ON THE SHOULDERS OF GIANTS

If I’m making an impact, I’m not aware of it. People who make impacts don’t know. They are not thinking about, ‘Oh, how will I look from this angle.’

         Ruth Sharp Altshuler

Some people are just naturally “larger than life.” They instinctually rise above the fray with courage, strength and dignity. They look upon obstacles as opportunities. And when we are touched by them, when their paths cross ours, we instantly know that our lives are so much richer.

So were the lives of Ruth Sharp Altshuler and her husband Dr. Kenneth Altshuler. To go into all of their achievements, to detail the lives they saved, to articulate the many ways in which they left the world a better place would take far too many words and would involve reams of paper. So, I can only summarize the many ways in which they improved society.

Ruth Altshuler was born on March 10, 1924, and raised in a home on Swiss Avenue.  At an early age, Ruth found her calling to help those less fortunate that herself. During one interview, Ruth credited her acts of compassion to one simple thing: “Guilt!” She stated, “When I joined the Junior League, I realized how privileged I had been my whole life. It was fortunate because it made [volunteering] a career for me.” And so, she became one of the most tireless and influential volunteers and civic leaders Dallas has ever seen. Through her decades of philanthropic work, she raised millions for area charities.

In addition to raising millions of dollars, Ruth also donated millions of her own. She served as chairs of both the Carr P. Collins Foundation and the Sharp Foundation. She helped SMU’s students by creating the innovative Altshuler Learning Enhancement Center and helped recognize the university’s outstanding faculty by establishing the Altshuler Distinguished Teaching Professor Award. 

For nearly 50 years she served as an SMU trustee and was the university’s first female board chair. In fact, Ruth’s lifetime of service was filled with many firsts. She was the first woman to serve on a grand jury in Dallas, the one that indicted Jack Ruby for killing Lee Harvey Oswald. She was the first woman on the board of First Republic Bank of Dallas. She was the first woman elected Chairman of the Executive Board of Highland Park United Methodist Church, and first female Chairman of the Board of the United Way of Metropolitan Dallas. She was the first lifetime member elected to the National Salvation Army Advisory Board, and was a founding board member of the Susan G. Komen Breast Cancer Foundation. She was also the first woman to serve as a board member of the Salvation Army of Dallas, Goodwill Industries, and the Dallas Citizens Council. 

President George W. Bush appointed Ruth to the Library of Congress Trust and she served on the board of the Laura Bush Foundation for America’s Libraries.

In 2004, Secretary of State Colin Powell named her to the United States Commission to the United Nations Educational, Scientific and Cultural Organization (UNESCO). In 2011, she became the first person in the U.S. to receive all three national service honors: the Outstanding Philanthropist of the Year Award from the National Society of Fundraising Executives; the national Alexis de Tocqueville Award of the United Way of America, and; the Distinguished Service Award given by the Association of Governing Boards of Universities and Colleges. She was one of three life members of the Salvation Army’s National Advisory Board. 

Ruth was undeniably a tireless and selfless champion for those suffering from mental health issues. And, she will forever be memorialized through her induction into the State of Texas Women’s Hall of Fame.

Toward the end of her life she ended every speech with her favorite quote by Albert Schweitzer, “Example is not the main thing in influencing others. It is the only thing.”  She left us on December 8, 2017 at 93 years old. And her passing left a void that cannot be filled.

So too, her beloved husband, Dr. Kenneth Altshuler also impacted countless lives and saved many more.

Over the course of a twenty-two year career at Columbia University, he became a pioneer in studying mentally ill patients with profound early deafness, and creating services for them. His work was made part of the State services for the mentally ill in New York, and was duplicated in several countries overseas. His awards for his work at Columbia University are too numerous to list.

He left Columbia University in 1977 to become the Chairman of the Department of Psychiatry at UT Southwestern Medical Center in Dallas. Charged with building an outstanding Psychiatry Department from one that was virtually defunct, he recruited outstanding faculty, raised fifty-two million dollars in departmental endowments, and increased the full-time faculty from five to over one hundred.

He received the Texas Star Award from the Texas Mental Health Association, the Outstanding Psychiatric Award from the North Texas Society of Psychiatric Physicians, and he was a two-time recipient of the Prism Award for community service from the Dallas Mental Health Association. On the national scene, Dr. Altshuler served as a Director of the National Board of Medical Examiners, as President of the National Association of Chairmen of Departments of Psychiatry, and as a Board Member and then President of the American Board of Psychiatry and Neurology.

In 1999, Governor George W. Bush appointed him to the Board of the Texas Department of Mental Health and Mental Retardation (1999-2004). Dr. Altshuler left us at age 91 on January 6, 2021. According to those who knew him best, Dr. Altshuler was always a source of clear thinking and deep wisdom, a person to be counted on for kindness and intelligent support.

To recognize the tremendous impact Ruth Altshuler had upon the mental health community in North Texas, Mental Health America of Greater Dallas started the “Ruth Sharp Altshuler Prism Award for Community Service.” This award is given annually to persons or organizations who have made a significant contribution to improving the mental health of the Dallas community. Past recipients have tenaciously fought for years and sometimes decades to improve the mental health of the Dallas County community.

Approximately two weeks ago, I received a call from the Mental Health America of Greater Dallas. During this call, I was told I was to be the recipient of the 2021 Mental Health America of Greater Dallas Ruth Sharp Altshuler Prism Award.

I was not even aware that I had been nominated. And then, after conducting research into the rich lives of Ruth Sharp Altshuler and Dr. Kenneth Altshuler, and after discovering some of the past recipients, I seriously wondered if a mistake had been made. These people were giants. I became involved with the mental health community only after my beloved daughter, Morgan was taken on October 30, 2016. But for that personal tragedy, there is a substantial likelihood that I would not be actively involved in the mental health community. I also believe that whatever meager accomplishments I have managed pale in comparison to past award winners.

And yet perhaps the obstacles, opportunities, twists and turns presented on our soul’s journey are not meant to be fully understood. Perhaps we are only meant to persevere, to keep our egos and selfish wants and perceived needs on the sidelines and continue going forward.

As surely we must.

SB 184 and World Eating Disorders Day

Today, June 2, 2021 is World Eating Disorders Day. For the most part, mainstream society does not know it exists. But, for those who have been devastated by eating disorders, it is one more significant day, a reminder of that which was taken from us. One more noted day in which we remember. A day to remember how parents like me, frighten so many of those involved in the eating disorder community.

But for today, we choose to not mourn the fallen but to embrace the future. For it is only by embracing a future with hope, with compassion, with strength and with resolve, that we can hope to save the lives of others. And so, let us embrace hope by first looking back at the recent past. At an event which occurred that gives us hope for the future.

Thursday, May 20, 2021.  A date the eating disorder community should celebrate. For on that day, an eating disorder bill was approved by a House of Representatives and a State Senate and sent to that state’s governor for signature. And it happened in one of the most unlikely of places. On that date, Senate Bill 184 (SB 184) was sent to Governor Greg Abbott for signature. What was that state? Texas.

What is SB 184?

SB 184 is embedded here:

https://legiscan.com/TX/text/SB184/2021

First, SB 184 was overwhelming approved with support from both Republicans and Democrats in the Texas State House and Senate.

So, why is SB 184 important?

It is axiomatic that when you build anything, a house, an office building, a relationship, an organization, you MUST first build a strong foundation. Without a strong foundation, you are building a mirage, a castle on sand. SB 184 builds a strong foundation. This bill states in material part:

(a)       The Department of State Health Services, in collaboration with the Health and Human Services Commission, shall prepare a report on the prevalence of eating disorders and eating disorder-related deaths in this state. The report must include:

(1)       A regional and statewide statistics regarding the prevalence of eating disorders and eating disorder-related deaths in this state;

(2)       An overview of national trends in eating disorders; and

(3)       An overview of state-funded behavioral health treatment options available to persons with eating disorders.

From that Report,  no later than December 1, 2023, the Department of State Health Services and the Health and Human Services Commission is required to prepare and submit to the legislature a copy of the report and any recommendations for legislative or other action to reduce the prevalence of eating disorders and eating disorder-related deaths in this state.

That’s it.

There is no demand for state funding. No education requirement. No nutritional teaching mandate. No demand for social engineering. Instead, the message of SB 184 is fundamental and clear, that is, we must first thoroughly understand this disease, how prevalent it is, how deadly it is and what current options exist to treat it. For it is only by thoroughly understanding the problem that we can hope to find real life solutions.

Further, this process of analyzing problems has a history of success in the State of Texas. A past legislature mandated a comprehensive white paper on overall mental health services for children in the State of Texas. In December of 2018, a 145 page paper was distributed to all of the incoming Representatives and Senators in Texas. This white paper resulted in SB 11 which created the Texas Child Mental Health Care Consortium which organized a collaborative entity among the health related institutions of higher learning, state agencies and private organizations to study and then find solutions for increasing access to mental health care on a state-wide basis.

On this World Eating Disorders Day, at least in Texas, we choose to not look at mistakes of the past. We choose to not question past decisions or eating disorder organizations or entities. Instead, we choose to embrace hope. We embrace vision. We embrace wisdom. We embrace the opportunity to strive forward, to look toward a brighter future. In Texas, a foundation is being built. A foundation that will support a mighty house upon which we can save lives, one precious life at a time.

