For people in the eating disorder community, this is not an abstract finance story. This is Center for Discovery, one of the most recognizable names in eating disorder treatment, a brand that for years presented itself as a leader in residential and outpatient care for adolescents and adults, and a major component of the larger Discovery Behavioral Health platform. That platform reportedly expanded across 16 states and more than 150 treatment centers at its peak.
On May 11, 2026, in the offices of a New York City law firm, shattered pieces of the Discovery Behavioral erstwhile empire, including Center for Discovery, are set to be sold in a private auction, “as-is, where-is,” to address nearly $270 million in debt.
The “as is, where is” phrase matters.
Families were sold something very different; expertise, safety, continuity, and clinical necessity. What is now being sold is the underlying reality. Center for Discovery was not just a treatment program. It was primarily collateral inside a leveraged financial structure.
Discovery’s history makes the point. Investors behind Webster Equity Partners, a private equity firm, bought the company in 2011. It later recapitalized and merged assets into what became Discovery Behavioral Health. It then went on an acquisition spree across eating disorder, psychiatric, and substance-use treatment. In 2021, Discovery reportedly refinanced with a $163 million term loan, a $30 million revolver, and an $86 million delayed draw commitment from HPS and Capital One. This was not organic growth because outcomes were so compelling the field could not ignore them. This was private equity doing what private equity does … consolidating a fragmented market, leveraging the platform, and expanding first while leaving proof and sustainability for later.
Then later arrived.
Discovery’s former CEO reportedly acknowledged in 2024 that its six-bed residential model had become unsustainably expensive because labor and operating costs were rising while payer reimbursement was not keeping up. That is not a side note. It is the business model speaking plainly. One of the very models the eating disorder world has been taught to regard as intimate, specialized, and clinically superior was also financially fragile. It worked until the math stopped cooperating.
After covenant breaches, missed reporting obligations, and an accounting reclassification that lenders viewed as a maneuver to avoid default, HPS and Capital One seized control in December 2025. It abruptly replaced leadership and moved the business toward sale. So yes, after years of telling families that these institutions existed to save lives, the market has finally clarified the arrangement.
What am I bid for Center for Discovery?
We are justified in asking who are the likely bidders. No one outside the process should pretend certainty, but the most obvious possibilities are: the lenders themselves through a credit bid; distressed healthcare investors; private equity buyers looking for selected assets at a discount, and; strategic operators who want individual programs, licenses, or regional footprints rather than the whole platform.
In other words, the bidders are unlikely to be grieving families or clinicians trying to preserve a mission. They are likely to be people asking a cold-hearted question … which pieces are still worth something, and on what terms?
So what happens to Center for Discovery after that? Again, no one should pretend certainty. But the usual possibilities are not mysterious. CFD may continue under new ownership. CFD may be rebranded. It may be consolidated with other treatment centers. It may be stripped of its most valued assets, if any, for sale to the highest bidder. It may close if it does not fit the buyer’s economics.
That is what happens when a treatment network is revealed to be a portfolio before it is a public trust.
But there is one undeniable truth. CFD has failed and has betrayed the families it pledged to help.
So, at this point families may be asking if they should leave their loved ones in Center for Discovery facilities. That answer is not simple and anyone pretending otherwise is being reckless. Families should not panic and abruptly remove a loved one without a continuity plan especially if that person is medically fragile. Sudden disruption in eating disorder treatment can be dangerous. But families also should not passively assume that a recognizable, failed brand name still guarantees stability. At a minimum, they should be demanding direct answers to the following questions from facility leadership …
Is this specific program being sold, transferred, or retained?
Will clinical staff remain in place?
Is there any risk of closure, consolidation, or transfer?
What is the contingency plan for continuity of care?
Who will notify families if ownership changes?
Are there any changes in medical coverage, supervision, or discharge planning?
If a facility cannot answer those questions clearly, families should understand that as a warning sign, not an inconvenience … and act accordingly. Nothing is more important than the health and life of your loved one.
And no one in the eating disorder system should pretend that this is only about Center for Discovery.
