, it presented statistics and it accurately calculated the economic cost. She later stated, “All this has been hugely influential in providing a foundation, an irrefutable reference point in challenging and correcting long-held misconceptions about eating disorders and in bringing about action at state and federal government level to improve access to eating disorder services and support.”
Back to the United States
With this background, it is logical to assume that the US Report will structurally be similar in many ways to the Australian Report.
Prevalence estimates would be categorized by the various types of eating disorders set forth in the DSM-V presumably using recent eating disorder surveys for the United States.
For the US Report to be broad based and useful, Deloitte would have to estimate the financial costs of eating disorders on the mental and medical health systems. Presumably, the US Report would include loss of productivity, other financial costs, and loss of well-being proximately caused by eating disorders.
Deloitte would need to estimate efficiency losses (a/k/a “deadweight losses”) caused by eating disorders. Efficiency losses refer to the costs of raising additional taxation revenue to pay for publicly-financed services. Similar efficiency losses should also be estimated for additional taxation revenue as both federal and state governments may need to increase taxes to offset the reduction in revenue.
As with the Australian Report, the US Report should include additional financial costs, people’s pain and suffering and premature death from eating disorders. These factors can be quantified as costs in terms of diminished quality of life. In the Australian Report, the loss of well-being was measured using the burden of disease methodology, which was developed in the 1990s by the World Health Organization, World Bank and Harvard University.
The US Report would need to include diagnosis, complications and comorbidities, prognosis, treatment options, and descriptions of the specific types of eating disorders. Finally, the US Report would need to include a thorough and clear language explanation of the methodologies, data sources and modeling techniques used to calculate the economic burden of eating disorders.
Application in the Industry
If the US Report is as thorough as the Australian Report, its application and use in the United States would be invaluable. The eating disorder industry would have statistics assembled by a reputable third party with no conflicts of interest or any appearance of impropriety.
Accurate mortality rates. Accurate financial cost numbers. Loss of productivity. The financial savings to employers and insurance companies by embracing proactive preventive care instead of reactive, ineffective treatment on the back end. Being able to approach employers, especially those which utilize self-insured, group health insurance plans and advise them that if they spend $1.00 on proactive, preventive care they can save $4.00 on reactive health costs. [Assuming that these are the numbers discovered by Deloitte.]
This Report would also be another weapon in the arsenal for attorneys to use against insurance companies which deny claims in bad faith.
The Report could also be utilized as a baseline in establishing actual evidence based treatment guidelines with em
The US Report could also constitute the foundation upon which eating disorder bills in the nation’s capital and in state capitals are based. Long abandoned bills which once emphasized research could be resurrected since they would now be supported by objective, third party information, statistics and facts. Research exploring that aggressive, preventive, proactive measures with possible pharmacological involvement could be pursued. Bills which emphasize research into this disease and which explore actual evidence based treatment guidelines could be developed.
Imagine having generally recognized and accepted standards of care to treat eating disorders.
The US Report is coming. Undoubtedly, there will be those who oppose or criticize it. In the spirit of openness, certainly their voices will be listened to and when necessary, if legitimate deficiencies are noted, one hopes that they will be addressed. But so too, their incentives, financial or otherwise, who oppose the US Report and its many possible positive ramifications would also be subject to scrutiny.
But, change is coming. And this time, it appears as if that change is for the betterment.