An insurance company denying your legitimate, desperately needed health insurance claim has become all too common, an ordinary way of life … and a large profit center for those insurance companies.
Finally one attorney, Brian Hufford, has dedicated his practice to addressing this widespread problem. But first, let’s look at the alarming statistics.
In 2023, insurers on the HealthCare.gov marketplace denied an average of 19% of in-network claims and 37% of out-of-network claims. Denial rates varied widely by insurer, ranging from as low as 1% to over 50%.
Surprisingly, the most common reason for denial isn’t related to medical necessity at all. A full 34% of denials fall under the nebulous category of “Other”—an unspecified catch-all that gives insurers maximum flexibility and patients minimum clarity. When these vague denials are appealed, they’re overturned approximately 55% of the time, suggesting that the majority have no solid justification.
Administrative issues account for another 18% of denials. These include coding errors, missing information, or duplicate claims—technical issues having nothing to do with whether the care was appropriate or covered under the policy. These denials have the highest overturn rate at 78%, as they’re often simple misunderstandings or clerical errors that can be easily corrected.
Claims categorized as “service not covered” make up 16% of denials. While these have a lower overturn rate of about 35%, successful appeals often demonstrate that the service actually does fall under covered benefits when policy language is properly interpreted or when the medical necessity is clearly established.
Prior authorization issues cause 9% of denials, with patients receiving care without getting the insurer’s permission first. These have a 65% overturn rate when appealed, particularly when the care was urgently needed or when the provider can demonstrate they attempted to secure authorization.
Perhaps most concerning are the “not medically necessary” denials, which represent 6% of cases. These denials essentially second-guess your doctor’s judgment about what care you need. Yet when patients and their doctors challenge these determinations, they succeed approximately 70% of the time—an alarming discrepancy that raises questions about how these decisions are made in the first place.
Despite these high denial rates, fewer than 1% of denied claims are ever appealed by consumers. A survey found that 85% of patients never file a formal appeal, often due to a lack of awareness of their appeal rights or the complexity of the process.
When consumers and providers do appeal, they have a strong chance of success. According to a recent KFF survey, patients who took the time to appeal their denials experienced a 44% success rate with initial internal appeals—meaning nearly half of all challenges succeeded in the first round. For those whose internal appeals were rejected and who proceeded to external review, an additional 27% succeeded at that level.
When healthcare providers manage the appeal process, over 54% of initially denied claims are ultimately paid after multiple rounds of review. Some sources suggest that up to 80% of appeals can be successful when pursued effectively.
In summary, despite the fact that while claim denials are common, and patients and providers who navigate the appeals process often succeed in getting the denial reversed, the vast majority of denials go unchallenged.
The 2023 KFF Survey of Consumer Experiences with Health Insurance found that 58% of insured adults said they have experienced a problem using their health insurance, including denied claims. Four in ten (39%) of those who reported having trouble paying medical bills said that denied claims contributed to their problem.
Each denial costs medical practices, on average approximately $43 to process, creating over $19 billion in administrative waste annually across the healthcare system. Small practices often spend more than 12 hours weekly wrestling with insurance companies over denied claims.
By making the process difficult and opaque, they ensure most people simply give up and pay out-of-pocket, or worse, forgo necessary medical care altogether. The financial result is billions in unpaid claims that boost insurance company profits while shifting costs to patients.
And at least one man, one attorney has had enough. Brian Hufford was one of the lead attorneys in the Wit v. UBH case still pending in California.
Briefly, David Wit along with other insureds brought a class action lawsuit challenging United Behavioral Health’s (UBH) use of flawed, financially motivated internal guidelines to deny coverage for mental health and substance abuse treatment, rather than applying generally accepted standards of care. The district court initially found during a class action trial that UBH violated the terms of its health insurance policies and breached its fiduciary duties under ERISA, ruling that UBH’s internal guidelines were defective and more restrictive than generally accepted standards of care. The Court of Appeals reversed this decision on the benefit claim and dismissed those class claims but sent it back to the district court to determine if the fiduciary duty findings should remain. Upon reconsideration, the district court again found that UBH breached its fiduciary duties. The case is on-going.
Despite that case still being active, Brian left his firm to start his own practice. After spending a career founding and running health insurance dispute practices at private firms, representing patients and clinicians against insurance companies, Brian opened his own practice as of July 1, 2025, to focus on public policy and advocacy.
His primary work is to expand help for people appealing health insurance denial. As the statistics show, this is a service that is wholly lacking in our current system. To address this matter, Brian is working with law schools to provide pro bono opportunities to law students who assist with health insurance appeals, working under his supervision. He is coordinating this effort through the People’s Action nonprofit, which is pursuing a Care Over Cost campaign, and Brian is serving as legal advisor to its National Appeals Team. Brian is also working as Senior Legal Advisor to Claimable, Inc., a start-up that is using AI to systematize health insurance appeals (www.getclaimable.com/).
If you have people who have been subjected to denials and need help with appeals, feel free to contact Brian (which is pro bono through his law school project). Depending on the number of patients who reach out, he may also connect people to Claimable for assistance.
Brian’s website is below, which has a link to a form patients can fill out. The form is automatically forwarded to Brian, and he will then follow up. You can contact Brian with any questions you may have.
This crucial resource for our families is so incredibly important. And could very well mean the difference between you getting the necessary care you or your loved one need versus suffering from an unjust system.
On October 30, 2016, my beloved daughter Morgan died after battling eating disorders for seven (7) long years. She was 23 years old when she was taken. At the moment of her death, when a daddy hears those dark words, “She’s gone” though he may not know it at the time, the better part of him is also ripped away.
Morgan was brilliant, kind, and fiercely determined to get well. She thought of others, often before her own needs. Her own words, “I can seem to help everyone else … I just can’t help myself” is her legacy. And yet, those very words still haunt her daddy every day.
When those words and the reality of a loss no parent should ever have to suffer are combined with the state of the eating disorder community today, you realize that there will be many more of our loved ones condemned to share the same fate which took my daughter… unless a seismic change is forthcoming.
A System Without a Compass
Even at that time, the system that claimed to know how to help Morgan had no map, no unity, and tragically, no accountability. Nearly a decade later, the eating disorder community is in even greater disarray. There are still no generally accepted treatment guidelines … no consensus on what works, no uniform standards for care, no consistency from one program to another and no accountability nor consequences. If you send your child for treatment, what happens next depends less on science and more on which center you happen to find, and what ideology dominates that space.
The Vanishing of Science and the Rise of Ideology
The dire crisis in the community has worsened as grant funding for research dries up. Federal and private funders have largely turned their attention to other mental health priorities, leaving eating disorder research chronically underfunded. Few new studies are being published, and the next generation of researchers is dwindling. Research professionals and medical clinicians on the front lines rarely collaborate. In this vacuum, ideological movements have filled the void … often louder, more absolutist, more absurd and less accountable to data or outcomes.
Militant factions within the “body liberation” movement now control far too much of the public conversation in the community. They label professionals, clinicians and even families in a gross, inflammatory manner. Anyone who speaks about weight restoration or malnutrition is labeled as “fatphobic.” White Supremacy Culture. Invasive species. Utilizing every “ism” word possible. Complex medical and psychiatric illnesses are reframed as political identity issues. The result? A silencing of nuance and a dangerous confusion between eating disorder treatment and radical social activism. Inflammatory labeling has become the substitute for reasoned professional, collaborative communication. And our loved ones suffer.
Private Equity and the Hollowing Out of Care
At the same time, private equity–owned treatment centers, once the great hope for scaling access, are collapsing under the weight of their own failed business models. Many have failed outright or are surviving only by slashing costs: laying off medical doctors who served as full time employees, replacing them with part time independent contractors and inexperienced working staff. Running skeletal programs that cannot provide the continuous, multidisciplinary care our loved ones require. The result is a race to the bottom: more marketing, fewer doctors, more “coaches,” less medicine. No accountability nor consequences.
Families are left navigating glossy websites and sales teams instead of evidence-based programs. If a family wishes to speak with the medical director of a program before entrusting their child to that program … good luck. Insurance denials come faster than ever. Inpatient stays are shorter. Step-down programs are often nonexistent.
When Morgan was fighting for her life, I wondered whether the lack of care was a failure of coordination. I no longer wonder. It has never been clearer that it was and continues to be, a failure of values.