Center for Discovery is simply the first case dramatic enough to make the architecture visible. If the treatment system depends on high-cost residential care, rising labor costs, payer resistance, lease drag, and heavy debt, there is no serious reason to think Center for Discovery will be the last emblem of the private equity era to fall in public. It may only be the first one wheeled into the auction room while the rest of the industry stares determinedly at the floor.
That is what makes this moment so important for the eating disorder community. Center for Discovery was not outside the system. It was one of the institutions that helped define it. One of the brands that normalized residential expansion. One of the names families were taught to trust.
Trust. The eating disorder system defined it. The eating disorder system betrayed it.
If Center for Discovery can be repossessed, stripped, and marketed for sale, then perhaps the question is no longer whether the system is unstable.
Perhaps the question is how long everyone intends to keep pretending this is an exception. Because there will be others. Center for Discovery is merely the first domino. Which brings us back to the first question …
On April 6, 2026, the journal, Fat Studies – The Interdisciplinary Journal of Body Weight and Society published the article, “GLP-1 medications for weight-loss: a triumph of marketing over patient care.” Written by Regan Chastain, Angela Meadows and Louise Adams, it is best understood not as a neutral clinical review but as an activist driven critique shaped by explicit ideological commitments.
This is not a baseless observation. It is disclosed within the paper itself and reinforced by the authors’ professional backgrounds. None of the three authors is a medical doctor, endocrinologist, cardiologist, or specialist in obesity medicine. Instead, the contributor statements identify them as a patient advocate and health writer (Chastain), a psychologist specializing in weight stigma (Meadows), and a clinical psychologist and weight inclusive health advocate (Adams). These are legitimate perspectives. But they are not equivalent to clinical trialists or physicians managing cardiometabolic disease.
More importantly the paper explicitly states that the authors “reject weight loss as a valid goal for individual or population level health promotion.” That declaration establishes a prior normative commitment that materially shapes the analysis. This is also known as “confirmation bias.”
When a paper begins by rejecting the primary therapeutic endpoint of the drugs under review, its conclusions are necessarily constrained by that premise. The result is not an open evaluation of evidence, but a framework in which any observed weight loss is either discounted, reframed as harm, or treated as irrelevant to health.
This foundational stance informs one of the paper’s most conspicuous factual distortions, the characterization of weight loss as a “side effect” that is intentionally “magnified” through high dosing. In the context of FDA approved obesity treatments such as semaglutide (Wegovy) and tirzepatide (Zepbound), weight loss is not an unintended side effect; it is the primary therapeutic objective.
Clinical trials are designed with weight reduction and related health outcomes as endpoints, and dosing is titrated based on efficacy and tolerability, not arbitrarily maximized to induce harm. Reframing the intended therapeutic effect as a “side effect” is not merely imprecise language. It is a rhetorical maneuver that allows the authors to imply that the treatment paradigm is inherently perverse. This constitutes a category error that undermines the paper’s credibility at the level of basic pharmacological description.
The paper’s treatment of clinical evidence further reflects a pattern of selective skepticism. The authors repeatedly emphasize industry funding, conflicts of interest, and pharmaceutical marketing as reasons to distrust the underlying evidence base. While these concerns are legitimate and important, they are deployed in a way that amounts to a genetic fallacy. The validity of clinical trial results is implicitly questioned based on their origin rather than their methodology, reproducibility, or regulatory scrutiny. At no point do the authors engage meaningfully with the fact that these trials undergo independent peer review, regulatory evaluation, and in many cases, replication across multiple studies and populations. Instead, financial entanglements are used as a proxy for unreliability.
This asymmetry becomes more pronounced when contrasted with the authors’ own evidentiary standards. While clinical trials are scrutinized for bias, the paper itself relies heavily on non-systematic sources, including journalism, activist materials, and even “personal communications.” The result is a double standard in which high evidentiary thresholds are applied to opposing evidence and substantially lower thresholds to supporting claims.
A similar pattern appears in the paper’s interpretation of major clinical trials, particularly the SELECT cardiovascular outcomes study. The authors criticize the widely reported 20% risk reduction as misleading because it represents relative rather than absolute risk, noting that the absolute difference was approximately 1.5%. While it is true that relative risk can be rhetorically amplified, presenting absolute risk in isolation is equally capable of minimizing clinically meaningful effects. Both measures are standard in medical reporting and are intended to be interpreted together.