NO, WEIGHT STIGMA AND DISCRIMINATION ARE DIFFERENT

Contrary to the belief of a certain eating disorder organization:

Weight stigma and weight discrimination are not the same and in fact, are different in many important ways. There is no “chicken or the egg” argument with regard to weight stigma versus weight discrimination.

Some of the material differences are best illustrated in the following, simple definitions:

Weight stigma involves negative attitudes toward people who are obese. Weight stigma is social devaluation and denigration of people perceived to carry excess weight. This type of stigma is more often than not, a precursor to weight discrimination but does not rise to the level of negative conduct and is not actionable in court. And  yet, it is serious.

Weight discrimination is defined as unequal treatment resulting from stereotypes, rejection or prejudice towards people because they are obese. The unequal treatment is associated purely with a person’s weight. Discrimination is manifested conducted directed toward a person or group of persons.

The judicial system in the United States only considers weight discrimination. Cases filed under the Americans with Disabilities Act (“ADA”) address conduct constituting possible weight discrimination. Despite research demonstrating that negative attitudes are having an impact on how obese people are treated in the workplace, weight discrimination in the workplace is still legal in forty-nine states.

Essentially, this means that due to the long-recognized practice of at-will employment and termination of employment, anyone who is classified as obese may be fired due to weight discrimination in the workplace. This sets a dangerous precedent, one in which employers can body shame their employees. Furthermore, based on the fact that women report more incidents of weight discrimination in the workplace, it reinforces the cultural ideation that women are valued more on how they look, than they are for their skill set.

Why is weight discrimination not illegal?

So, how does our judicial system look upon weight discrimination in the workplace? The laws governing weight discrimination are based on constitutional prohibitions, and on state and federal statutes.

The U.S. Supreme Court has established certain tests for determining whether disparate (different) treatment of a group is discriminatory and illegal. If the treatment is based on what the law refers to as a “suspect classification,” the disparate treatment will be subject to “strict scrutiny.” A suspect classification is some characteristic of the victim, typically immutable (one that cannot be changed, such as age, gender or race), that has no bearing on the person’s ability to perform his or her job. Under current Supreme Court rulings, there are four traits that are considered suspect classifications: race, national origin, religion and alienage (the status of being an alien).

Courts have also identified what are known as “quasi-suspect classifications,” including gender and legitimacy of birth. Actions based on either of these characteristics are subject to “intermediate scrutiny.”

If the basis for the disparate treatment is neither suspect nor quasi-suspect, the court will only concern itself with whether or not there is a “rational basis” to treat the group differently. Disparate treatment based on disability, political affiliation, age, wealth or status as a felon—all are subject to the rational basis test.

Since obesity is not a suspect or quasi-suspect classification, courts will only consider whether there is a rational basis for an employer to treat obese persons differently. But first, the fundamental question, “Is Obesity a Disability?” must be asked. If the answer is always no, the analysis ends at that point. And that is where the Militant Fat Activists (“MFA”) hurt the very cause they are advocating.

Is obesity a disability? If it is not, then for the most part, employers can discriminate based on weight no matter how vociferously the MFAs argue, protest, harass and harangue. If a litigant cannot show that obesity is a “protected class” under the ADA, they will lose.

The ADA protects employees and applicants with disabilities from discrimination, and requires employers to make reasonable accommodations for employees with disabilities. The ADA states that height and weight, within normal parameters, are not disabilities. However, some courts and the Equal Employment Opportunity Commission (EEOC) have found that obesity may qualify as a disability, at least in limited circumstances:

  • If an employee or applicant has an underlying physiological impairment that has resulted in obesity (such as diabetes), the employee may be protected. The employee would have to prove that he or she had a disability as defined by the ADA. In other words, the employee would have to show not only that he or she had such an impairment, but also that it substantially limited a major life activity or major bodily function.
  • The EEOC has said that “severe” obesity, defined as weight that is greater than twice the average weight, is itself an impairment that could be a disability. Again, the employee would have to show that it substantially limited a major life activity or major bodily function.

But, according to the MFAs, obesity is never a disability. They believe that if you even use the biomedical word “obesity” you are “fat-phobic.” You can have health at your size! Medical community be damned … ignore your science, research and facts and listen to our anecdotal stories! If obesity is not ever a disability, then the MFAs who espouse that position are undermining themselves, obesity can never be the basis for a violation of the ADA and companies will be permitted to continue to discriminate at will based on obesity.

Corporations and Weight Discrimination

However, a corporation has no emotional incentive to engage in weight discrimination. From a public relations perspective alone, if a corporation was found to be engaging in overt acts of weight discrimination, the financial and societal ramifications could be devastating. In these times of “The Great Race to the Top of Woke Mountain,” many corporations seem to be vying to be the king of that mountain. “Mirror, mirror on the wall, who is the wokeist one of all?”

So, what incentive does a corporation have to combat weight stigma in the workplace to lessen the likelihood of weight discrimination? We can perhaps find the answer to this question in the February 2020 edition of the Journal of Occupational and Environmental Medicine.

In that Journal, an extensive multi-year study on the economic costs of obesity was published. Its findings showed that when compared with a lower BMI, obesity was associated with higher direct healthcare costs and indirect work loss-related costs, including costs related to disability, absenteeism (absence from work, such as sick leave), and presenteeism (reduction in productivity while at work). This report cited The Milken Institute report. The Milken report estimated a total cost of $1.72 trillion associated with obesity and its related comorbidities in 2016. 

Of this $1.72 trillion, $480.7 billion was incurred in direct health-care costs and $1.24 trillion in lost productivity. This study drew on research evidencing how being obese (as that term is defined by the biomedical community) elevates the risk of diseases such as breast cancer, heart disease, and osteoarthritis, and estimates the cost of medical treatment and lost productivity for each disease.

To combat this loss of revenue, numerous studies indicate that corporations which have an aggressive employee wellness program tend to be more employee friendly places to work. These corporate wellness programs result in improved employee health behaviors, reduced elevated health risks, reduced health care costs, improved productivity, reduced absenteeism, and improves employee recruitment and retention.

Corporations attempt to address obesity issues and weight stigma through extensive employee wellness programs. Corporations, people and organizations have financial incentives to encourage wellness programs. Weight discrimination lawsuits are not likely to succeed. Further, the MFAs continue to sabotage the ability to succeed in courts. So, we are justified in questioning why the MFAs continue to fight losing battles in the eating disorder community when an established fat acceptance community exists and would be far more welcoming.

The National Association to Advance Fat Acceptance (“NAAFA”) was founded in 1969.  It is a non-profit, all volunteer, fat-rights organization. It is dedicated to protecting the rights and improving the quality of life for fat people. The NAAFA seeks to eliminate discrimination based on body size through advocacy, public education and support. MFAs and the NAAFA would seem to be a match made in … well somewhere.

The MFAs may argue that weight stigma and weight discrimination are as important as any other issue because they dramatically impact eating disorders. They argue a Zero Sum Game and detract and distract from all other issues which plague persons afflicted with eating disorders. But, MFAs tend to be primarily “Fat Acceptance Advocate Wolves” first and foremost merely dressed in the sheep’s clothing worn by the eating disorder community.

This is especially true when we consider that not all people who are defined as obese have eating disorders.  With all of the fundamental dysfunctionalities inherent in the eating disorder community, why would any responsible eating disorder organization solicit donations ostensibly for eating disorder advocacy and research and yet then turn around and apply those donated funds to attempts to have weight discrimination laws implemented in various states?

In 2019, one now disgraced, former officer of an eating disorder organization disclosed, “[XXXX] is currently working with five other states in anti-weight discrimination legislation around the country, but there is still plenty of work to be done.”  Weight discrimination? Not eating disorders research or treatment?

And yet as shown above, since this same organization in 2019, demonstrated that it did not understand the significant differences between weight stigma and weight discrimination, it is not surprising that it would pursue its off mission agendas.

Weight stigma is a serious issue. Weight discrimination is a serious issue. Weight stigma can be a triggering element leading to an eating disorder. And yet …

No federal bills on research into eating disorders have been filed since 2013.

There are no generally accepted standards of care in the industry.

There is very little federal or state ethical oversight over therapists and counselors.

There are no agreed upon standards regulating marketing of services provided.

The mortality rate for eating disorders continues to escalate.

Covid-19 has resulted in increased eating disorder issues amongst all populations.

So called eating disorder community leaders refuse to support collaborative studies because of “personality differences.”

Intolerance and animosity have run a number of highly respected mental health care professionals out of the eating disorder community.

With these tremendous issues and problems plaguing the eating disorder realm, are weight stigma and weight discrimination the cross upon which we want to hang not just our future, but the future of our children? After all, NAAFA has 52 years experience in handling fat acceptance and weight discrimination. There is no doubt that the NAAFA would welcome Militant Fat Activists with arms akimbo.

It is long past time for fresh thinking, new ideas and rational, intelligent solutions to be presented. Just as it is long past time for bad actors, charlatans and frauds to be exposed and removed from the community.