A Community in Financial and Moral Crisis
The largest eating disorder nonprofit organizations, long believed to be the moral anchors of the community, are collapsing financially some losing more than $200,000 per year. Echo chamber thinking and associated conduct have replaced outreach to professionals who respectfully disagree with their view. Where at one time, these organizations were led by persons of vision, true giants of the community, now with very few exceptions, they are led by boards who shrink away from transparency, oversight and responsibility. These organizations host conferences and awareness campaigns, but their impact is negligible at best and failing at worst.
Their messaging has grown vacuous and timid, shaped more by the politics of social media than the needs of our loved ones. Once they were advocates for treatment access and medical rigor; now too often, they stand meekly on the sidelines … mere bystanders to the on-going carnage.
The Human Cost
The price paid for the wholesale failure of the community is measured by the dearest blood possible … the lives of our loved ones. The mortality rate for eating disorders, already the highest among psychiatric illnesses [apart from opioid addiction] has worsened. Suicide and medical complications are climbing. The promise that “recovery is possible” rings increasingly hollow to families who can’t even get a proper diagnosis, let alone a full course of the highest quality medical and mental health care. Which results in:
Behind every number is a person, a victim. Behind every person is a family like mine, standing outside a treatment center, a hospital, a counselor’s office, desperately holding on to the only thing they can … that is, the fading hope that this time will be different.
Where Do We Go From Here?
Families are entitled to transparency. Accountability. Honesty. From our doctors, clinicians, and counselors. Families should demand nothing less. But, to accomplish this reality, we not only need an evolution of thought and wisdom … we require a bold reckoning. The eating disorder community must reclaim science, ethics, and accountability. The community can only provide those necessary qualities by demanding:
The adoption of national treatment guidelines grounded in evidence, not ideology.
Federal, state and philanthropic investment in clinical research and longitudinal outcomes.
Oversight of private treatment companies that market medical care that is not forthcoming as it sheds experienced medical practitioners and licensed staff.
Strong, bold, new leadership in nonprofit organizations that prioritize patients over politics.
Measured inclusion of all reasonable, rational, intelligent viewpoints and persons.
But these steps require a courage of conviction… conviction which is sorely lacking.
Not just Morgan, but all those who have died from eating disorders cannot die in vain. But until we admit that this system and community are broken, until we expose the silence, the failures, the charlatans, thed fraud and the fear … we will keep losing more daughters, more sons, more loved ones, more years of life.
The eating disorder community once promised healing. Today, it must fight simply to survive. For survive it must. But in an evolved, intelligent, collaborative manner.
Two of the more troubling topics confronting mental health communities are: (1). Lack of Minority Representation in the Mental Health Workforce and (2). Limited Accessibility of Mental Health Care in Minority Communities.
We will be focusing on exploring real world, workable solutions instead of using inflammatory labels, pointing fingers and embracing the litany of “isms” being cavalierly thrown around.
Any solution necessarily begins with starting and having open, collaborative conversations. While recognizing that a start is just that … a start and not a solution. And yet, from that start perhaps seeds are planted from which bold, forward-thinking initiatives grow which could ultimately result in a better world.
Increasing Minority Representation in the Mental Health Workforce
No one disputes that minority representation in the mental health workforce is grossly lacking. So, let’s address some of the issues which produced this inequity and explore possible solutions.
1. Financial Pathway Support
Problem: The cost and duration of training (graduate degrees, licensure) are major barriers for minority students.
Possible Solutions:
Targeted scholarships and loan repayment programs for minority students in psychology, psychiatry, counseling, and social work (e.g., HRSA’s Behavioral Health Workforce Loan Repayment Program could be expanded or localized).
Paid internships and residencies in community-based organizations serving minority populations.
Employer-based tuition reimbursement tied to post-graduation service commitments in underserved areas.
2. Pipeline Programs (High School → Graduate School)
Problem: Minority students are underrepresented early in the pipeline.
Possible Solutions:
Create “Grow Your Own” mental health workforce programs in high schools and community colleges — exposure to mental health careers, mentorship, and clinical shadowing.
Partner with HBCUs, HSIs, and Tribal Colleges to create joint degree or accelerated pathways into counseling, psychology, and psychiatric nursing.
Establish bridge programs for paraprofessionals (e.g., caseworkers or peer specialists) to obtain advanced clinical credentials.
3. Licensure and Training Reform
Problem: Licensure barriers disproportionately impact minority and bilingual professionals.
Possible Solutions:
Reciprocity agreements among states to ease cross-state licensing for clinicians serving telehealth clients.
Allow supervised hours to include culturally competent community-based or telehealth work, not just traditional clinical settings.
Bilingual competency credits or pathways for professionals providing care in multiple languages.
4. Mentorship and Professional Networks
Problem: Isolation and lack of role models lead to attrition.
Possible Solutions:
Fund minority mentorship programs through professional associations (e.g., APA, NASW, NBCC).
Develop online professional communities for peer support and continuing education focused on serving minority communities.
There are no “zero sum game” arguments. No white people must step aside. No looking backward as to what was previously done wrong. No obsessing on the past.
Simply a possible roadmap to start discussions to increase minority mental health providers.
This is going to become even more important in the future as research scientists increasingly discover additional biological links between the brain and mental health issues. We could be at the genesis of a bold new frontier regarding how mental health issues are studied, researched and treated. We need all persons to be involved in this process.
With this reality facing us, how do we increase accessibility of mental health care?
Increasing Accessibility of Mental Health Care to Minority Communities
Mental health care providers, resources and treatment centers must become more available and accessible in minority communities. Let’s explore how we can start to address this issue.
1. Community-Based and Culturally Anchored Services
Problem: Mainstream clinical settings in minority communities are few and far between and when they do exist, can feel unwelcoming or irrelevant.
Possible Solutions:
Fund community-based organizations, churches, and cultural centers to offer embedded mental health services (e.g., co-located clinics).
Recruit faith leaders, barbers, and cultural ambassadors as mental health liaisons trained in Mental Health First Aid or peer support.
Support mobile crisis units staffed with culturally and linguistically matched professionals.
2. Telehealth Expansion and Equity
Problem: Digital divides and lack of culturally competent telehealth platforms persist.
Possible Solutions:
Subsidize broadband and devices for patients in rural or low-income minority areas.
Require telehealth platforms to support multilingual access and easy interfaces.
Train clinicians in telehealth cultural competence (e.g., cross-cultural communication online).
3. Insurance and Reimbursement Reform
Problem: Minority-serving clinics often cannot sustain services due to poor reimbursement rates.
Possible Solutions:
Equal reimbursement for behavioral health and physical health under parity laws (and enforce it). [This requirement is already provided by federal law. Insurance companies have found ways to avoid or get around this requirement. These loopholes must be closed by legislative bodies.]
Expand Medicaid coverage for peer support specialists and community health workers.
Incentivize integrated care models (behavioral + primary care) in federally qualified health centers (FQHCs) and minority-owned practices.
4. Public Awareness and Trust-Building
Problem: Stigma and mistrust are major deterrents.
Possible Solutions:
Fund anti-stigma campaigns featuring diverse community voices and lived experiences.
Partner with trusted local messengers (e.g., influencers, pastors, tribal elders).
Offer mental health literacy programs in schools and workplaces, especially in minority-majority areas.
Of course, all of this is not probable unless there is greater policy, corporate, institutional and legislative support. This support could resemble the following:
Policy and Institutional Support
Data collection and accountability: Require reporting of workforce demographics, service access, and outcomes disaggregated by race/ethnicity.
Federal and state grants: Prioritize funding for programs demonstrably improving minority recruitment and retention.
Cross-sector collaboration: Involve education, housing, and criminal justice systems in joint mental health equity initiatives.
An “Integrated Implementation Model” could be structured as follows:
Minority Mental Health Workforce Accelerator (state-level example):
Provides full scholarships and living stipends to minority students pursuing behavioral health degrees.
Requires 3–5 years of post-graduation service in designated shortage areas.
Operates mentorship and continuing education programs led by culturally competent practitioners.
Partners with community-based agencies that receive reimbursement incentives for hosting trainees.
The mental health field, particularly the eating disorder community, talks of the need to increase minority mental health providers and the necessity of having greater access to mental health care for minorities. The community is absolutely correct. But that is as far as rational discussions go.
More often than not, discussions take place in an echo chamber. The community points fingers at the patriarchy, white supremacy culture, the diet culture and apply many other inflammatory labels … and nothing is accomplished. The community is defined by the past. A failed past. Instead of embracing a bold future.
Solutions to provide mental health care for our minority population can only be found by looking to the future. A future filled with hope and unlimited possibilities.
The mental health system in the United States is inundated with inequities and is hindered by limited access to care. Universal complaints about mental health include gross underfunding of services, provider shortages, fragmented care between mental and physical health, inadequate insurance coverage and widespread stigma that creates policy and opportunity barriers for people with mental illness. No one disputes that reality.