By framing relative risk as exaggeration and absolute risk as trivialization, the paper engages in selective statistical framing rather than balanced analysis. This issue is compounded by the authors’ reliance on subgroup analyses to argue that benefits are not broadly applicable. They note that certain subgroups did not show statistically significant results but fail to acknowledge that such analyses are often underpowered and not designed to establish definitive absence of effect. Treating non-significant subgroup findings as evidence that benefits do not exist is a well-known statistical error.
The paper’s handling of trial attrition and long-term outcomes further illustrates a tendency toward speculative inference. For example, the authors suggest that high attrition rates in the SELECT trial imply that results overestimate long-term efficacy, and they hypothesize that participants with poorer outcomes were more likely to withdraw. However, this claim is not substantiated with evidence demonstrating the direction or magnitude of attrition bias. Modern randomized controlled trials routinely employ intention-to-treat analyses and other statistical methods to mitigate such biases.
Without demonstrating that attrition systematically favored positive outcomes, the authors’ conclusion remains conjectural. Similar questionable reasoning appears in their discussion of weight regain, where findings from withdrawal studies and historical dieting literature are extrapolated to predict long-term failure of GLP-1 therapies. While weight regain after discontinuation is well documented, projecting this pattern onto long-term continuous pharmacotherapy without sufficient longitudinal data constitutes an overextension of the available evidence.
The paper’s treatment of adverse event data is particularly problematic from an epidemiological standpoint. The authors cite large numbers of adverse events and deaths reported in the FDA Adverse Event Reporting System (FAERS) and suggest that these figures indicate significant risk. However, FAERS is a passive surveillance system that collects voluntary reports and does not establish causality. It also lacks a denominator, meaning the total number of users is not accounted for.
As a result, raw counts of adverse events cannot be used to infer incidence rates or comparative risk. Presenting these figures without appropriate context creates a misleading impression of danger. The claim that GLP-1 drugs “exceed the death toll” of prior withdrawn weight-loss medications is especially flawed, as it fails to normalize for vastly different exposure levels and durations of use. This is a classic example of an apples-to-oranges comparison that inflates perceived risk.
Methodologically, the paper’s analysis of pharmaceutical marketing practices is also weak. The authors acknowledge that their evidence was drawn from a “convenience sample of Google search results” and selected examples from journalism and public sources. This approach is neither systematic nor reproducible and is highly susceptible to selection bias and confirmation bias. Nevertheless, the authors generalize from these examples to characterize a global, coordinated campaign shaping the narrative around obesity and GLP-1 drugs. While there is ample evidence that pharmaceutical companies engage in aggressive marketing, the paper’s methodology does not support the breadth of its conclusions. The critique may be directionally valid, but it is not methodologically rigorous.
The paper repeatedly conflates sociocultural critique with clinical evaluation. Extended sections discuss weight stigma, body image, and the cultural meaning of fatness, often framing the use of GLP-1 drugs as part of a broader “anti-fat” or “eliminationist” narrative. These are important sociological considerations, but they do not directly address the clinical question of whether the drugs improve health outcomes for patients with obesity related conditions. The implicit argument, that because weight stigma exists, medical interventions targeting weight are suspect, does not logically follow. This conflation allows normative concerns about social justice to substitute for empirical evaluation of efficacy and safety.
In sum, the article raises several legitimate issues including the influence of pharmaceutical marketing, the prevalence of conflicts of interest, the challenges of long-term adherence, and the importance of informed consent. However, these valid concerns are embedded within a framework characterized by pre-committed ideological assumptions, selective interpretation of evidence, misuse of statistical and epidemiological data, and methodological weaknesses.
The authors’ explicit rejection of weight loss as a legitimate health goal, combined with their non-clinical backgrounds and advocacy oriented positioning, reinforces the conclusion that this is not a balanced medical review. Rather, it is a perspective piece that critiques GLP-1 therapies from within a specific ideological paradigm, and its conclusions should be evaluated with that context clearly in view.