Lives depend on it.

Militant Fat Activists – In Nomine Patris, et Filii, et Spiritus, Sancti

The only thing necessary for the triumph of evil is for good men to do nothing.

            Edmund Burke, Irish Statesman and Philosopher

What is objectionable, what is dangerous, about extremists is not that they are extreme, but that they are intolerant. The evil is not what they say about their cause, but what they say about their opponents.

            Robert Kennedy

“… once evil is invited in, tremendous effort is required to show it to the door and kick its cloven hoof off the threshold.”

            E.A. Bucchianeri, Author, Vocation of a Gadfly

For a number of years, Militant Fat Activists (“MFAs”) have been allowed to infiltrate and wreak havoc in the eating disorder community. This is particularly perplexing since obesity, in and of itself, is not recognized nor treated as a mental illness. Whereas, research studies seem to indicate that people at a higher weight are at increased risk of disordered eating compared with the general population, living in a larger body (or “obesity” as it is referred to in a biomedical context) is not an eating disorder or mental disorder. And yet, MFAs have engaged in reprehensible conduct without consequence or ramifications in the eating disorder community.

MFAs have verbally abused, interrupted and harassed medical and mental health experts giving presentations at national and international conferences.

MFAs have demanded that the medical and mental health professionals stop using the terms “obesity” and “overweight” because they are allegedly terms of derision which do not accurately describe a health condition. According to one MFA, “the medical community has it all wrong.”

MFAs have demanded that weight stigma and weight discrimination be elevated to the highest level of importance in the study and research of eating disorders.

MFAs have looked upon the research and treatment of eating disorders as a “Zero Sum Game” in which the eating disorder with the highest mortality rate, anorexia nervosa, must be minimized because anorexia is traditionally represented in the media by thin, white women.

MFAs have taken HAES, a principle that was designed by very few people and which has no research based origins, to address their own, one sided perspectives on social justice and healthcare. They moved it away from  their self-proclaimed, “new, peace movement.” Instead, MFAs have turned it into an angst filled, antagonistic, sordid battleground as they bask in their own self-loathing. If you disagree with any of their positions, you are “fat-phobic.”

MFAs uncompromisingly promote their own positions as superior to all others and thus betray their own core values of inclusion and equality whether you are on the privileged or disadvantaged spectrums.

MFAs refuse to intelligently discuss the obvious medical and societal shortcomings of HAES and instead attempt to denigrate and back stab any persons who do not slavishly adhere to every nuance of HAES no matter how extreme, illogical or ignorant of medical knowledge those positions are.

MFAs make blatant misrepresentations to the general public in order to solicit donations ostensibly for eating disorder advocacy when in truth and in fact, those persons are soliciting donations for “fat-centric” weight discrimination laws.

MFAs utilize and bastardize eating disorder organizations to further their own agendas, agendas which emphasize obesity and fat acceptance rather than eating disorder research.

There are many other ways in which MFAs have caused an incredible amount of harm in the eating disorder community. MFAs cause this harm without regret, without remorse and without apology. And yet ironically, MFAs cannot grasp that they are the very authors of their own destruction.

For with a more reasoned, intelligent, rational approach, “obesity” could have been elevated into a protected right under the Americans with Disabilities Act (“ADA”). As a practical matter, this means that employers could not discriminate against people who are fat, obese or “morbidly obese.” People who provide housing not only could not discriminate but would have to provide special accommodations. Through intelligence, guile, wisdom and collaboration, MFAs could have already reached one of their main goals. And yet even using the word “obesity” is tantamount to waving a red flag in front of a charging bull… a bull which is heedlessly running to its own demise.

So, let’s explore how the MFAs have self-sabotaged their own movement.

There is no Constitutional right to Health Care.

MFAs have argued there is a constitutional right to health care for fat persons or obesity. They are incorrect.

First, the U.S. Constitution does not set forth an explicit right to health care … unless you are incarcerated. The Supreme Court has not interpreted the Constitution as guaranteeing a right to health care services. While the U.S. Constitution and Supreme Court interpretations do not identify a constitutional right to health care for those who cannot afford it, Congress has enacted numerous statutes, such as Medicare, Medicaid, and the Children’s Health Insurance Program, which establish and define specific statutory rights of individuals to receive health care services from the government.

So, any type of argument alleging there is a Constitutional right to health care for obesity or fat people will fail in the United States court system.

Civil Rights laws do not apply to obesity.

Sadly, one now disgraced, former officer of an eating disorder organization stated, “It’s a civil rights issue because people are discriminated against and harmed by their body size.” To characterize that statement as foolishly wrong and misguided would be charitable.

Title VII of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, religion, sex or national origin. Provisions of this civil rights act forbids discrimination on the basis of sex, as well as, race in hiring, promoting, and firing. The Act prohibits discrimination in public accommodations and federally funded programs.

But, Title VII does not include obesity as a protected standard. This means it does not prohibit employers from discriminating based on weight or obesity. In fact, there is no federal law protecting persons who are overweight or obese. Only 1 of the 50 states  has passed legislation protecting overweight or obese people in the workplace.

So without the protections of the Constitution or civil rights laws, the MFAs logically should be turning towards the Americans with Disability Act (“ADA”) for statutory protection and expansion of their mission. And yet, MFAs stubbornly refuse to pursue that option.

The Americans with Disabilities Act

The ADA protects employees with disabilities from discrimination, and requires employers to make reasonable accommodations for employees with disabilities. The ADA states that height and weight, within normal parameters, are not disabilities.

Under the ADA, “disability” is defined as “a physical or mental impairment that substantially limits one or more major life activities of such individual.” In 2008, Congress amended the ADA to provide a broader interpretation of the definition of disability, and added a “regarded as” disabled component of disability discrimination.  Thus, under the amendments, employees who cannot show they have an actual disability within the meaning of the ADA may nonetheless prevail if they can prove their employer regarded them as disabled.

The EEOC issued interpretive guidance explaining that the definition of the term “impairment” does not include physical characteristics, including weight, that are within “normal” range and are not the result of a physiological disorder.  Applying a “natural reading” of the EEOC’s interpretive guidance, four federal courts of appeal (the courts just below the US Supreme Court) have all held that obesity alone, without evidence of an underlying physiological condition, is not a physical impairment amounting to a disability under the ADA. In 2020, the Fifth Circuit in dicta, also made this determination.

Therefore, the law appears to be settling on the principle that obesity only qualifies as a disability under the ADA if it is caused by an underlying physiological disorder or condition (such as Type 2 diabetes, hypertension, or a thyroid disorder) and that obesity is an ADA impairment only if it is the result of an underlying physiological disorder or condition. In addition, the EEOC has said that “severe” obesity, defined as a weight that more than twice the norm, is itself an impairment that could be a disability. Again, the employee would have to show that it substantially limited a major life activity or major bodily function. So, why is this so important?

If the MFAs were willing to intelligently discuss the benefits and drawbacks of HAES and their views on obesity in an objective manner, working with the medical community to further a “severe obesity as a disability” agenda in the court system, that could have resulted in unprecedented progress in advancing their objectivities in the courts, before legislative bodies and in mainstream society. Yet, MFAs cannot get out of their own way.

Hoisted With Her Own Petard

Instead of engaging in a lucid, thoughtful strategic plan emphasizing positivity and long term goals and objectives, the MFAs blindfold themselves and attempt to play a game of checkers using bottlecaps for some of the missing pieces on Funk & Wagnall’s porch.

MFAs do not trust evidence base medical or mental health care for the reason that it allegedly did not help them. They openly state that there are people who are publicly chastised and harmed continuously by the medical profession. They believe that public health in this country is getting it so wrong and that there is a better way. And all people need to do is ignore science and medical professionals and be willing to actually listen to those being harmed.

MFAs seek to play the ultimate Zero Sum Game by stating, “We must also be centering and supporting BiPOC, LGBTQ+, fat therapists and professionals. This is no space for white, straight and thin folks to jump in.”

We even have examples of how MFAs have sabotaged their agenda in court. In the case of Gena Powell vs. Gentiva Health Services, Inc. filed in a federal court in Alabama, Powell worked for the defendant for about one year. Powell alleged that the defendant terminated her employment on the basis of her disability, “morbid obesity,” in violation of her rights under the ADA.  Powell was 5’3”, approximately 230 pounds.

With respect to her weight, Powell testified, “I know I’m overweight, I’m not an idiot.” And then, despite the fact that she sued on the basis that her disability was caused by morbid obesity, she claimed then not to be disabled, that her weight did not impact her job or her daily life activities. No medical expert testimony was offered to refute Powell’s statements. Naturally, the court made short work of Powell’s case.

One can only imagine how differently the case would have turned out had Powell been open to embracing the medical community to assist her claim and lack of self-awareness. A positive decision in the Powell case could have been a springboard for other cases and the precedential value of that decision would have been utilized to further greater knowledge and acceptance of obesity. Instead? Powell is the poster child for the MFAs, destroying her own case and negatively impacting others because she stubbornly turned away from medical science.

That is the perfect characterization of MFAs.

MFAs can no longer be permitted to bellow their angst and anguish to the detriment of those suffering from eating disorders. No longer. The line in the sand must be drawn.