When significant cultural issues confront us and change is demanded, generally there are two types of people.
There are those people who lead, who are people of vision. They recognize and identify the problems and then commit to explore workable, rational, obtainable, collaborative solutions. These people who will negotiate with Satan himself if it leads to more people receiving the help they so desperately need.
Then there are “the ROYS.” In Texas, that acronym stands for “Rest of Y’alls.” This constitutes the vast majority of people. Those who are content with only complaining about the problems without being willing to invest in finding a rational, reasoned, collaborative solutions. When facing those issues, they immerse themselves deeper in their tribes safely ensconced in the comfort of their echo chamber. They are satisfied with whining and applying inflammatory labels to the issues. Their egos and fears drive their lack of vision. They refuse to interact with anyone who does not agree with them.
With that backdrop, how may we presume the eating disorder advocacy/therapist community responds to the daunting issues confronting mental health in general, and eating disorders specifically?
In the past few years, I have spoken with research professionals, medical doctors, therapists and advocates about the state of the eating disorder community. All seem to be unanimous in their view that things have never been worse in the eating disorder industry and communities.
As such, it should come as no surprise that the community seems largely content to address daunting, societal mental health issues by fostering divisiveness through utilizing inflammatory labels on their websites, publications and even a purported certification program. In general, inflammatory labels are cavalierly directed toward other people in the community, but only from a person’s keyboard.
So, what is inflammatory labeling? Inflammatory labeling is just as it sounds. It is when we assign highly negative or even cruel labels to people or organizations.
Focusing on inflammatory labels instead of solutions in social justice movements, or for that matter in any context, hinders progress by reducing complex issues to oversimplified caricatures. This practice intensifies social divides, alienates potential allies, and prioritizes outrage over tangible reforms. While rhetoric is central to advocacy, the way it is framed can either drive constructive dialogue or deteriorate into unproductive polarization.
Studies on social movements have found that extreme or inflammatory rhetoric, including labeling, tends to decrease public support for a cause. This is because such tactics reduce the average person’s sense of identification with the movement, making it difficult to find common ground. Inflammatory labels simplify people into negative stereotypes, making it harder to recognize their full humanity.
This reflects the sociological concept of “labeling theory,” which posits that assigning a negative label can lead to a self-fulfilling prophecy and further entrench deviance. Labeling opponents with charged terms can create a binary “us vs. them” mentality, making it difficult to challenge ideas through reasoned debate. Instead of addressing the complexities of an issue, discourse devolves into a culture war of labels, name calling, and finger pointing all of which obscures real policy solutions.
By way of example, radical eating disorder activists casually throw out inflammatory labels like:
There are so many others: White Privilege, Whitestream Research, toxic masculinity. These inflammatory terms of derision are directed at anyone who does not agree with their viewpoints as well as the mainstream medical and mental health communities. In addition, the term “invasive species” is even being used to define or refer to the same White Supremacy Culture and people and organizations which fall under that umbrella. And that is supposed to be productive?
As for any proposed practical, realistic collaborative solutions to address the inequities in mental health care? They propose none.
A few years ago, a small group of people published a letter directed at eating disorder organizations and treatment centers. Amongst the demands made in the letter included: providing reparations to Black People, Indigenous people and People of Color, (“BIPOC”) especially queer and transgender BIPOC; hiring a transgender consultant to revise your marketing material; establishing sliding fee scales for BIPOC, transgender and gender diverse clients; redistributing wealth from the for-profit ED treatment world; providing access to Hormone Replacement Therapy.
Other radical activists equate mental health research and treatment as a zero sum game. That BiPOC, LGBTQ+, fat therapists and professionals must be centered and that there is no space for white, straight and thin people to jump in. Or that white, liberal female therapists should focus more of their attention on social justice issues and political reform in all they do.
Of course, in the unlikely event the latter ever happened, those therapists would then be labeled as White Saviors and would be publicly eviscerated in the town square ala Lindo Bacon.
There must be a way. Other than inflammatory labeling, whining and complaining, what possible solutions exist which could be explored to address some of the inequities in mental health care systems?
Inequities which include far too few medical doctors, therapists, counselors and other medical and mental health professionals who are BIPOC. Minority and BIPOC communities are far underserved. Medical school training largely ignores eating disorders and BIPOC issues. Far too few BIPOC persons receive mental health care. Access to meaningful mental health care is severely limited for BIPOC persons. Research has not included significant BIPOC participation. Mental health care can be prohibitively expensive.
These complex, daunting issues require collaborative wisdom. And when progress is made on these issues, as they surely must be, this necessarily will result in a more enlightened society. So, the question must be asked again … how are name calling, tribal mentality and inflammatory labeling going to be remotely effective in addressing these serious issues? Answer … they aren’t.
A roadmap does exist for systemic mental health reform in the U.S., prioritizing enforceable, high-impact interventions first while building toward longer-term initiatives. The roadmap assumes some federal and state collaboration, leveraging funding, licensing, audits, and measurable metrics. But it is possible. It will not be easy. It will require participation, wisdom and sacrifice from society as a whole. It will require us looking past our human frailties and being bold and forward thinking. But it is possible.
2025 Weight Stigma Awareness Week (“WSAW”) is upon us. Much of what it stands for was clarified in 2023. That year, WSAW produced a white paper entitled, Impact Council White Paper (“ICWP”).
The ICWP states it, “… hosted an Impact Council roundtable with advocates, educators, clinicians, and leaders in healthcare, non-profit organizations, and media to discuss the greatest roadblocks to accessibility and inclusivity, as well as goals for the future.”
The ICWP has two major premises:
Premise 1 — “The medical community has done significant damage by promoting the idea that ‘obesity’ is a greater risk to individual and public health than weight stigma and anti-fatness are.”
Premise 2 — “Lived experience should be treated as credible data and prioritized (as much as or more than textbooks and quantitative research) for clinical recommendations and treatment plans.”
These are foundational, core premises at the heart of the weight stigma awareness movement. If these premises can be objectively proven to be accurate, then the corresponding recommendations and information arguably have more substance and merit and need to be thoroughly explored by a collaboration of organizations and professionals.
However, if the foundation, the core premises collapses, so does everything built upon them. The corresponding recommendations would be grounded in science fiction, not science, and if ever adopted, would inevitably result in doing greater harm to patients.
So, let’s explore more closely these two premises.
Premise One
“The medical community has done significant damage by promoting the idea that ‘obesity’ is a greater risk to individual and public health than weight stigma and anti-fatness are.”
There is no dispute that weight stigma is itself harmful to health. Stigma increases stress, social isolation, depression and anxiety, and can worsen cardiometabolic outcomes through behavioral (avoidance of care, disordered eating) and physiological (stress-axis) pathways. When clinicians stigmatize patients, it reduces trust and adherence and discourages preventive care (fewer screenings, delayed care).
Certainly, focus on BMI alone oversimplifies risk. BMI is an imperfect proxy for health; it doesn’t capture fitness, fat distribution, socioeconomic drivers, or comorbidities. Over-reliance on BMI can miss metabolically healthy people who need care and wrongly pathologize others.
Social determinants and structural drivers matter. Emphasizing individual “weight control” can obscure food access, economic inequality, built environment, racism, trauma, and other upstream determinants that shape both weight and health.
Even with this reality, the obvious flaws in the first premise are legion.
First, the medical and scientific communities without exception embrace the reality that there are measurable health risks associated with higher adiposity for many people. Epidemiologic studies link higher BMI (particularly when accompanied by central adiposity) to type 2 diabetes, osteoarthritis, some cancers, and cardiovascular disease. Discounting these risks wholesale would be irresponsible.
Further, there is a false dichotomy risk at issue. Framing this issue as “either stigma is the main harm or obesity is” sets up a false binary. In reality, both can be true: stigma causes harm and excess adiposity can increase risk for some outcomes. Policies must address both.
There is the aspect of public-health communication challenges. Minimizing messages about risk could reduce motivation for preventive behaviors in those who would benefit. Public health must balance non-stigmatizing language with clear information about risk and actionable steps.
There are other factors involved. There is heterogeneity of evidence and population differences. The magnitude of adiposity-related risk varies by age, sex, race/ethnicity, and metabolic profile. Broad absolute statements risk ignoring subgroups with high absolute risk.
One of the biggest flaws and drawbacks from the ICWP, is that the people behind the ICWP represent that the medical community has caused more damage by emphasizing that obesity is a greater risk to health than weight stigma and anti-fatness. They have phrased this issue using an absolute criterion while needlessly pointing fingers to assess blame. They have placed their own beliefs and interpretation of their own life experience at the forefront of this issue. They erred.