Which brings us to the final point. The current discourse surrounding GLP-1 medications particularly within the eating disorder community has become increasingly polarized, with positions often shaped more by ideological alignment than by balanced clinical evaluation. Competing camps advance claims of authority over a complex and evolving area of medicine, responding to one another not with constructive engagement, but with entrenched rebuttal. This dynamic does little to advance patient care. Instead, it reinforces fragmentation, inhibits meaningful dialogue, and ultimately leaves patients and families navigating uncertainty without the benefit of a coherent, multidisciplinary consensus.
This pattern is neither new nor unique, but its consequences are particularly acute in a field as clinically sensitive as eating disorders, where nuance, individualized assessment, and careful risk-benefit analysis are essential. When discourse devolves into parallel monologues rather than genuine exchange, [see, Terminal Anorexia] opportunities for progress are lost. The absence of collaboration among stakeholders, clinicians, researchers, and advocates creates an environment in which important questions remain insufficiently examined and practical guidance remains underdeveloped.
By contrast, there are models for a more constructive approach. Recent clinical discussions led by experienced physicians underscore the value of measured, evidence-based engagement with this issue. For example, presentations by clinicians such as Dr. Anne O’Melia reflect a balanced perspective grounded in decades of experience treating eating disorders. Such perspectives acknowledge that GLP-1 medications when appropriately prescribed and carefully monitored, may offer benefits in certain contexts, while also recognizing that they may pose significant risks in others. Similarly, clinicians like Dr. Wendy Oliver-Pyatt have emphasized the importance of rigorous risk-benefit analysis and fully informed consent particularly in vulnerable populations. These are not absolutist positions; they are clinically grounded, context-sensitive frameworks.
One can readily envision this type of productive discourse in which such perspectives are brought into direct, professional engagement. Where clinicians with differing views examine the same body of evidence, interrogate assumptions and refine understanding through structured dialogue. A forum characterized by medical rigor, intellectual honesty, and mutual respect would yield far greater insight than the current pattern of isolated advocacy and reactive critique.
As with many areas of contested medical practice, progress will not emerge from unilateral assertions of certainty but from sustained, interdisciplinary collaboration. The complexity of GLP-1 therapies, spanning metabolic, psychological, and behavioral domains demands precisely this kind of engagement. A more integrated approach would better serve not only the advancement of clinical knowledge, but also the patients and families who depend on it.
The best way to embrace the future, to increase our understanding of eating disorders, to reach enlightened consensus … is through collaboration.
Dr. Jennifer Gaudiani’s first book, Sick Enough became one of the most influential medical texts on eating disorders for a mixed audience of clinicians, patients and families. Her recent Second Edition considerably expands its reach. It is broader in diagnostic scope, more explicit in its rejection of weight stigma, and more attentive to populations historically marginalized within eating disorder discourse, patients in larger bodies, those with ARFID or atypical anorexia, athletes, neurodivergent individuals and others.
The second edition is a substantial, clinically ambitious and humane book. This is an updated guide with a wealth of information for patients, families, and clinicians. It has an expanded coverage of weight-inclusive care, “unmeasurable” medical problems such as Positional Orthostatic Tachycardia Syndrome (POTS) and Mast Cell Activation Syndrome (MCAS) and includes specific populations such as athletes, people in perimenopause, and those with PTSD or ADHD.
Its table of contents also shows a broader scope than a narrow anorexia only manual. The Second Edition covers purging, BED, ARFID, atypical anorexia, recovery and several special populations.
It is one of the strongest medically oriented eating disorder books for a mixed audience. Especially if the reader wants a text that combines clinical seriousness with anti-stigma framing. Its greatest strength is that it repeatedly emphasizes that eating disorders are medically dangerous across body sizes and presentations. However, one of its limitations is that it can be too expansive, too clinician-shaped, and at times too structurally diffuse for readers who want either a purely patient facing guide or a tightly organized medical handbook.
What the book does very well
The Second Edition directly attacks the “not sick enough” myth. This is the book’s central moral and medical achievement. Dr. Gaudiani makes the case that eating disorders are not validated by emaciation alone and that serious risk can exist in larger bodies, in atypical anorexia, in purging disorders, and in undernutrition that is not socially legible. The Second Edition’s explicit emphasis on weight stigma and weight inclusive philosophy is one of its defining strengths.