Ramifications

No more. No longer. The lives of far too many children have been offered as sacrifices on the altar of eating disorders.

The MFA’s days of being allowed to poison the messaging of the deadly nature of eating disorders must be over. The MFA’s days of causing dissension, of bullying, of harassing and abusing medical and research professionals are over.

Instead of simply identifying issues and problems and hoping that a solution will “magically appear,” [as is characteristic of MFAs and others in the community] there are practical solutions to address the wrongdoing perpetrated by the MFAs.

Universities which may employ MFAs have ethics committees. Tenure at most universities simply means “due process.” Even tenured professors can be fired for acts of incompetence or unethical or unprofessional conduct. Complaints to those ethics committees can be made.

Every state has oversight boards for counselors, psychologists and psychiatrists. Some professionals have malpractice and general liability insurance policies. Well worded complaints with evidence of gross conduct will start the process and impose accountability.

Eating disorders are a deadly mental illness. The community does not exist for Militant Fact Activists to spew forth their venom, gross incompetence and to parade their injured psyches and fractured egos.

If that is not sufficient then I can arrange for any Militant Fat Activist to meet, face to face with a number of parents whose children have died from this disease. And MFAs can try to convince them that whereas it may be unfortunate that their child died, the fragile egos and self-loathing of the Militant Fat Activists are far more important.

The time of the Militant Fat Activists is over. It surely must be. For the sake of those suffering from eating disorders. And for the sake of those who have died from eating disorders.

THE BATTLE BEFORE US

Courtrooms are battlegrounds where society’s bullies and the oppressed clash, where the victims of abusers seek recompense, and where parties cheated by scalawags seek retribution. … Justice depends upon an array of factors including the prevailing case precedent, the skills of the legal advocates, and the merits of each party’s claims and counterclaims.

― Kilroy J. Oldster, Dead Toad Scrolls

The litigation process is rife with peril. The courtroom is a crucible in which irrelevancies, innuendo, falsehoods and deflection are burned away leaving only … the truth. A skilled attorney well versed in the art of cross examination looks upon an adverse witness as a snake. Through artful questioning, the attorney wields the scalpel of his wording so adroitly, making an incision here, a shallow cut there, that the witness, like a snake, more easily sheds its skin of subterfuge so that only the truth is left.

And yet, when the stakes of litigation are so incredibly high, when the very existence of an organization is at stake, when the needs of our families suffering from mental illness are the predominate issue, we must embrace that which is in the best interest of those who are suffering … and dying. And since the stakes are so incredibly high, life and death, our soul must first look for honorable resolutions. We embrace the translated words of the Chinese general, Sun Tzu in his treatise, “The Art of War,”:

“If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.”

Sun Tzu is referring to a balance of power. He wisely suggests that, at all times, you should make the option of avoiding conflict, or surrendering during conflict, appear more appealing for your enemy.

So too, an honorable resolution was offered to the National Eating Disorder Association in the recent class action lawsuit. In fact, even before the lawsuit was filed numerous communications (at least 15 emails) with NEDA were made attempting resolution. A cordial one hour discussion occurred with NEDA’s interim CEO. Settlement offers were made. No counter resolutions were offered. And so, litigation was filed. Even still, for the sake of the community, early resolution was again attempted.

During the past few months, an honorable resolution through mediation was offered to NEDA. An olive branch. Mediation is a private opportunity in which all parties air the strengths and weaknesses of their case and a skilled mediator utilizes this information to attempt settlement of the case. The process is confidential. A settlement which would lead to hope for those families who are so suffering from this disease.

And so, mediation was scheduled for March 11. After this date had been agreed upon, an alleged “conflict” arose with NEDA’s representative and NEDA asked to reschedule. Another date was set, this time April 2. And again, because of an alleged mistake by the attorneys retained by the insurance company for NEDA, mediation will not occur. And with that, hope for an expeditious resolution faded away.

With the federal court demanding progress, with the hope of resolution through early mediation extinguished, we surely must now go to war. And to war we will go. With courage. With strength. With the facts and law on our side. With absolute resolve.

In litigation as in war, you achieve victory by engaging in a relentless, aggressive, well-orchestrated and carefully designed plan to obtain victory and deprive your opponent of the initiative. You make your opponent pay a price higher than it expected for choosing the path of war.

So, war it is. In litigation, an attorney has the power of the legal system at his/her beck and call. Issuing subpoenas for relevant documents not just from the named parties but also from third parties and witnesses. Deposing people who may have information of relevant facts. Uncovering lies. Exposing fear, arrogance, greed and collusion. Discovering facts which support long held suppositions. Where necessary, including third parties as possible liable parties. Hundreds of hours spent on the process. The uncertainty.  The unexpected. For example, did United Behavioral Healthcare dare to consider that in the Wit case, it would lose its ability to control its own claims process and possibly have to pay attorneys’ fees exceeding $3o million dollars?

The greatest truth to embrace, the truth that keeps one focused through this great process is the reality that people who suffer from eating disorders will undoubtedly benefit from this challenge. Families who suffer from this disease may find comfort and greater opportunities to heal. Fraud, and those who perpetrate it will at long last be exposed.

And yet, we must continually be looking forward, always forward. We cannot look back at those who have died from this disease. But, we can help those who still suffer. THAT is what this lawsuit is about. Saving lives. That is the absolute reality which keeps one focused, which guides one through the turbulent days, weeks, months and years which lie ahead. Saving lives.

And so, “Once more unto the breach dear friends, once more …”

NOW BEHOLD, THE AWFUL PRICE OF TREASON!

Mel Gibson’s epic 1995 movie, “Braveheart” told the tale of one of the Scottish rebellion led by William Wallace against King Edward I and England. The movie did take some liberties with facts and portrayed King Edward I rather harshly. It also included the largely factual torture and death of William Wallace who was found guilty of treason against the Crown.

Immediately before the start of his torture, Wallace is given the opportunity to repent and if he did, he would receive a merciful death. When he refuses, the executioner yells to the leering crowd, “Now Behold, the Awful Price of Treason!” Wallace is tortured in a particularly gruesome manner and killed.

So too, our friends at United Behavioral Healthcare (“UBH”) are facing their own calls to repent. And like William Wallace, UBH is refusing and is having to face the consequences for its own acts of treason.

In prior articles, the importance of the Wit, et al v. United Behavioral Healthcare case to the mental health industry was explained. To briefly recap, a federal magistrate judge certified that the case could continue as a class action thereby impacting as many as 50,000 insureds of UBH. Then, on March 5, 2019, that judge issued a sweeping ruling holding that UBH on a class wide basis, violated its fiduciary duties to its insureds, ran its treatment guidelines through its finance and accounting departments, and improperly denied payment for necessary treatment. The ramifications and remedies for this bad faith conduct were yet to be determined.

In order to try to minimize the damage, on September 13, 2019, UBH made an announcement regarding new level of care guidelines for treatment of mental health disorders. UBH “voluntarily” stated that it would be implementing and enforcing guidelines developed by third parties to guide payment/treatment decisions for their insureds. According to UBH, they changed their prior level of care guidelines because the L/C/E “guidelines have been externally validated; that common language drives improved care and the six dimensions provide a more holistic view of acuity and chronicity of behavioral condition, thereby promoting more appropriate care for patients and a better overall experience.”

For some reason known only to God and broccoli, UBH failed to mention that they also presumably changed their guidelines because a federal court decision held their prior guidelines were grossly deficient if not outright fraudulent and the Sword of Damocles was hanging over their heads.

That Sword has now dropped.

In November 2020, Magistrate Judge Spero issued a 99 page ruling setting forth the “Awful Price” UBH must pay for its “acts of treason.” That ruling is embedded here:

https://www.courtlistener.com/recap/gov.uscourts.cand.277588/gov.uscourts.cand.277588.491.0.pdf

The first indication that UBH’s “Awful Price” would be steep is contained in the first sentences of the order:

This case arises out of pervasive and long-standing violations of ERISA by United Behavioral Health (“UBH”). UBH denied mental health and substance use disorder treatment coverage to tens of thousands of class members using internal guidelines that were inconsistent with the terms of the class members’ health insurance plans. UBH engaged in this course of conduct deliberately, to protect its bottom line. To conceal its misconduct, UBH lied to state regulators and UBH executives with responsibility for drafting and implementing the guidelines deliberately attempted to mislead the Court at trial in this matter. After the trial, the Court found for Plaintiffs.”

UBH must now reprocess 67,000 claims it denied for 50,000 people from 2011 to 2017. The Court entered a permanent injunction against UBH requiring UBH to evaluate claims using independent guidelines developed by professional mental health associations instead of its internal guidelines, which it had previously used to protect its bottom line.

The injunction requires UBH to use the Level of Care Utilization System (LOCUS), Child and Adolescent Service Intensity Instrument (CASII), and Early Childhood Service Intensity Instrument (ECSII)—assessment tools developed by the American Association of Community Psychiatry (LOCUS) and the Academy of Child and Adolescent Psychiatry (CASII and ECSII)—as well as criteria developed by the American Society of Addiction Medicine.

This injunction is effective for the next ten (10) years.