There are different study designs and evidence strength. The obesity→mortality evidence includes very large pooled prospective cohorts and individual-level meta-analyses (GBMC/Di Angelantonio et al.) with millions of participants and long follow-up that estimate dose–response relationships and cause-specific mortality. That level of evidence supports an accepted causal inference for some outcomes.
Contrarily, much of the stigma literature is smaller, newer, and more heterogeneous: cross-sectional studies, smaller cohorts, and observational work using self-reported stigma measures. Even the stronger longitudinal analyses are far smaller in scale than the pooled obesity cohorts. This difference in scale and design limits how directly you can compare effect magnitudes.
Second, there are measurement differences and misalignment of outcomes. Studies of obesity typically measure objective exposures (BMI, waist circumference, body composition) and hard outcomes (incident diabetes, MI, cancer, all-cause mortality).
Studies of stigma usually rely on self-reported experiences (e.g., “have you experienced weight discrimination?”) or internalization scales — valuable but inherently subjective and vulnerable to recall bias and reporting differences. Outcomes often include psychological measures, behavior change, intermediate biomarkers, or, in a few cases, mortality. These are not directly isomorphic to the obesity literature’s end points.
Third, there are confounding and directionality / causality problems. People who experience weight discrimination are, unsurprisingly, often higher weight; disentangling whether worse outcomes are caused by stigma per se or by the underlying higher adiposity (or by shared upstream causes) is difficult. The study conducted by Sutin et al. adjusted for BMI and some covariates and still saw an association, but residual confounding (socioeconomic factors, comorbid illness, lifetime exposures) and reverse causation (illness leading to both weight change and discrimination) remain plausible. Further, establishing causality (stigma → disease → mortality) requires randomized or natural-experiment evidence or sufficiently rich longitudinal mediation analyses; those are scarce.
Fourth, population attributable burden has not been estimated comparably. To claim, “stigma causes more harm than obesity,” we need comparable population-level metrics (e.g., population attributable fraction of mortality or years of life lost due to stigma vs due to elevated BMI). Those metrics exist for BMI (GBMC estimated mortality burden across BMI categories), but do not exist in a comparable, robust form for weight stigma.
The study by Sutin et al. reports an HR for mortality but translating that into population attributable mortality would require representative exposure prevalence estimates, reliable adjustment for confounders, and replication across populations.
What the best current evidence shows: Weight stigma is independently associated with worse mental health, adverse behaviors (disordered eating, activity avoidance), physiological stress markers, and — in at least two cohorts — higher mortality after adjustment for BMI and some covariates.
What the evidence does not show: There is no robust, widely accepted, population-level set of criteria demonstrating that weight stigma causes more total harm to population health (e.g., more deaths, more DALYs) than obesity itself. The obesity→mortality/evidence base is far larger, multi-cohort, and quantifies dose–response relationships; stigma literature is convincing in signaling independent harm but is currently smaller, less consistent, and lacks comparable population attributable estimates.
Clearly, the goal should be to move clinicians toward respectful, trauma-informed care; strengthen social-policy responses (food access, housing, anti-discrimination); and develop interventions that improve health without weight stigma.
So, should we be asking with this shared goal, why would the people behind the ICWP frame this issue as an absolute? Especially when they have no reputable, scientific, medical or socio-economic studies to support their position that an emphasis on obesity has caused more harm than anti-fat bias?
Without any reputable, third-party studies, they framed this issue as an absolute to fit their narrative. The tragic, unfortunate reality is the solution was right in front of them. All they had to do was rephrase this issue in a strong, evidence-based, factual manner … such as …
“Weight stigma and anti-fatness are inextricably intertwined with obesity and should be collectively classified as a public health issue. This would require the medical and scientific research communities to increase their research, study, understanding and treatment of these serious health issues on an equal basis.”
What is there to disagree with in that phraseology? This would have removed the finger pointing blame game perpetrated by the ICWP and would have provided a collaborative way forward together. But that was not to be. And the reasons for that lack of vision are set forth in our analysis of Premise No. 2.
Premise No. 2
“Lived experience should be treated as credible data and prioritized (as much as or more than textbooks and quantitative research) for clinical recommendations and treatment plans.”
The second central premise—that lived experience should be prioritized above textbooks and quantitative data—turns medical practice into witch doctory and personal storytelling. This is not a serious framework for healthcare; it is activism dressed up as evidence.
The problems with this premise are legion.
There are obvious methodological problems. Anecdotes do not constitute medical evidence. Individual stories can be powerful but lack controls, generalizability, and statistical rigor. Treatment guidelines based on lived experience risk being skewed by outliers or vocal subgroups.
There are also bias and recall issues. Patients may unintentionally misreport causes, timelines, or treatment responses due to memory bias, emotional interpretation, or secondary gain.
We are also required to consider over-representation of advocates and activists. Those most active in advocacy or online discourse are often not representative of the broader patient population, creating sampling bias.
Then there is the risk of undermining evidence-based care. There is “treatment drift.” Prioritizing anecdotes could encourage clinicians to substitute “what worked for one person” for protocols validated across thousands in trials.
The medical community must also consider neglect of biological mechanisms. Obesity and eating disorders involve complex neurobiological, metabolic, and genetic components. Patient narratives may not reflect these dimensions.
There is also false equivalence. Equating lived experience with systematic research elevates subjective impressions over reproducible science, undermining evidence hierarchies critical for patient safety.
For obesity, some narratives reject all weight management as “harmful,” ignoring evidence that structured interventions improve metabolic outcomes. This can fuel distrust of effective therapies.
The medical and scientific research communities would inevitably experience ethical and legal challenges and concerns.
There is standard of care liability. If guidelines deviate from established evidence to favor lived experience, clinicians risk malpractice exposure when outcomes are poor.
There are also equity gaps. Vocal groups whose experiences get prioritized, may dominate marginalized, silent or less empowered populations.
Potential conflicts of interest exist. Patient advocates with financial or ideological agendas could influence treatment norms, displacing objective science.
The systemic consequences of this misguided belief are obvious and notorious. This belief would lead to an erosion of research investment at a time when research grants have been eradicated. If lived experience is placed on equal or higher footing, incentives to conduct rigorous trials would diminish, weakening long-term scientific progress.
It would also result in fragmentation of care standards. Different doctors, clinics and treatment centers might prioritize different anecdotal narratives, leading to inconsistent, non-comparable practices.
Most alarmingly, obesity and eating disorders already carry high morbidity and mortality; steering care away from empirically validated interventions risks worsening public health outcomes.
Again, we should be asking why would the people behind the ICWP frame this issue as an absolute? Especially when they have no scientific, medical or socio-economic studies to support their position?
The ICWP had the ability to reconcile both premises into a practical clinical and policy approach. They chose not to. Perhaps one of the co-founders of Weight Stigma Awareness Week gave us the reason for this ill-fated, Quixotic position when she said, “It bothered me that all the air was taken by a white perspective … This is no space for white, straight and thin folks to jump in … Those of us who have done the work around our internalized biases no longer trust the medical establishment to actually help us.” … Public health in this country is getting it so wrong and there is a better way, but we need to be willing to actually listen to those being harmed.”
These people are not embracing science. They are embracing science fiction.
Perhaps the answer to all legitimate questions asked above is simply … to maintain their voice, to assuage their feelings of pain, self-loathing and anger, the maladjusted, militant fat activists must embrace their own reality because society will not.
The ICWP fails
The ICWP fails at the starting line. Its first major claim—that medicine has caused more damage by warning about obesity than by neglecting weight stigma—is not just wrong, it is reckless. It is divisive. It dismisses decades of clinical evidence linking obesity to disease and early death, replacing science with ideology.
Its second central premise—that lived experience should be prioritized above textbooks and quantitative data—turns medical practice into guesswork and personal storytelling. This is not a serious framework for healthcare; it is radical advocacy dressed up as evidence.
Beyond the flawed premises, the rhetoric in the ICWP itself gives the game away. The authors rely on moralizing language and sweeping accusations, framing the medical community as a monolithic villain rather than engaging with the nuance of scientific debate. Raw emotion is substituted for data, using anecdotes and identity politics to demand deference in place of proof. This kind of rhetorical sleight of hand may stir outrage, but it does not withstand scrutiny.
When the core assumptions collapse, so does everything built upon them. The ICWP is not grounded in science but in science fiction. Far from being an authoritative white paper, it is merely a manifesto masquerading as scholarship, and it deserves to be treated as such.