That matters because many books on eating disorders still smuggle in a hierarchy of seriousness. Sick Enough pushes against that hierarchy. It is corrective in the best sense, not merely compassionate, but clinically corrective.
The book also bridges medicine and lived experience better than most clinician authored books. The book emphasizes case presentations, stories, metaphors, practical strategies, and approachable science. That combination seems to be the key to the book’s reputation. An independent professional reviewer noted that Dr. Gaudiani combines expertise with a compassionate tone and keeps the book accessible without drowning newer readers in jargon.
This is important because eating disorder medicine can quickly become alienating. A text can be medically accurate yet useless to frightened patients or exhausted families. Dr. Gaudiani appears to avoid that trap by translating physiology into understandable language without trivializing it.
The table of contents shows a book that does not stop at restrictive anorexia. It includes chapters on purging, BED, ARFID, atypical anorexia, recovery, neurodiversity, diabetes, athletes/REDs, males, gender and sexual minorities, sexual and reproductive health, substance use, older age, and gastrointestinal or autonomic complications.
That breadth makes it unusually useful in real world practice where some patients rarely present as textbook stereotypes. The Second Edition seems designed to reflect the heterogeneity of eating disorders rather than forcing everyone into one familiar clinical script.
The Second Edition explicitly includes a section on “The Unmeasurables,” including MCAS and POTS. Whether every reader will agree with the framing, this signals one of the book’s core virtues. It approaches in a professional manner, the messy borderlands of eating disorder medicine where symptoms may be debilitating even when medicine has not produced neat explanatory boxes.
That gives the book emotional and clinical credibility. Patients with complicated, long-standing illness often feel erased by handbooks that only recognize what fits clean laboratory or diagnostic boundaries.
A number of medical treatises are technically solid but ethically thin. Sick Enough seems to understand that care is not just about identifying bradycardia, electrolyte derangement, endocrine suppression, or GI dysfunction. It is also about how bias delays treatment. The weight stigma material is not simply ornamental. That makes the book more than a manual. It is also an intervention into how clinicians think.
Room for Improvementor Greater Clarity
As with all books, papers, studies and treatises there are areas for greater explanation and clarity.
The organization of the Second Edition may frustrate readers who want a classic systems-based handbook. One independent review from a dietitian praised the book but made a sharp structural criticism, that it did not organize material primarily by body system, so a reader trying to track for example, cardiovascular or GI consequences across diagnoses may need to jump between chapters.
That is a meaningful weakness. For a clinician in a hurry or a student trying to build a clean mental map, a systems based structure can be more efficient. Dr. Gaudiani’s presentation-by-presentation approach may feel more human and clinically realistic, but it is not always the fastest for cross-referencing.
The Second Edition also may be too medical for some patients and too general for some specialists. This is a classic hybrid text problem. By trying to serve patients, loved ones, and clinicians at once, the book likely lands a little imperfectly for each subgroup. For patients early in illness or recovery, the sheer amount of medical detail may feel overwhelming. For subspecialists already steeped in eating disorder medicine, some sections may read as broad synthesis rather than cutting edge dispute. That does not make the book weak. It makes it broad. But broad books inevitably trade some depth for reach.
One of Dr. Gaudiani’s strengths is having a strong clinical voice. The downside of that voice, in any physician authored guide, is that it can sometimes produce a subtle asymmetry. The reader is being expertly guided, but nonetheless guided. For some readers, especially those wary of medical paternalism, this can feel comforting; for others, it can feel managed.
There are also some topic choices which may invite debate. [Debate has never been a weak spot for Dr. Gaudiani.] The inclusion of conditions such as MCAS and POTS under “unmeasurables” will resonate deeply with some readers and prompt skepticism from others, especially readers sensitive to how contested syndromes are discussed in medicine.
That is not necessarily a flaw. But it does mean the book is not purely conservative in scope. It steps into areas where interpretation, causality, and framing are complicated. Some will see that as brave and patient honoring. Others will worry it risks overextension.