The injunction also requires that UBH personnel be trained in the use of the court-ordered medical necessity criteria.

On January 27, 2021, the Court appointed Mr. Douglas Young as Special Master to oversee UBH’s claims process and to ensure UBH applies the new standards, created by professional groups including the American Society of Addiction Medicine and the American Association of Community Psychiatrists. Mr. Young has the authority to retain attorneys and assistant administrators, to engage one or more psychiatrists to engage in the claims process. UBH has the privilege of paying for all costs and expenses of the Special Master. The Court has already authorized the Special Master to retain  and engage psychiatric consultants.

The last matter to be decided by Judge Spero is the amount of attorney’s fees to be awarded to Plaintiffs’ attorneys. The Plaintiffs’ legal firms are requesting approximately $28,000,000 in attorneys’ fees and approximately $1,500,000 for reimbursement of costs and expenses. It should come as no surprise that UBH is vigorously challenging an award of fees.

It should also come as no surprise that UBH has already filed its appeal to the 9th Circuit Court of Appeals with its opening brief due March 29, 2021. The case has been placed on the calendar for oral arguments in August 2021.

The Wit case should embolden medical and mental health providers to more aggressively push back against all insurance benefits providers. In any appeals of treatment decisions, the Wit case should be cited and argued. The Austen Riggs Center, in Massachusetts reports that it has won more appeals of denied treatment since the 2019 ruling, which it cites in its responses to insurers.

UBH turned its back on its insureds and those persons and their families who suffer from mental infirmities. That is, if they ever cared to begin with. The “Awful Price of Treason” that UBH must pay is not so much the amount of attorney’s fees it will have to pay or the dollar amount in damages it will pay,  but the fact that a court was forced to step in and take control over the manner in which UBH conducts its business and how they process their claims, an integral part of its business. That price will reverberate for years.

Our families, our loved ones who die as a result of this disease will be heard. And for those who do not listen, the price that will be paid will echo through eternity.

THE WEEK THAT WAS

Last week was eating disorder awareness week. And yet, the week was unlike any other prior “eating disorder awareness” week. Events transpiring in 2020 shook our nation to its core. And similarly shook common sense out of many organizations. Small but vocal aspects of society called for dismantling law enforcement. Socializing our communities. Destroying certain aspects of our history. Cities burned. Every type of “ism” called out as being reprehensible. Social justice run amuck leaving behind reason and logic.

Perhaps moreso than any other mental health community, the eating disorder community fecklessly rushed headlong into the fray. Last week, organizations and persons under the NEDA umbrella embraced anecdotal stories discussing black mental health matters, insights from the LBGTQ+ community, voices from the higher weight community, caregivers.  Organizations and persons conducted virtual yoga classes, talked about implicit bias and systemic oppression, thin bias, inclusivity and diversity. Ableism, healthism.

The following is a list of some of the “lessons and insights” that were spewed forth by persons under NEDA’s umbrella during the week:

  1. Some advocates opined that they wished the default in healthcare was that everyone was diagnosed with disordered eating.

2. Simply living in a diet culture equals living with trauma.

3. We are all victimized and oppressed by diet culture.

4. Everybody has a destructive relationship with food.

5. Society has formed its opinion of eating disorders by looking at someone’s “skin and bones in a hospital getting treatment.” [direct quote]

6. Atypical anorexia exists only because of fat phobia.

7. If we provide treatment to persons with the “most privileges” it doesn’t help persons with the “least privileges.”

8. Treatment providers tell thinner patients in front of fat patients that fat patients are “disgusting.”

9. When we are looking at genders, there are an infinite number of genders.

10. A person can try to shape themselves into being a man and a woman at the same time and that they can be neither.

11. We can impress upon ourselves that “toxic binary” is the only framework we have when it is not accurate for the population when we have so many genders.

12. That media portrays eating disorders with the most extreme version as the thin white woman and that’s not fair.

13. Apparently, another “privilege” is having a really good treatment team.

14. When we’re creating recovery, when we’re creating treatment, when we’re creating policies and guidelines they need to be made for the most marginalized person and that is the person who suffers from every marginalized identity.

15. We don’t need to be making recovery guidelines for cis white heterosexual men and women because they are just the top of the privilege chain.

16. We must envelope marginalized identities who are absolutely more at risk because they’re more likely to go under the radar and more likely to be ignored and gas-lit by families and medical professionals.

Those were the highlights of NEDA’s contributions to 2021 eating disorder awareness week.

We also listened to discussions concerning a lack of BIPOC and LBGTQ+ therapists and treatment professionals. We heard about a lack of treatment options for BIPOC and LBGTQ+ persons. Treatment that is too expensive. Treatment that is not equally available to all. These were and are certainly legitimate issues. However, these issues are societal in nature and are not unique to the eating disorder community. These broad based societal issues do not make eating disorders a social justice disease. They are being discussed by every other mental health and medical advocacy community.

Oppression of marginalized persons permeates society at large. The same issues are being discussed pertaining to admission to private schools, universities, job opportunities. Because the issues of race or sex or gender discrimination impact not just society in the United States as a whole, but is present on a global scale, it is certainly not unique to eating disorders and its community. But, we fail to address that point.

We also failed to focus on the issues unique to eating disorders.

No generally accepted treatment standards? Ignored.

Clinicians not collaborating with research doctors? Ignored.

Issues inherent with private equity ownership? Ignored.

The importance of dads in the recovery process? Ignored.

The incredibly high mortality rate of anorexia? Ignored.

No research based bills pursued in over eight years? Ignored.

Those are issues unique to eating disorders. All ignored.

And this past week, one can’t help but wonder why NEDA chose to ignore these issues and intentionally attempted to erase the line separating broad based societal issues from issues particular to the eating disorder community. What motivation could NEDA possibly have for undertaking this action?

Some people are aware that NEDA’s future will be determined by a federal district court judge and a jury based in Dallas, Texas. A lawsuit that when it reaches its inevitable conclusion, could result in NEDA dissolving. One of the allegations is that NEDA surreptitiously changed its mission to emphasize social justice and political issues without disclosing this information to its donors. That the person leading this vainglorious charge not only did not trust the medical community but believed they are doing tremendous harm. If NEDA continues to portray itself as the voice for families suffering from eating disorders, it has the absolute, non-delegable duty to be open and transparent with its donors regarding its changed mission. NEDA failed to comply with this duty.

One only needs to consider the line-up of social justice activists NEDA paraded during eating disorder awareness week and the topics discussed. Contrast that with the absence of  educating the general public of the dangers of each type of eating disorder and how best to combat them. When that comparison is made, NEDA’s agenda comes more into focus.

As NEDA invited “everyone to have a seat at the table,” an obvious omission became clear. NEDA posted a graphic, “Who’s at Your Table?” NEDA included, “Someone Who Makes You Smile,” “Someone You are Proud of,” “Your Recovery Hero,” and of course, “Favorite Body Liberation Activist” as well as a few other entities. So what is missing?

Perhaps, “Your Family Member Who Loves and Supports You.” In fact, the importance of family in the recovery process, the positive aspects of Family Based Therapy, parents, siblings are not just missing from this Table Graphic but were largely absent the entire week. Except for a very nice attempted save by the Caregiver group on Thursday, the incredible importance of the family structure was not only not discussed in detail, but was not discussed at all. And one must wonder why. Our families are the ones who are suffering.

And if you are a dad, forget it. You are merely a cis, white heterosexual binary person basking in the glow of your privileges and not deserving of mention or respect.

One must wonder how we have gotten so far off base? Isn’t the end goal the same for everyone, that is, eradicating eating disorders? Shouldn’t we all be working toward that end goal?

How did we let personal agendas sabotage this end goal? Are the jealousies, insecurities, fear and ego that permeate some of our perceived leaders so great, that they cannot listen to new ideas with interest and open minds?

Some incredibly intelligent, passionate people employed by companies with great financial resources have been driven out of the eating disorder industry or have left in frustration. Why? Why do we continue to get no research funding from the federal government? Why the dysfunctionality?

If an entrepreneur decided to bequeath $10 billion to the eating disorder community and industry with just one provision … that the eating disorder industry need only come to a mere consensus on developing generally accepted treatment standards and the most effective way to spend those proceeds, would we be able to?  Would the REDC/EDCoalition, iaedp, NEDA, AED, and Equip be able to look past all differences and accomplish this? I think we all know the answer to these questions.

No accountability. No demand to perform or perish. No demand for excellence. Little, if any collaboration. Little, if any transparency. No agreed standards of treatment. Ignorance of how companies outside of the eating disorder industry could assist in developing treatment protocols. Jealousy. Insecurity. Greed. Ego.

Sansón Carrasco, The Knight of Mirrors has arrived. And like Don Quixote, the eating disorder community fails to recognize their own metaphorical reflection in Sansón’s behavior as well as their physical reflection in the mirrors on the armor.

And our children continue to die. In fact, I challenge any so called leader in the eating disorder community to find a way to meet with any mother, meet with any father of a child who has died from eating disorders in the last year. You look them in the eyes and talk to them. Ask them what worked … and what did not.