Tragically … it did not have to be like that. But, when so-called leaders place the manifestations of their own mania before reputable, medical and mental health based criteria, their message is lost. The Power of the Message is lost.
And all that is left is chaos, shattered dreams, and the final, weak beats of a Tell-Tale Heart.
Recently, after expressing my views on the eating disorder community and its many dysfunctions, I was informed by an “eating disorder advocate” that I only had “righteous indignation.” In the past, this same person also opined that I was in the eating disorder community solely to make money.
Righteous indignation? Solely to make money? Let me answer both plainly: my anger is earned, and my motives are grief-forged — not mercenary. I paid my entry fee into this dysfunctional community with the dearest blood possible: my daughter’s. I did not come here to be liked, or to join the chorus of vapid, comfortable, egomaniacal voices. I came because someone I loved was ripped from life. Silence would be complicity.
Make no mistake, there are some incredible, soulful, intelligent, compassionate souls in the eating disorder community. Unfortunately, they largely remain silent, on the sidelines. Fearful of being ostracized or cancelled by the hate filled, social justice warriors.
I wish with every fiber of my being that I was not in this decaying eating disorder community. I wish that I did not know even one person in this horrifically comical, appalling community. For that would mean my daughter, Morgan lived. But since she died, I will allow my “righteous indignation” to illuminate what having a beloved child ripped from life is like.
Sunday nights in an intensive care unit in a hospital in a large city can be very quiet. But, not for you. You hear the ear shattering blaring of alarms, screaming out “Code Blue.” Death is sounding for your daughter. Death has come for you!
With panic in your eyes, you look into her room and cannot even count the number of hospital employees trying to bring her back to life. For at that moment, she is dead. Her heart is not beating. And you feel nothing at that point. The greatest fear a parent can face has you in its powerful, icy grip. Your brain has stopped working. You are not aware of anything… except the frantic efforts to bring her back to life. Finally … they detect a faint heartbeat after nine excruciating minutes.
Do you know what it’s like to have your child dead for 9 minutes while you look on helplessly? It is a lifetime. You are drenched in sweat. You are aware of nothing. Except … for the briefest of times, she is living again.
Until once again … she dies … and you again hear those horrific alarms of death. Again … her room is filled with employees doing all they can to bring her back. You are numb. Your entire world is in that room … on that incredibly dark night. And once more … they briefly bring her back.
That is when the doctors pull you aside and tell you … each time it is more difficult. You ask if she feels any pain. They cannot give you a straight answer. They tell you that in all likelihood, there is already substantial brain and organ damage. You ask them if there is truly any hope. They cannot look you in the eyes and are mumbling non-answers. And you know. You know. You are faced with the most difficult decision any person will ever have to make.
You remember one time in the past, your beloved daughter saying … “Daddy … don’t let me die.” And you know, you know, for an absolute certainty … that your life will never be the same. You wonder if you can ever forgive yourself for betraying those sacred words.
There is nothing performative about that grief. It is not a credential.
You slowly nod your head and quietly, while tears are pouring down your cheeks, say … no more alarms. No more bells. She will go in peace.
You sit next to her, holding her hand, praying for a miracle … knowing that one will not come. Finally, you hear those words which rip the heart from any parent … “She’s gone.”
You slowly walk down the dark hospital hallways. Sunday nights can be quiet in a hospital. You go to a waiting room where your daughter’s mom is waiting with friends. You can’t say the words… only shake your head. And you hear that heart wrenching scream of anguish. And yet, you feel nothing.
Your life as you knew it … is over.
You live in a fog. Making funeral arrangements, service arrangements. You feel nothing. Food has no taste. Your soul is numb. You wonder if you even want to wake up.
But you find a way, some way, to wake up and to keep living. Now, imagine that for most of your professional life, you had been a shallow, superficial, asshole. An attorney without a soul. But something has awakened within you. You begin to feel driven. Perhaps for the first time in your life, you are aware of something far greater than you.
In your daughter’s name, you only want to make a difference. You want to help others. But you are so broken. You make mistakes. You live in a constant state of guilt and shame. Nonetheless, you pledge to help others. And so, you try.
You then discover in the eating disorder community, children’s lives are being reduced to talking points, a and mortality is sidelined in favor of crowd-measuring. You read that this is no place for thin, white people to jump in. You realize that families are being betrayed by radical activists who only wish to parade their own ignorance and internal pain. Nonetheless, you continue to try. You try to serve.
You give two TEDx talks on eating disorders.
You organize and with a medical doctor, present a talk to Apple … and its 150,000 employees. The talk was broadcast on Apple’s North American network.
You organize and with that same medical doctor, present a talk to Raytheon … and its 75,000 employees. Also broadcast on its national network. This talk was so informative and compelling that the Raytheon office hosting it won a national corporate award for collaboration with the community.
You organize and present a 30-minute segment every week on a local radio station entitled, the Mental Health Moment. You have national experts on mental health appear on your show.
You appear on the local CBS and Warner affiliates talking about eating disorders.
The methodist church you belonged to does a video on your daughter and her struggles. With over 300,000 views, no other videos this church has done comes even close.
You speak to school district’s counselors and nurses. You organize presentations to communities. You visit young people in treatment programs. That is still not enough.
You are still living in a twilight that knows not joy, nor love, nor happiness.
Because you do not check the correct political and social boxes, because you frighten people, the eating disorder community turns on you. Have you made mistakes? Hell yes.
But it gets worse. Just five years ago, your father, your mother and your older brother all die within 14 months of each other. Your brother was the picture of health. And he only trusted you to tell the doctors to end his bodily functions. Imagine that much death in such a short period of time.
At that moment in time, your son and his wife have a baby. Imagine the very first time you hold your granddaughter in your arms, you have to tell your son you are flying to Florida the very next day to tell doctors to remove life sustaining equipment from your brother.
You know the eating disorder community doesn’t care. You frighten them because you do not play their pedantic games. You care about life and death not social justice and political statements.
And so, your mindset begins to evolve. You see the vile, on-going corruption in the community. You see the illness which claimed your daughter’s life being used as a platform to spew forth the community’s social justice and political viewpoints. And you reach a point where you say … enough!
Donors to NEDA come to you so angry that NEDA is being turned into a social justice and political side show by Chevese Turner and her social justice warriors. You have the ability and skill to take action. But first, you give NEDA almost 20 opportunities to talk before you file suit. An expeditious settlement is reached, a settlement which also financially benefits research into the genetic aspects of eating disorders. And yet, the very person who attempted to destroy NEDA’s purpose, skates by with no tangible consequences. She knows that her minions and cohorts in the community will continue to breathe life into her. Consequences and ramifications are foreign to the eating disorder community.
Undeterred, you go after more inappropriate conduct in the community. You see the specter of death appear in the words, “Terminal Anorexia.” Like many others, you are horrified. University-based professors write neatly composed articles opposing it, articles which accomplish nothing. Nothing tangible is being done.
So, you take action. You file a number of medical board complaints. That changed everything. You meet Dr. Jennifer Gaudiani and look her in the eyes. Much to your surprise, you do not find a monster. Instead, you find a professional. A soul. A human being. A person then in pain. You talk. And then collaborate with many others. What grew from that hard work was not triumphalism but human connection: colleagues turned collaborators, pain turned toward repair. And maybe … just maybe, you find through adversity a greater understanding about life and death. You realize that the manner in which we face death is just as important as the manner in which we face life.
Then, there is iaedp. The corruption and stupidity in that organization were and are legion. And the eating disorder community DID NOTHING. It cowered. The rot there was obvious and long tolerated. You initially do not pursue headlines and seek to meet and resolve all issues privately. That outreach is rejected. So, professionals in the community request action. The result: past due taxes, penalties and interest in the hundreds of thousands of dollars are being required to be paid. Board certification is being reformed and made more affordable. Individual chapters are gaining their independence. Thousands of therapists are now being spared needless expense. The community has improved — slightly, imperfectly — and for that action, very, very few people have said thank you. Predictable.
You are not finished. Not nearly. You expose how Chevese Turner and others of her ilk took down the Legacy of Hope. And for their misconduct, they have been rewarded and still have a voice. The community blindly accepts those who think like they do. Contrarily, you continue to exist. Living with the greatest heartache possible.
No matter how many times textbooks say, “it’s not a parent’s fault,” or some vacuous therapist tries to convince you of that, they fail. They haven’t lived it. They don’t live with the daily pain, the heartache. The anguish.
I do. Every … single … day.