Sick Enough does underscore the lethality of eating disorders and makes clear that anorexia nervosa carries the highest mortality rate of any psychiatric illness, citing markedly elevated death rates relative to healthy peers and a significant contribution from suicide. However, the book does not organize this point as a sustained comparative analysis across diagnoses. Instead, it embeds the explanation within its broader medical framework. The cumulative effects of prolonged undernutrition, multi-system physiological deterioration, and heightened suicide risk. In this way, Dr. Gaudiani establishes the mortality hierarchy clearly, but explains it implicitly through the biology of starvation and clinical risk rather than through a dedicated, diagnosis-by-diagnosis examination of mortality mechanisms.
The best features and biggest improvements in the Second Edition appear to be: a stronger emphasis on weight stigma and weight-inclusive care; broader recognition of ARFID, atypical anorexia, BED, and diverse patient groups; added treatment of neurodiversity and psychiatric complexity; inclusion of POTS, MCAS, and complex digestive issues, and; more explicit attention to athletes, males, gender/sexual minorities, sexual and reproductive health, and older adults.
That is exactly the sort of expansion a Second Edition should make. Not just “more studies,” but a wider and more current model of who gets sick and how illness presents. The Second Edition may be structurally imperfect as a reference manual, occasionally vulnerable to being too broad for specialists and too dense for lay readers, and open to debate in some of its more complex “unmeasurable” territory.
However, it is authoritative, compassionate, modern in its anti-stigma stance, broad in diagnostic scope, and far better than most medical books at explaining why a person can be very ill without “looking sick.” It seems especially strong on translating eating disorder medicine into language usable by non-specialists.
Although not flawless, [what book is?] it is the kind of book that can genuinely change how people understand eating disorders: medically, morally, and diagnostically.
That is rare.
Which makes the Second Edition a must read for medical and mental health professionals and not just those in the eating disorder community.
The March 25, 2026 jury verdict in Los Angeles against Meta and Google, paired with the $375 million New Mexico verdict against the same companies the day before, mark a structural shift in how courts conceptualize harm arising from social media platforms. These cases do not merely expand liability. They reframe the legal ontology of digital platforms from neutral intermediaries into potentially defective consumer products.
In this article, we will explore what this means for the way in which we look upon eating disorders … and what therapists and clinicians should know.
For eating disorders, conditions already deeply entangled with algorithmic amplification, body image distortion, and compulsive engagement, the shift in liability for digital platforms is particularly consequential. The emerging litigation theory may provide for the first time a coherent legal pathway to attribute causation and duty in eating disorder related harm.
The recent Meta/Google verdicts succeeded because plaintiffs changed the theory of liability. The old framing was, “You allowed harmful content to exist.” Federal statutes provided immunity for this reasoning. Case dismissed.
The new framing is now, “You designed a system that predictably causes harm.” This is the doctrinal pivot. The plaintiffs were able to bring forth evidence that the platforms knew about harm (e.g., to teens, body image, ED risk) but continued optimizing engagement anyway. This evidence supports claims of negligence, recklessness and malice. This also strengthens the argument that the wrongdoing lies in corporate decision making not user content.
Why This Matters Specifically for Eating Disorders
Eating disorder harm fits the “Design, Not Content” model argued in courtrooms. Eating disorders are not typically triggered by a single post. But by repeated exposure, escalating comparison and behavioral reinforcement. These are clearly algorithmic phenomena.
Unlike traditional media, social media platforms can identify users engaging with dieting and body comparison content. This increases the likelihood of exposure. This frames a plaintiff’s argument that harm is not incidental. It is systematically intensified. There is also substantial evidence that social comparison leads to body dissatisfaction and repeated exposure leads to disordered eating behaviors
This makes it easier to argue that harm was predictable, foreseeable and safer alternatives were available but disregarded.
The recent verdicts are also significant not because they establish a medical causation of eating disorders, but because they elevate platform design and algorithmic exposure into the realm of foreseeable mental health risk.
In effect, the verdicts reinforce three propositions that are directly relevant to clinical practice:
Digital environments can function as risk-amplifying exposures, particularly for adolescents;
Algorithmic curation is not neutral, but can intensify engagement with appearance focused or psychologically harmful content; and
Harm need not arise solely from user intent but may be driven by product design features.
From a standard-of-care perspective, these propositions are likely to influence what constitutes “reasonable” clinical conduct.