Then, you tell them you are doing your best. You look into their eyes. And you tell us all what you will see. And then look at your own hands. And what do you see Lady Macbeth?

MEN’S GROUP

He who masters the power formed by a group of people working together has within his grasp one of the greatest powers known to man.”
― Idowu Koyenikan, Consultant and Author

This year’s eating disorder awareness week is coming to a quiet ending. And once more, I am left with the impression that fathers, husbands, grandfathers, boys, and male siblings for the most part continue to be largely ignored by the eating disorder community. Let us look at some facts:

By way of example, in the last 7 years at iaedp’s annual conference they have had 418 educations sessions. Only 3 were specifically about boys and men.

Toward the end of 2020, Project HEAL announced a change in its mission to, “We’re committed to anti-racism, anti-oppression, gender equity, and taking action to create justice.

NEDA has a history of excluding dads and men. From paying lip service to a bold, new program, a “Dad’s Initiative” approximately nine (9) years ago, and then mothballing it before its launch, to generally excluding boys and men in its “Everybody Has a Seat at the Table”  theme for its Eating Disorder Awareness Week.

It should come as no surprise that Men have been, as a matter of course, excluded from leadership positions in the eating disorder organizations. Of the 41 leadership positions listed in the top eating disorder organizations, 37 leaders are women and 4 are men.

There are numerous research studies indicating that the father–daughter, father-son relationship is incredibly important in the recovery process. And yet, this important part of the puzzle is being largely ignored by the eating disorder community.

However, there is at least one residential treatment program which has a monthly session of exclusively men. It is led by a male psychiatrist employed as a Medical Director at that eating disorder residential treatment program. This past year, I had the privilege of appearing as a “guest speaker” at one of these sessions. That week, it was attended by 40 men.

With no script prepared, I just began to talk with them. Of my past experiences. Of theirs. Nothing rehearsed. The questions and comments began to come from the dads and husbands. A few of them reached out to me afterwards with their stories of strength and resiliency. I was also advised that one dad, in a counseling session the very next week was more engaged and interactive than he had ever been before.

After consulting with a number of medical and mental health treatment professionals, we decided that this type of Men’s Group on a national scale was not only very much needed, but could be the foundation to allow men, dads, husbands, sons, grandfathers and siblings to find their voice, to become more active in their loved ones recovery. For men to understand that they are not alone. That a shared brotherhood exists and binds us all.

And so, I reached out to a number of treatment centers to ascertain whether they would support a Men’s Initiative. A program that would involve the participation of the dads, the husbands, the siblings of their patient population. If so, we would simply ask that they circulate information of these meetings which we would supply to them. That was it. No financial commitment. No long term commitment. No formal recognition or public statements indicating their commitment.

We stated that the educational and information session would be led by a male medical doctor and conducted once a month, probably on a Sunday afternoon via Zoom and would include an open discussion on eating disorders, father’s and husband’s, sons and sibling’s roles, providing a forum so men knew they were not alone and giving them a safe place to talk and share their emotions and thoughts.

The response was immediate and overwhelming. In the first 48 hours, EIGHT (8) treatment centers not only stated they would be involved but thought the initiative was very much needed and could provide an invaluable service.

By working from the ground up, by approaching men directly, by providing a safe place where their self-awareness, strength and passion can grow, where men will know they are not alone, perhaps the seeds of something mighty can find root … and start to grow.

In the next week or so, information will be released discussing this initiative in much more detail and welcoming participation.

Dads, husbands, sons, siblings, for far too long have been left in the shadows. No longer. For the sake, for the love, for the lives of our loved ones, our beloved children, wives, parents, our voices will be heard.

We will stand tall with all of the knowledge, courage, strength, passion and intelligence at our command.

Our loved ones demand nothing less.

A 4% Chance of Helping 1/3 of 1%

In the last Congressional session, the EDCoalition aggressively pursued the SERVE Act. It is also supporting the new SERVE Act which was recently filed. The Supporting Eating Disorders Recovery Through Vital Expansion Act (SERVE) Act sought to, and seeks to expand TriCare, allowing military family members over age 20 access to eating disorders care, and ensures servicemembers and their families have access to comprehensive eating disorders treatment nationwide.

It is admirable that the EDCoalition would focus on our military and the eating disorder needs within that community. My father was an Air Force pilot. Among other planes, he flew the F86 Sabre jet, the U.S.’s first swept wing fighter. I have a nephew who at 30 years old, is a Captain in the Air Force stationed at the Pentagon. I have two uncles who proudly served. And yet, with regard to eating disorders, the number differential between civilians and military personnel who suffer from this disease is staggering.

If the numbers are to be believed, 30 million Americans have or will have an eating disorder in their lifetime. There are currently approximately 1,400,000 active United States military personnel. The EDCoalition estimates that up to 8% of military personnel suffer from eating disorders. That would be 112,000.00. However, that number may be a bit high. The Armed Forces Health Surveillance Branch states that between 2013 and 2017, 1,788 active-duty troops were diagnosed with an eating disorder.

Whether you use the figure of 1,788 over five years or 112,000, both numbers pale in comparison to 30,000,000. 112,000 is approximately 1/3 of 1% of 30,000,000.

Certainly, there are aspects of Tricare which need to be amended. Stopping treatment in residential treatment centers for mental health issues including eating disorders at age 21 is nonsensical. With some persons serving in the armed forces for decades, this age limitation certainly needs to be amended.

In the past, Tricare on its website stated that it did not cover residential treatment care for eating disorders. That is no longer the case. On August 7, 2020, the U.S. Government Accountability Office issued a position letter on Tricare and eating disorders.

https://www.gao.gov/assets/710/708697.pdf

As one can readily tell, Table 3 in that Report provides a comprehensive list of Network and Non-network treatment facilities where eating disorder treatment is covered. This Report also states, “DOD [Department of Defense] is examining ways to improve its screening of eating disorders in the military as well as to identify possible ways to prevent such conditions in the military.”

The Report also states, “… DOD recently expanded the available research funding for eating disorders in its Peer-Reviewed Medical Research Program (PRMRP) with the goal of obtaining more comprehensive information on prevalence of eating disorders in the military and exploring ways to improve diagnosis of and treatment for the condition. In addition, the PRMRP is funding opportunities for research identifying biological and environmental risk factors associated with eating disorders, which could inform efforts to prevent or reduce the prevalence of these conditions. For example, one recently sponsored PRMRP project is developing an eating disorder screening tool for use with veterans and the military population.”

It is gratifying to see that at least one entity is pursuing research funding.

Military Veterans in Congress

With regard to Congress, military veterans constitute a strong and influential presence. The following military veterans served in the 116th Congress which just concluded:

• 96 total veterans in the 116th Congress.
• 30 were Democrats, 66 were Republicans.
• 19 served in the Senate, 77 served in the House.
• 48 served in the military after 2000.
• 21 served in the military in the 1960s or earlier.
• 19 were first-time lawmakers.
• 7 were women.
• 50 served in the Army, Army Reserve or Army National Guard.
• 17 served in the Marine Corps or Marine Corps Reserve.
• 17 served in the Air Force, Air Force Reserve or Air National Guard.
• 13 served in the Navy or Naval Reserve.
• 1 served in the Coast Guard

That constitutes about 18% of all Senators and Congresspersons with representation in both major parties. With such a strong presence, one could presume that support for eating disorder bills impacting the military would be relatively low hanging fruit.

How the EDCoalition fared with SERVE Act in the last Congress.

With regard to the SERVE Act, we can rightly presume that our military veterans serving in Congress would support this bill. However, the facts indicate otherwise.

The following table indicates the Military Veterans in Congress and whether they supporting the SERVE Act.