I have made mistakes, and I will make more in the future. Grief is not a moral compass. But the stubborn refusal to confront corruption, the eagerness to defend the performative rather than the practical, that is the real moral failure. When children’s lives are reduced to talking points, when mortality is sidelined in favor of crowd-measuring, the community betrays the very people it claims to serve.
So — righteous indignation? It is paid in blood and sleepless nights. It is the only honest response left when an industry cloaks politics in the language of care and ignores the medical science in front of it. If you are offended by my anger, consider why the community has earned it.
I do not wish to be part of this community. I wish — every day — that I did not know anyone in it. I wish my daughter, Morgan, were alive. I mourn her constantly. My activism is not grandstanding; it is grief turned toward accountability, toward saving the next life.
If you call that righteous indignation, so be it. I am guilty as charged. And I will keep speaking and acting until this feckless culture chooses truth over theater.
So … righteous indignation?
A brilliant light was extinguished in Dallas on October 30, 2016. That tragedy is the ledger against which I measure every day. Righteous indignation is paid with the dearest blood possible — and I will not apologize for the balance I keep.
Weight Stigma Awareness Week should be an opportunity to confront one of the most damaging forces in healthcare: bias against people in larger bodies. This should be a week for data, clinical rigor, and constructive collaboration. Done well, it can highlight evidence-based solutions, elevate medical leadership, and foster collaboration across disciplines. And families who are suffering are the ultimate recipients of this shared wisdom.
Next week’s agenda includes sessions that could help shape our response to stigma and patient care. For example:
Rebecka Peebles, MD, FAAP, DABOM, & Lauren Hartman, MD — “Healing Without Harm: Ending Weight Stigma in Healthcare.” Practical, evidence-based strategies for clinicians who treat real patients in real exam rooms. The goal is not slogans but practical training rooted in science.
Leslie L. Williams, MD — “Navigating Eating Disorder Risks in the Age of GLP-1 Medications: A Weight-Inclusive Clinical Approach.” With GLP-1 drugs reshaping public conversations about weight and health, the need for clear, medically sound guidance has never been greater. Families deserve facts, not fearmongering.
Abigail Pont, MD — “Anti-Fat Bias in Medical Education Through the Eyes of a Medical Trainee.” Change must begin with training. Reforming curricula to prepare physicians to treat all patients with dignity and competence is not optional — it is essential.
These are the conversations that deserve attention, funding, and follow-through. They are the ones that have the potential to save lives.
But here lies the danger: while some leaders are advancing medicine, others are actively working to undermine it. Instead of fostering collaboration, maladjusted activists reject it. Instead of engaging with science, maladjusted activists ignore and dismiss it. Instead of building trust between patients and the medical community, maladjusted activists sow division, reject science, reject collaboration, and replace patient-centered work with grievance theater.
The weapons they use are fatuous ideology and vacuous grievances void of real substance and merit. This leaves patients and families caught in the crossfire.
This is the dark side of the ledger: militant, maladjusted, angry activists, wallowing in such internal pain, who reject collaboration, denigrate clinicians, and weaponize grievance for influence. This sadly is not theoretical.
It played out in 2021 at the Legacy of HopeSummit — a convening of some of the field’s foremost experts intended to build consensus and advance patient-centered solutions. Instead of joining that work, some radical activists not only opposed it, both before and after, but they tried to burn it down.
The most vocal critic was Chevese Underhill Turner, co-host of Weight Stigma Awareness Week, who also serves on the Board of Advisors of Within Health and is “Queen of the Ashes.”
Regarding the Legacy of Hope, Turner wrote:
“The entire ED community is getting ‘upskirted’ by certain men and we cannot put our own FOMO aside long enough to see it. Instead, we attend these men’s meetings and give them power to continue their gaslighting and lack of any willingness to see the intersections affecting our field. I’d love for other women to join me (and a few others) in being difficult when it comes to these people.”
This was not a critique grounded in evidence. It was not a call for better data or stronger collaboration. It was a deliberate attempt to sabotage a convening of experts — through crude language, ad hominem attacks, and an open invitation to disrupt and destroy.
Turner’s misguided viewpoints do not end there. On various podcasts and in social media, Turner has attacked clinicians, mocks evidence, and replaces medicine and science with grievance politics.
Her own words make it clear:
“It bothered me that all the air was taken by a white perspective.”
“My heart is in the higher weight community, whether a person has an eating disorder or not.”
“I believe bodies are political.”
“Everything is political.”
“I came out of the womb as a political beast.”
“When I hear “marketing” in the context of ED services to marginalized communities I hear white folks not learning from colonization and slavery. We need to stand down.”
“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.”
“When we constantly protect the feelings of those who are oppressing then we never actually get to the work needed to undo the oppression.”
Turner, in writing stated that she supported and was working toward the following: “ … providing reparations to Black People, Indigenous people and People of Color, (“BIPOC”) especially queer and transgender BIPOC; hiring a transgender consultant to revise your marketing material; establishing sliding fee scales for BIPOC, transgender and gender diverse clients; redistributing wealth from the for-profit ED treatment world; embracing and incorporating non-western treatment practices; providing access to Hormone Replacement Therapy.”
These extremist radical views come from ignorance and distrust of the medical community. In Turner’s own words:
“The DSM [Diagnostic and Statistical Manual of Mental Disorders], it is what it is … it’s not great.”
“Those of us who have done the work around our internalized biases no longer trust the medical establishment to actually help us.”
“That has only grown into a place where we are now. Body Positivity Movement. We don’t want to be judged on our looks and our size. The medical community said, ‘Ok. We’re going to judge you on your health.’”
“Most of the country is at a higher BMI, but when you begin to talk about people above a 35 who are visually fat, the oppression increases — plenty of data on that. People in the 50, 60 etc (superfat) range experience even more oppression. These are the folks who are publicly chastised and harmed continuously by the medical profession. Oh, the stories I could tell. Public health in this country is getting it so wrong and there is a better way, but we need to be willing to actually listen to those being harmed.”
“There may be some things with eating disorders that are brain issues … I don’t know.”
Turner’s harmful, illogical, extreme points of view do not constitute insight – they are ignorance masquerading in cartoon regalia, strutting as wisdom. They demonstrate contempt for medical science disguised as activism, reckless to the point of sabotage. And yet, somehow, they earn you the golden ticket to co-host Weight Stigma Awareness Week. Turner’s very presence doesn’t elevate the cause; it cheapens it, hollowing the message until nothing credible remains.
In the past, Turner redirected organizational platforms away from patient-centered care and toward political crusades. As a former officer of NEDA, one of the largest eating disorder organizations in the country, she proudly declared, “We won’t be deterred in our social justice work.” Under her “leadership,” donors were encouraged to contribute to the Minnesota Freedom Fund — an organization later revealed to have posted bail for accused murderers, rapists, and other violent offenders.
Ask yourself: who benefits from public disruption? Certainly not patients. Nor families. Nor clinicians attempting to balance complex risks and benefits. Disruption for its own sake only produces a cacophony of racket instead of clarity. It produces division where we need partnership and collaboration.
And yet, Turner is annually trotted out as a co-host of Weight Stigma Awareness Week even though her message never changes. She is still handed the microphone. Still made co-host. Still rewarded.
Turner’s destructive, insidious pattern is consistent and consequential. When so called leaders prioritize ideological purity tests over rigorous science, they do more than dispute ideas — they undermine care. When organizational platforms are repurposed for partisan causes, and donors are steered toward politically charged funds with questionable implications, the field’s credibility erodes. When individuals who oppose expert collaboration are nonetheless rewarded with boards, speaking invitations, and opportunity, the message is clear: rhetoric is encouraged; results are irrelevant. And yet, that is the reality in the eating disorder community.
In any other professional community, such conduct would bring harsh consequences. Suspension. Banishment. In the eating disorder world, it brings greater influence and opportunity. But it does not have to be that way.
The way forward is clear but it requires courage and resolve:
Elevate science-first voices. Medical experts who ground their work in data and clinical care should be at the center of not just this week, but every week and this field.
Insist on collaboration. Medicine is not the enemy. Progress depends on partnership between clinicians, researchers, and advocates willing to engage constructively.
Enforce accountability. Organizations must set standards of conduct. Those who undermine collaboration with reckless rhetoric cannot continue to hold leadership roles.
Protect patient-centered care. Eating disorder treatment should not be a platform for partisan politics. The focus must remain on evidence-based approaches that save lives.
Patients deserve better than empty slogans. Families deserve better than spectacle and disruption. The eating disorder community deserves leaders who are accountable, collaborative, and grounded in science.