Even in the absence of formalized guidelines, foreseeability plays a central role in negligence analysis. As juries begin to recognize social media design as a source of mental health harm, clinicians may be expected to:
Screen for social media use with greater specificity (not merely duration, but type of content and engagement patterns);
Incorporate digital environment management into treatment planning; and
Provide anticipatory guidance to patients and families regarding online risk factors.
Failure to do so over time may be framed as a deviation from evolving professional norms even in the absence of codified standards.
Evolution of Standard of Care Through Litigation Rather Than Consensus
In fields lacking clear clinical standards, the standard of care often evolves through case law, expert testimony, and institutional practice patterns.
The Meta and Google verdicts may accelerate this process by:
Providing a judicially recognized framework for linking platform design to mental health harm;
Encouraging plaintiffs to incorporate digital exposure into causation narratives; and
Pressuring professional organizations to issue more explicit guidance in response.
In this sense, the verdicts may function as de facto catalysts for standard formation even if formal consensus lags behind.
Clinicians and treatment programs that proactively integrate digital-risk assessment may therefore position themselves more favorably relative to an emerging baseline of care.
Implications for Causation Frameworks in Eating Disorders
Historically, eating disorders have been understood through a multifactorial model, incorporating genetic predisposition, temperamental traits, family dynamics, trauma and sociocultural influences. The recent verdicts do not displace this model. However, they may recalibrate the weight assigned to environmental and systemic contributors, particularly those mediated through technology. Importantly, this shift may influence not only clinical practice, but also the narrative frameworks used in litigation and public discourse.
Anticipated Expansion of Social Justice and Structural Etiology Arguments
One of the more complex implications of these developments is the possible expansion of social justice based etiological frameworks, including arguments that locate eating disorders within broader systems of oppression.
Within certain academic and advocacy contexts, eating disorders have increasingly been linked to:
Eurocentric beauty standards,
Fatphobia,
Structural inequities in healthcare access, and
Cultural norms associated with what has been termed “White supremacy culture” (e.g., perfectionism, control, individualism).
The Meta and Google verdicts may indirectly reinforce these perspectives in several ways:
1. Externalization of Harm
By attributing liability to platform design rather than solely to individual behavior, the verdicts support a broader shift toward externalizing causation. This aligns with social justice frameworks that emphasize systemic over individual factors.
2. Validation of Environmental Influence
The recognition of algorithmic amplification as harmful lends credibility to arguments that cultural and media environments actively shape pathology, rather than merely reflecting it.
3. Expansion of Duty Beyond the Individual
If platforms can be held liable for contributing to mental health harm, analogous arguments may be advanced that cultural systems, institutional practices, and dominant norms also bear some responsibility for shaping risk.
As a result, Plaintiffs may increasingly incorporate cultural and systemic critiques, expert testimony on media ecology and sociocultural pressure, and arguments linking platform content to broader ideological frameworks as part of causation narratives.
Tension Between Clinical Rigor and Expanding Etiological Narratives
While these developments may broaden the scope of inquiry, they also introduce tension. From a clinical and evidentiary standpoint multifactorial models require specificity and measurable variables and overly diffuse causation theories risk diluting analytical precision.
From a legal standpoint courts require evidence that is not only plausible, but attributable and proximate. Expansive social frameworks (e.g., “White supremacy culture”) may be more difficult to operationalize in a manner that satisfies evidentiary standards. Accordingly, while social justice perspectives may gain rhetorical and academic traction, their translation into clinical standards or legal causation will likely depend on the development of measurable constructs, empirical validation, and clear linkage to individual harm.
Increased Eating Disorder Liability
For eating disorder related claims, liability may no longer depend on identifying specific harmful posts. Instead, plaintiffs can target recommendation algorithms, engagement loops (likes, scroll, autoplay) and behavioral reinforcement systems. This aligns directly with how eating disorder pathology operates; repetition, reinforcement, and escalation, not isolated exposure.
Historically, eating disorder related litigation struggled with causation; eating disorders are multifactorial (genetics, trauma, culture) and Courts viewed platform influence as too attenuated.
The recent verdicts suggest juries are now willing to accept alternatives. The Los Angeles case framed harm through addiction mechanics; compulsive use, reinforcement loops and diminished control. This maps closely onto eating disorder pathology; compulsive restriction, bingeing, or purging, reinforcement through comparison and validation and escalating behavioral cycles.