DistrictPartyNameServiceEraSERVE Act Score
GA 9GOPDoug CollinsAF Reserve2000s-2010sNo
WY SenateGOPMike EnziAir Force1960s-1970sNo
SC SenateGOPLindsey GrahamAir Force1980s-2010sNo
PA 6DemChrissy HoulahanAir Force1980sNo
VA 5GOPDenver RigglemanAir Force1990sNo
OR 4DemPeter DeFazioAir Force1960s-1970sNo
TX 36GOPBrian BabinAir Force1970sNo
MS SenateGOPRoger WickerAir Force1970s-1990sNo
OH 6GOPBill JohnsonAir Force1970s-1990sNo
GA 11GOPBarry LoudermilkAir Force1980s-1990sNo
UT 2GOPChris StewartAir Force1980s-1990sNo
NE 2GOPDon BaconAir Force1980s-2010sNo
CA 33DemTed LieuAir Force1990s-2010sYes
IL 16GOPAdam KinzingerAir Force2000s-2010sNo
GeorgiaRepublicanJohnny IsaksonAir Force1960s-1970sNA
FL 16GOPVern BuchananAir NG1970sNo
PA 10GOPScott PerryArmy NG1980s-2010sNo
OK SenateGOPJim InhofeArmy1950sNo
KY SenateGOPMitch McConnellArmy1960sNo
MA SenateDemEd MarkeyArmy1960s-1970sNo
RI SenateDemJack ReedArmy1970sNo
AK SenateGOPTom CottonArmy2000s-2010sNo
IN 4GOPJim BairdArmy1960s-1970sNo
TN 7GOPMark GreenArmy1980s-2000sNo
CO 6DemJason CrowArmy1990s-2000sYes
FL 6GOPMichael WaltzArmy1990s-2010sNo
FL 17GOPGreg SteubeArmy2000sNo
KS 2GOPSteve WatkinsArmy2000s-2010sNo
NY 11DemMax RoseArmy2010sNo
AK (House)GOPDon YoungArmy1950sNo
GA 2DemSanford Bishop Jr.Army1960sNo
IL 1DemBobby RushArmy1960sYes
MN 7DemCollin PetersonArmy1960sNo
NJ 9DemBill PascrellArmy1960sNo
NY 15DemJose SerranoArmy1960sNo
NC 1DemG.K. ButterfieldArmy1960sNo
CA 5DemMike ThompsonArmy1960s-1970sYes
NC 3GOPWalter JonesArmy1960s-1970sNo
VA 3DemBobby ScottArmy1970sNo
TN 1GOPPhil RoeArmy1970sNo
TX 11GOPMike ConawayArmy1970sNo
LA 3GOPClay HigginsArmy1970s-1980sNo
TX 1GOPLouie GohmertArmy1970s-1980sNo
SC 2GOPJoe WilsonArmy1970s-1990sNo
FL 2GOPNeal DunnArmy1980sNo
NV 2GOPMark AmodeiArmy1980sNo
AR 1GOPRick CrawfordArmy1980s-1990sNo
KY 2GOPBrett GuthrieArmy1980s-1990sNo
OH 8GOPWarren DavidsonArmy1980s-1990sNo
IL 15GOPJohn ShimkusArmy1980s-2000sNo
NY 1GOPLee ZeldinArmy2000sNo
FL 18GOPBrian MastArmy2000s-2010sNo
IL SenateDemTammy DuckworthArmy NG1990s-2010sNo
IA SenateGOPJoni ErnstArmy NG1990s-2010sNo
SC 4GOPWilliam TimmonsArmy NG2010sNo
KY 5GOPHal RogersArmy NG1950s-1960sNo
NY 2GOPPeter KingArmy NG1960s-1970sNo
AR 3GOPSteve WomackArmy NG1980s-2000sNo
OH 15GOPSteve StiversArmy NG1980s-2010sNo
MS 1GOPTrent KellyArmy NG1990s-2010sNo
HI 2DemTulsi GabbardArmy NG2000s-2010sNo
KS 1GOPRoger MarshallArmy Reserve2010sNo
MD 4DemAnthony BrownArmy Reserve1980s-2010sNo
OH 2GOPBrad WenstrupArmy Reserve1990s-2010sNo
LA 5GOPRalph AbrahamCoast Guard, ANG1980s-2010sNo
KS SenateGOPPat RobertsMarine Corps1950s-1960sNo
CT SenateDemRichard BlumenthalMC Reserve1970sNo
IN SenateGOPTodd YoungMarine Corps1990s-2000sNo
AK SenateGOPDan SullivanMarine Corps1990s-2010sNo
IN 6GOPGreg PenceMarine Corps1970s-1980sNo
TX 3GOPVan TaylorMarine Corps1990s-2000sNo
ME 2DemJared GoldenMarine Corps2000sNo
CA 8GOPPaul CookMarine Corps1960s-1980sNo
IL 12GOPMike BostMarine Corps1970s-1980sNo
MI 1GOPJack BergmanMarine Corps1970s-2000sNo
AZ 7DemRuben GallegoMarine Corps2000sNo
MA 6DemSeth MoultonMarine Corps2000sLead
PA 17DemConor LambMarine Corps2000s-2010sNo
CA 50GOPDuncan HunterMarine Corps2000s-2010sNo
WI 8GOPMike GallagherMarine Corps2000s-2010sNo
CA 24DemSalud CarbajalMC Reserve1990sNo
MI SenateDemGary PetersNavy1990s-2000sNo
FL SenateGOPRick ScottNavy1970sNo
CA 39DemGil CisnerosNavy1990s-2000sYes
NJ 11DemMikie SherrillNavy1990s-2000sYes
VA 2DemElaine LuriaNavy1990s-2010sYes
PA 14GOPGuy ReschenthalerNavy2000s-2010sNo
TX 2GOPDaniel CrenshawNavy2000s-2010sNo
TX 22GOPPete OlsonNavy1990sNo
DE SenateDemThomas CarperNavy Reserve1960s-1990sNo
IN 8GOPLarry BucshonNavy Reserve1980s-1990sNo
MD 1GOPAndy HarrisNavy Reserve1980s-2010sNo
CA 20DemJimmy PanettaNavy Reserve2000sNo
IN 3GOPJim BanksNavy Reserve2010sNo
MS 4GOPSteven PalazzoMarine Corps/Army1980s-2010sNo
AZ SenateGOPMartha McSallyAir Force1990s-2010sNo

In the Senate, of the 19 Senators who are military veterans, their support, or the lack thereof, was unanimous. Not one of the 19 Senators who served in our military supported the SERVE Act.

In the House of Representatives, 8 Congressmen and women, including the lead Congressman supported the SERVE Act. That means sixty-nine (69) Congresspersons did not support the SERVE Act.

With eating disorders allegedly being more prevalent within our military personnel, it is perplexing that our Congressmen and Congresswomen who previously served in the military, did not uniformly support the SERVE Act. So, out of fairness we should consider the other politicians in Congress and their outlook on not just the SERVE Act but on the other initiatives supported by the EDCoalition.

Congress and the SERVE Act

Our friends at the EDCoalition assemble a scorecard for Senators and Congresspersons. Each time a politician either signs a letter showing support for a bill, or introduces legislation they co-sponsored or legislation they voted directly for relating to eating disorders, they receive a positive check. A grade of 0 through 4 is then assigned to each check, with o points indicating no support and 4 indicating support. (There are other ways to increase the score such as being the sponsor and introducing the bill). Naturally, if a politician has not indicated any support at all, they receive a score of zero.

The EDCoalition makes it clear that, “It is important to note that the legislative efforts listed on this scorecard reflect a combined effort from the eating disorders community, and not solely EDC-led initiatives.”  Presumably this refers to NEDA and the REDC who pay the same lobbyist, Center Road Solutions.

The EDCoalition then listed fifteen (15) bills, resolutions, letters and initiatives they supported. One would be justified in assuming that if the bills had merit, politicians, especially those who previously served in the military, would support in theory, if not practice, those bills.

The EDCoalition issued its most recent scorecard on December 15, 2020. To say the numbers are disturbing would be charitable.

In the Senate, of the 53 Republican Senators, FORTY-SEVEN (47) received a score of ZERO. This indicates no support whatsoever for eating disorder bills and resolutions. And lest one think that Republicans alone are forestalling bills on eating disorders, of the 45 Democratic Senators, TWENTY-SEVEN (27) received a score of ZERO. Of the two, Independent Senators, both had a score of ZERO, including Senator Bernie “Mittens” Sanders.

Of the Democrats in the Senate, the following well known Senators had a score of ZERO: Cory Booker (D) NJ, Elizabeth Warren (D) MASS, Diane Feinstein (D) CA, and our current Vice President Kamala Harris (D) CA.

In the House of Representatives, the numbers are equally alarming. Of the 199 Republicans, one hundred sixty-eight (168) received a score of ZERO.  Of the 235 Democrats, ninety (90) received a score of ZERO. Of the Democrats in the House, the following well known Congresspersons had a score of ZERO: Adam Schiff (D) CA, Maxine Waters (D) CA, and Henry Cuellar (D) TX. Two members of the Democratic Socialist “Squad” registered scores of ZERO; Rashida Tlaib (D) MI and Ayenna Pressley (D) MASS. Two other members of the Democratic Socialist Squad, Alexandria Ocasio-Cortez (D) NY and Ilhan Omar (D) Minn each registered scores of one (1).

Apparently, eating disorder bills are being ignored by both conservative Republicans on the far right and liberal Democrats on the far left. To date no stand-alone eating disorder bill has ever made it out of Committee for debate on the House or Senate Floor. No eating disorder bill emphasizing research funding has even been introduced for eight (8) years.

With so many politicians from both sides of the aisle ignoring eating disorder bills, at what point is the community justified in demanding explanations and accountability. Even though the concepts of accountability or “perform or perish” are alien to the eating disorder community, when faced with such an overwhelming display of ineptitude and incompetence, are we not justified in looking at alternative ways of accomplishing goals?

As we saw last week, appropriations for funding of research of mental health issues are usually submitted through the National Institute of Mental Health (“NIMH”). NIMH makes funding requests to be included in the annual federal Appropriations Bill. 

Statements from the EDCoalition that “meaningful progress in eating disorders treatment and intervention will only be realized to the extent we meaningfully invest in its science” ring hollow since their words are not backed by its conduct. Research means Progress. Progress means Hope. Hope begets Recovery.

As shown last week, Congressional bills have on average, a 4% chance of being enacted into law. That means we are looking at a 4% chance of success on a bill that will have an impact on 1/3 of 1% of people who suffer from eating disorders. AGAIN, THAT IS A 4% CHANCE OF HELPING 1/3 OF 1% OF THOSE WHO SUFFER FROM EATING DISORDERS.