Weight Stigma Awareness Week should not be a stage for any one person’s hate filled ideology. It should be a platform for medical and science based workable solutions.
The choices confronting us are simple.
Evidence based treatment over drama and dysfunction.
Clinicians and researchers who do the hard work of translating evidence into care over charlatans who sell social justice snake oil.
Collaboration over spectacle.
Accountability over impunity.
Lives are at stake. Families are desperate for solutions grounded in competent, humane care. Patients cannot wait for ideology to sort itself out. If we allow disruption to replace discourse, we become complicit in the harm that follows.
Since prolific anti-semitism directed toward Jewish therapists by non-Jewish therapists is an appalling reality, it was predictable that the assassination of Charlie Kirk would reveal the worst in humanity … including of course, eating disorder therapists and family liaisons. More’s the pity.
When a loved one has an eating disorder, families are already living in a war zone. Every meal feels like a battlefield. Every doctor’s appointment feels like judgment day. And when parents turn to therapy, they are not looking for ideology, slogans, or someone’s Twitter feed come to life. They are looking for life saving help.
Eating disorders don’t care about politics. They don’t care about hashtags. Eating disorders only care about shutting down organs, hijacking minds, and killing people. But too many therapists, treatment centers, and professional organizations are importing America’s divisiveness into treatment. The result? Families are left paralyzed, distracted, and betrayed.
More and more therapists and family liaisons are peddling something else: politics disguised as treatment. Some wave the flag of “Free Palestine” with militant zeal. And yet, most could not even remotely explain the complex nuances of Middle East politics going back thousands of years. When the phrase, “From the River to the Sea,” is spewed forth with all the hatred and horror which exists within the soul, many therapists and activists cannot even identify which river or which sea is being referred to, let alone identify the dark significance of that phrase.
These militant therapists and family liaisons sneer that the death of Charlie Kirk, a conservative commentator was deserved, and in their ignorance and room temperature IQs, slap “ism” labels on him and then rejoice that his life was tragically cut short. These providers and activists are intentionally obliterating the line between activism and care. Families should take this as the clearest possible warning sign: walk away. As fast as you possibly can. Do not trust those people or their organizations.
It is bad enough that families seeking help often find therapy rooms that sound more like activist seminars than clinical spaces. Instead of guidance on food and recovery, they get:
“Diet culture is colonialism.”
“Anorexia is a symptom of white supremacy.”
“Thin privilege is the real disease.”
These are not treatment strategies. They are slogans, ripped from Twitter and recycled in therapy sessions. When families should be hearing about family-based treatment (FBT), CBT-E, or medical stabilization, they’re handed culture-war scripts that do nothing but fracture trust.
Eating disorders thrive on chaos and division. They feed on families who are fractured, therapists who are distracted, and organizations that are broken. Every minute spent arguing over slogans is a minute not spent on saving a life. Every resource squandered on activism is a resource stolen from recovery.
Therapy is supposed to be a sanctuary from the chaos of the outside world. It is supposed to be a space where pain is met with compassion, not political litmus tests. Injecting social justice battles into that space doesn’t just distract — it actively harms.
Here’s how:
It replaces healing with indoctrination. Patients and families arrive desperate for answers about food, weight, fear, and survival. Instead, they may be handed lectures about geopolitics, race, or privilege. The family’s suffering becomes a prop for the therapist’s personal crusade. That is gross exploitation, not care.
It breeds division when unity is essential. Eating disorders tear families apart. Recovery depends on pulling together. A therapist who filters everything through activism risks turning family members against each other based on political or cultural identity. That kind of manufactured division is gasoline on the fire.
It signals contempt for dissent. A therapist who proudly mocks the death of someone they dislike politically is broadcasting one thing: if you disagree with me, I do not respect you. How could any family trust such a provider to respect their child, their family bond, or their values? Trust collapses before therapy even begins.
It encourages rigidity instead of curiosity. The most effective therapists know they don’t have all the answers. They ask, they listen, they adapt. But the activist-therapist thrives on certainty: oppressors vs. oppressed, good vs. evil, us vs. them. That rigidity suffocates the flexibility patients desperately need for recovery.
It undermines professional ethics. The ethical codes of every counseling profession warn against imposing personal beliefs on clients. Therapists who cannot resist bringing their political militancy into the room have already failed the most basic test of professionalism.
Let’s be clear: cultural awareness and respect for diversity are good things. But respect is not the same as ideology. Sensitivity is not the same as indoctrination. Families need therapists who can meet them where they are, not therapists who drag them into battles they never signed up to fight.
Eating disorders are the second most lethal mental health illness, outpaced only by opioid addiction. This is life-or-death work. Families should demand nothing less than evidence-based treatment, humility, and compassion. When a therapist instead advertises their political rage as part of their practice, they are showing you what matters most to them — and it isn’t your child’s recovery.
The therapy room should be sacrosanct and must never be allowed to become another front line in America’s political battles. Families: if your loved one’s treatment starts to look like activism instead of medicine, get out. Your child’s survival depends on science, unity, and clarity — not the noise of a broken country bleeding into a broken field.
“We have to abandon the conceit that isolated personal actions are going to solve this crisis. Our policies have to shift.”
Al Gore — Inventor of the Internet
“Effectively, change is almost impossible without industry-wide collaboration, cooperation and consensus.”
Simon Mainwaring — Author, Consultant, Branding Expert
In the past month, eating disorder organizations collectively released two podcasts. These podcasts featured several purported leaders in the eating disorder community. The theme was “collaboration and coalition.”
This first podcast was entitled, “Unity in Action: How NEDA, AED, and iaedp are Reimagining Collaboration in Eating Disorder Care.” Its moderator was Dawn Gannon, the Executive Director of iaedp. The participants were Dra. Eva Trujillo, Chairperson of the Executive Committee of iaedp, Doreen Marshall, the Chief Executive Officer of NEDA and Gry Kjaersdam Telleus, PhD, FAED, President of AED.
The second podcast was entitled, “Hope in Action: Advocacy, Education and Family Support in Eating Disorder Care.” Its moderator again was Dawn Gannon, the Executive Director of iaedp as moderator. The participants were Dra. Eva Trujillo, Chairperson of the Executive Committee of iaedp, Judy Krasna, Executive Director of F.E.A.S.T. and Johanna Kandel, Founder and CEO of the National Alliance for Eating Disorders.
[As an aside, Judy Krasna is working tirelessly at F.E.A.S.T. The hand she was dealt is incredibly daunting. Judy’s ability to bring hope to others despite her own personal tragedy is inspirational. This article is in no way, directed at Judy nor F.E.A.S.T., a parent focused organization.]
As for the others though …
Having turned their backs on cooperation for years, these organizations through their annointed leaders now peddle podcasts on “unity” — as if the worsening eating disorder statistics their arrogance helped create have nothing to do with them. This is not collaboration; it is historical revisionism dressed up as thought leadership, an attempt to recast failure as vision while the damage to patients, families, and the field itself continues to deepen.
For decades, these organizations have operated less like partners in a shared mission and more like rivals protecting their turf. Their leaders’ unchecked egos, refusal to share platforms, and insistence on gatekeeping professional legitimacy fractured a field that desperately needed cohesion. While the need for collaboration was obvious to clinicians, patients, and families, the so-called “leaders” chose pride over progress.
The results are plain in the data. Nearly 9% of Americans — about 28.8 million people — will face an eating disorder in their lifetime. Yet fewer than half of those suffering ever receive treatment specifically for their condition.
When my beloved daughter, Morgan died from anorexia in October 2016, the mortality rate was believed to be one death every 62 minutes. Under the “leadership” of these organizations, the mortality rate worsened. Now … the death toll is one soul every 52 minutes. One beloved daughter, son, wife, husband, brother or sister … every 52 minutes. At least one family fractured and condemned to exist in a living hell every 52 minutes. 10,200 Americans every year. To call this a systemic, reprehensible organizational failure would be charitable.
These outcomes did not happen in a vacuum — they were shaped, in part, by these organizations that prioritized self-promotion and control over collective action.
Now, with public scrutiny mounting, their very existence in doubt because of their incompetence, corruption, and statistics impossible to ignore, these same voices have turned to podcasting as if to reinvent themselves as conveners of dialogue. But dialogue without accountability is just performative. To applaud their sudden embrace of “collaboration” is to reward the very behaviors that deepened the crisis and worsened the mortality rate.
The Podcasts: A Sudden Conversion to Collaboration?
In their recent podcasts, the organizations present themselves as apostles of unity. “We don’t need to say the same thing. We need to say the right things together,” one leader insists, followed by declarations that “true partnership is not a press release” and that the field must “move from collaboration to coalition.” The language is lofty, almost aspirational — but it also reads like a confession.