The subject matter of bills and the subsequent lobbying efforts on those bills are dictated by those who provide the financial resources for those endeavors. So, as our families continue to suffer and our children continue to die, aren’t we entitled to transparency and honest answers to the questions of who is supplying the funding for these foolhardy ventures, who is making the decisions to pursue certain bills and why isn’t crucial research funding being pursued?

It is an absolute certainty that if an organization, like NEDA, solicits donations from the general public and as part of its solicitation efforts it represents that “… It’s time we stop treating them [eating disorders] as vanity illnesses and put serious effort into research that can help us broaden the understanding of what eating disorders are and who they affect.” … “The more funding allocated to eating disorders research, the quicker we can learn more about what causes them — and the quicker we can save more lives.” that organization has the absolute, non-delegable duty to advise its donors what specific legislative initiatives it is pursuing. Especially when that organization collaborates with other entities and jointly pay lobbyists a six figure revenue stream. As the EDCoalition publicly stated, “It is important to note that the legislative efforts listed on this scorecard reflect a combined effort from the eating disorders community, and not solely EDC-led initiatives.”  Undoubtedly, this refers to NEDA and the REDC who pay the same lobbyist, Center Road Solutions.

Suppose that an organization solicits donations representing to the public in general and the eating disorder community in particular, that said donations are going toward crucial research on eating disorders but in fact, those donations are not being directed toward research based Congressional bills. Then presume that same organization conspires with other organizations, pools their funds to pay a single lobbyist to pursue bills which not only are not research based but do not pertain to the vast majority of people who suffer from this disease. If these facts are proven, then it is axiomatic that all organizations and persons participating in this subterfuge should be held accountable.

Difficult questions need to be asked. Transparent answers to these difficult questions must be demanded and can be voluntarily made. But, we cannot expect that. So, if transparent answers are not voluntarily given, they can always be discovered during sworn, deposition testimony or in a court of law.

And in a lawsuit through discovery, there is a much greater likelihood than 4%, that the answers sought will be at long last uncovered.

RESEARCH FUNDING EVERYWHERE AND NONE OF IT FOR US

Shepherding a bill through Congress, from introduction through being enacted into law is incredibly difficult. Between 2001 and 2015, nearly 74,500 bills were introduced in Congress. However, only 2,345 became law. This equates to approximately four percent (4%). That number is actually high when you consider bills that become law are often changed, sometimes materially, from their introduction to passage.

If bills you support, like the Nutrition Care Act (H.R. 3711), the Serve Act (H.R. 27670) or the Eating Disorders Prevention in Schools Act (H.R. 6703) are not signed into law during a legislative session, when a new Congress is seated in January of odd numbered years, your bill dies. Bills need to be reintroduced anew, are renumbered and the process begins again. That process is daunting and complicated. That was apparent even back in 1976 when Schoolhouse Rock first aired its iconic, “I’m Just a Bill” episode.

As for eating disorders, enactment of bills into law is non-existent. Introduction of bills which emphasize research into eating disorders has been completely abandoned. And yet, that in and of itself is curious since all persons recognize that in order to diagnose and properly treat this illness, the highest priority must be research.

In September 2019, EDCoalition president, Chase Bannister, made the following remarks before the National Institute of Mental Health National Advisory Mental Health Council:

“This mortality rate underscores the severity of this illness, as it is common for individuals with eating disorders to have co-occurring medical and behavioral health conditions, increasing the complexities of proper intervention and treatment.”

“Proper intervention and treatment for any condition requires an investment in research.”

“Amongst all psychiatric conditions, … funding for eating disorder research remains among the most discrepant from the burden of illness they represent.”

“Meaningful progress in eating disorders treatment and intervention will only by realized to the extent we meaningfully invest in its science.”

That same day, the ED Coalition issued a press release stating in material part: “For too long, research funding for eating disorders has been an order of magnitude away from what’s necessary. Meaningful progress in eating disorders treatment and intervention will only be realized to the extent we meaningfully invest in its science. We call upon NIH – and all who make or shape policy – to invest in eating disorders research. To do what’s necessary.”

With this universal understanding, it is particularly perplexing to see that bills emphasizing funding for the research of eating disorders have been completely abandoned by the EDCoalition. The last such bill was introduced in Congress in 2013. Eight (8) long years ago. And that is perplexing and is the basis for many questions which need to be asked … and transparently answered. Answers we know that will never be voluntarily forthcoming.

First, appropriations for funding of research of mental health issues are usually submitted through the National Institute of Mental Health (“NIMH”). NIMH makes funding requests to be included in the annual federal Appropriations Bill. Without its passage, federal programs are not funded and government run agencies and organizations cease to operate.

Prior to the 2021 Appropriations Bill being signed in late December of 2020, NIMH submitted to the United States Senate an “Explanatory Statement for Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriations Bill, 2021 Summary of Budget Estimates and Committee Recommendations for Fiscal Year 2021.” This was a  281 page document. The document made requests and recommendations regarding funding research for mental health issues to be included in the 2021 Appropriations Bill.  For example, requests were made for the following:

$300 million increase for Alzheimer’s and dementia research funding at the National Institutes of Health (NIH), including $15 million to fund and implement the BOLD Infrastructure for Alzheimer’s Act (P.L. 115-406), and advances the Improving HOPE for Alzheimer’s Act (S. 880/H.R. 1873);

$8.48 billion for the National Science Foundation (NSF), with $6.91 billion (a $169 million [2.5%] increase) dedicated to research and related activities. 

$6.015 billion for Substance Abuse & Mental Health Services Administration (SAMHSA) an increase of $133 million which includes:

  • $757.5 million for the community mental health services block grant, including a NEW $35 million block grant set-aside for crisis services, a NAMI priority;
    • $24 million for the National Suicide Prevention Lifeline, an increase of $5 million

$500,000,000 to the National Institutes of Health for research related to opioid addiction, development of opioid alternatives, pain management, and addiction treatment at the National Institute of Neurological Diseases and Stroke and the National Institute on Drug Abuse.

$52,344,000 for Autism and Other Developmental Disorders program for this program which supports surveillance, early detection, education, and intervention activities on autism and other developmental disorders, as reauthorized in the Autism Collaboration, Accountability, Research, Education and Support [Autism CARES] Act of 2019 (Public Law 116–60).

$41,619,000 for University Centers for Excellence in Developmental Disabilities for the University Centers for Excellence in Developmental Disabilities, a network of 67 centers that are interdisciplinary education, research, and public service units of a university system or public or nonprofit entities associated with universities.

As for eating disorders? In this 281 page Recommendation Report, the only reference to eating disorders appears on page 115 and states as follows:

Eating Disorders.—The Committee commends NIH for supporting multi-Institute research on the chronic, fatal, and serious mental illnesses encompassing eating disorders that affect 30,000,000 Americans during their lifetimes, and its association with other conditions such as diabetes, infertility, heart disease, post-traumatic stress disorder, substance use, polycystic ovary syndrome, and tooth decay. The Committee recognizes that eating disorders are a deadly bio-psycho-social illness and that multiple research topics must be explored to understand, prevent, and treat eating disorders, including psychosocial issues; health disparities and food insecurity; environmental factors such as weight stigma; the complex interplay of metabolic processes; and maternal health. The Committee encourages NIH to continue to support a multi-Institute approach and to report on current research efforts related to the prevention, diagnosis, and treatment of eating disorders in the fiscal year 2022.” [emphasis added]

No specific funding recommendation.

No recommendation for specific grants or grant amounts.

No recommendation for a financial commitment.

No specific funding for research into the biological and genetic causes of eating disorders.

Although the Committee stated that it commended NIH for supporting multi-Institute research on the chronic, fatal, and serious mental illness known as eating disorders it did not recommend any specific funds be appropriated for research.

So where did this language come from? [Apologies for ending a question with a preposition.] A little digging results in the answer to this question. This language came from a March 2020 letter addressed to the Chair and the Ranking Member of the Committee on Appropriations Subcommittee on Labor, Health & Human Services and Related Agencies. The letter was signed by forty-three (43) Congresspersons. A copy of that letter is attached here:

Despite the fact that this letter contains no requests for funding of research, I am confident that our friends at the EDCoalition stood on the sidelines, and as is their wont, “applauded or praised” this worthy endeavor.

But once again, a mental health illness which is believed to impact nine percent (9%) 0f the United States population is excluded from specific federal funding.

A mental health illness which is believed to result in one death every fifty-two (52) minutes is excluded from specific federal funding.

Admissions from the EDCoalition that “meaningful progress in eating disorders treatment and intervention will only be realized to the extent we meaningfully invest in its science.” And yet no research based bills are pursued by that organization which presumably results, in part, in NIMH making no specific financial recommendations for eating disorder research in fiscal year 2021.

On the other hand, those Congressional bills which have a four percent (4%) or less chance of being passed and which, even if passed, will not impact research, await! The death toll rises. And even still, there is no demand for accountability.

In the next article, we will explore the “Congressional Scorecard of the EDCoalition,” apply it to the EDCoalition and look at what the future may hold.