For decades, collaboration has not only been neglected, it was actively resisted. The leaders now calling for “shared goals” and “mutual accountability” echo the same tired voices who presided over years of exclusion, ego-driven silos, and public refusal to partner. Their own admission — “we really don’t collaborate, and I think that’s holding us back” — is less revelation than confirmation of what patients, families, and professionals have long known.
The sudden insistence that “the field is watching, families are listening, we must speak with one voice” rings hollow when measured against history. It was precisely the lack of one voice — the splintering of the field into competing fiefdoms — that weakened public understanding, delayed medical recognition, and contributed to the worsening statistics. To now stage podcasts about “harmony” is to behave as though the crisis simply materialized, rather than acknowledging their own role in deepening it.
Even their calls for memorandums of understanding, shared campaigns, and joint advocacy are telling. These are not bold new ideas — they are the most basic commitments of any field facing a public health emergency. That such fundamentals are being floated as if groundbreaking only underscores how long the organizations refused to take even the first steps toward genuine partnership and how lost and vapid these organizations are.
The Gap Between Words and Actions
The dissonance lies not only in what is being said, but in what is conspicuously absent. These podcasts are heavy with declarations of urgency, integrity, and mutual respect, but strikingly light on accountability for past failures. Nowhere is there acknowledgment of how long collaboration was resisted, how many opportunities were squandered, or how deeply the credibility of the field was damaged by turf wars and egos.
The most obvious, blaring example of organizational hubris and failure is their betrayal of the Legacy of Hope Summit conducted in 2021.
Over 20 of the foremost experts in eating disorders met in Dallas, Texas to reach a collaborative consensus on eating disorders. All of the organizations were invited to attend and participate. All attended. However, as the Legacy of Hope process developed, those same organizations which attended the summit with grand words of cooperation, one by one withdrew from the process. Only AED, because of its then Executive Director, Elissa Myer, saw the project through to publication. The others? Actively slunk away from collaboration and sought to protect their own fiefdom.
In fact, one radical activist, who is embraced by one treatment center and as usual, is being trotted out during Weight Stigma Awareness Week had this to say about the Legacy of Hope: “The entire ED community is getting upskirted by certain men and we cannot put our own FOMO aside long enough to see it. Instead, we attend these men’s meetings and give them power to continue their gaslighting and lack of any willingness to see the intersections affecting our field. I’d love for other women to join me (and a few others) in being difficult when it comes to these people.“
Further, it is particularly galling that Johanna Kandel, one of the persons on the second podcast appeared at the Legacy of Hope in person and via telephone and then… Nothing. She did not sign off on the Legacy. She and the organization she leads did not endorse it. She and her organization turned their backs on the community’s greatest hope for collaboration. Without explanation. Just silence. And now she is one of the voices calling for collaboration?
What could have started as the foundational cornerstone for collaboration instead turned into one of the darkest moments for the eating disorder community. Perpetrated by these organizations, their egos and self-interest.
There is no concrete evidence that their current rhetoric will translate into change. Promises of “more clinicians trained,” “a new website,” or “sharing resources” are thin commitments when weighed against the scale of the crisis. Families listening to these conversations do not need another press release in audio form — they need assurance that the field is finally willing to dismantle the silos that have left so many patients without timely, effective care.
Meanwhile, the systemic problems remain glaring. Most medical schools still provide only a few hours of eating disorder training — if any at all. Physicians themselves admit they lack confidence diagnosing or treating EDs, leaving patients vulnerable to misdiagnosis and harmful delays. Early detection remains the exception rather than the norm.
When leaders now speak of “raising the bar for what trained really means,” the statement lands as an indictment of their own failure to make such training a priority long ago.
The access gap is equally damning. Even when patients are identified, treatment is often out of reach due to cost, lack of specialized providers, or long waiting lists. The promise of “connecting people to care” is meaningless without structural solutions to these barriers. Instead of confronting these realities, the podcasts retreat to abstractions about “shared truths” and “moving mountains” — lofty words detached from the urgency families are facing right now.
What Real Collaboration Would Look Like
Real collaboration does not begin with polished talking points or podcasts lacking in substance.
It begins with humility. It begins with listening — not only to one another as institutions but to the families, survivors, and frontline providers who have long recognized the cost of division. It means relinquishing the obsession with brand dominance and professional gatekeeping in favor of shared goals that truly prioritize patients over power and profit.
True collaboration would look like joint initiatives with transparent governance, shared funding streams that prevent duplication, and open access to resources across organizational boundaries. It would mean building structures that ensure accountability — not merely mouthing the word. And it would require leaders to acknowledge their role in perpetuating division before claiming the mantle of unity.
Until that happens, these podcasts serve less as roadmaps for progress than as monuments to irony: the fox guarding the henhouse, the arsonist auditioning as a firefighter, the vampire running the blood bank.
The eating disorder field — and the people it is meant to serve — deserve better than revisionist performances of collaboration.
“One of the saddest lessons of history is this: if we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. That bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”
-Carl Sagan
“Integrity, transparency and the fight against corruption have to be part of the culture. They have to be taught as fundamental values.”
-Angel Gurría, OECD secretary general.
In the past, I have been asked why I focused quite a bit of attention on iaedp and Acadia.
Regarding Acadia, that is about to end. Not because of great strides made by Acadia in terms of patient care. Certainly not because of transparency nor implementation of a state-of-the-art eating disorder treatment program which addressed all past sins. Oh no.
It is because … there is but one remaining.
On September 10, 2025, media outlets reported that Acadia was shuttering four facilities. Options Hospital in Indianapolis and Azure Springs in California.
Oh… and Carolina House and Montecatini. Their last day of operations will be October 9, 2025. Although if you look at their websites, you will never know they were shuttering.
Montecatini still advertises on its website that it is, “Southern California’s Premier Residential Eating Disorder Treatment for Female-Identifying and Nonbinary Individuals Providing Life-Changing Care for Adults and Adolescents for Over 30 Years.” It fails to mention … at least until October 9, 2025. After all, we have to squeeze every last penny from our victims!
Carolina House on its website still advertises, “Personalized Programming in a Safe, Healing Environment. Carolina House offers a range of programming options for individuals struggling with primary eating disorders (age 17+) or primary mental health concerns (age 18+).” It fails to mention … at least until October 9, 2025. After all, that incentive bonus of $1.7 million payable next March to Acadia’s feckless CEO is not going to pay itself!
So, we are left to wonder… are they closing because of gross incompetence of the treatment staff? Or are they closing because they simply were not profitable? And really, aren’t the two inextricably intertwined?
Even though they are closing, are they still accepting new patients? And if so, are they telling those who are suffering that they are being accepted only because Acadia needs a few last dollars and their recovery could possibly be compromised or set back because of Acadia’s greed? Aren’t we justified in assuming new patients, if any, are not being told because Acadia cannot even be transparent on the websites of those two entities?
So, Acadia is left with one eating disorder specific treatment center. McCallum Place. How long will it be before Kim McCallum’s legacy is shuttered?
Kim McCallum and her husband Mark, opened McCallum’s Place in 2002. In 2014, they sold to Acadia reportedly in a cash and stock deal valued at $40 million. Who can blame them? Although that stock portion isn’t looking too rosy right now with Acadia’s stock price in the last year, plummeting from $82 a share to $21.87 today. [Hope you already cashed out Kim.]
McCallum Place is now owned by McCallum Group, LLC. McCallum Group’s organizer, vice president and secretary was Christopher Howard. Mr. Howard was also general counsel to … Acadia Healthcare until he retired in 2023. In short, Acadia Healthcare, which is NOT a provider of any mental health nor eating disorder treatment services, owns and runs all operations of McCallum Place.
The same Acadia Healthcare which owned Timberline Knolls. Until gross incompetence and systemic abuse resulted in that facility closing.
The same Acadia Healthcare which owned Carolina House. We are justified in questioning whether it was gross incompetence or simply a lack of profiteering which caused that facility to close.
The same Acadia Healthcare which owned Montecatini. We are justified in questioning whether it was gross incompetence or simply a lack of profiteering which caused that facility to close.
Acadia has already clearly demonstrated its “treatment model” for operating eating disorder facilities is an epic failure. How many people suffering from eating disorders have had their recovery set back because of Acadia’s incompetence? How many more will there be?
At this point, we do not know that answers to those questions. But the one thing we do know … for an absolute fact is … McCallum Place … step to the plate.
A DAD'S JOURNEY WITH EATING DISORDERS 