Unlike traditional media, social media platforms learn user vulnerabilities and optimize content delivery accordingly. For eating disorder claims, this enables arguments that platforms did not merely expose users to harmful content. They systematically increased exposure based on detected susceptibility.
This is a qualitatively different form of causation, not passive distribution, but active behavioral shaping.
Among potential harm categories, EDs are uniquely positioned for litigation success due to a high predictability of harm. There is extensive internal and external research linking social comparison to body dissatisfaction to disordered eating. We now know that social media platforms can track repeated viewing of weight loss content, thinspiration and calorie restriction narratives. This creates a potential evidentiary record of foreseeable harm combined with continued amplification.
Courts are especially receptive to harms affecting minors and failure to implement protective measures. Eating disorder onset often occurs during adolescence, aligning directly with peak social media usage and peak psychological vulnerability.
Long-Term Structural Changes
As a result of these cases, we may see an emergence of “Digital Duty of Care” particularly for minors. Social media platforms may be held to standards similar to product safety law and pharmaceutical risk disclosure. Courts may formalize liability tied to predictive amplification of harm. And we may see potential legislation impacting youth specific design standards, limits on engagement optimization and/or mandatory transparency for algorithmic systems.
We may also see evolving clinical implications for eating disorders. Eating disorders may increasingly be viewed not only as psychiatric conditions but environmentally induced or exacerbated disorders linked to platform design.
Clinicians should begin to document social media exposure patterns and incorporate platform use into diagnostic frameworks. This could strengthen litigation evidence and insurance coverage arguments.
In addition, eating disorders may be reframed as partially technology-mediated disorders. This parallels lung cancer (tobacco) and opioid addiction (pharmaceutical design and distribution).
The Meta and Google verdicts do not merely increase litigation risk, they signal a paradigm shift in how harm from digital systems is understood and adjudicated. For eating disorders, the implications are profound:
A viable legal theory now exists
Causation barriers are weakening
Platform design is becoming justiciable
Large-scale settlement frameworks are increasingly likely
Most importantly, these developments may redefine eating disorders not only as clinical phenomena, but as foreseeable outcomes of engineered environments optimized for engagement at the expense of psychological safety.
If this trajectory holds, the next phase of litigation will not ask whether platforms contributed to eating disorders, but to what extent, and at what cost.
The complexities of eating disorders require medical monitoring, psychiatric oversight, nutritional rehabilitation and clinical judgment. Eating disorders demand the highest level of expertise and professionalism from medical and mental health providers.
And yet, in a rapidly expanding corner of the wellness marketplace, they are being addressed by people who are not licensed, not regulated and, in many cases, not clinically trained at all.
They call themselves “Eating Disorder Coaches.”
There is no statutory definition of that role. No minimum education requirement. No mandated supervision. No governing board. No uniform ethical code enforced by law. It is merely a name. A brand. A vacuous title.
And no reliable mechanism to stop them if they cause harm.
Now make no mistake … there are “Eating Disorder Coaches” who are compassionate, intelligent professionals whose services are invaluable in working with a cohesive treatment team. But, in a community which rarely imposes consequences or adverse ramifications for reprehensible conduct, the danger of incompetent eating disorder coaches is far too real.
A Title Anyone Can Use
In most US states and in the UK, the title “eating disorder coach” is not protected. Anyone can adopt it. There is no state exam. No residency. No clinical hours requirement. No continuing education mandate enforced by a licensing authority.
A former state licensing board investigator describes the situation bluntly:
“From a regulatory standpoint, ‘coach’ is a marketing term. It does not confer legal authority, and it does not trigger professional oversight.”
If a licensed psychologist commits misconduct, a complaint can be filed. A board can investigate. A license can be surrendered, suspended or revoked.
If a coach commits misconduct, unless they also hold a license and the conduct falls squarely under licensed practice, there is often no comparable public accountability mechanism.
In practical terms, this means individuals with minimal training can advise medically fragile clients about food exposure, weight restoration, purging behaviors, exercise patterns and relapse decisions … issues that in clinical settings, are handled by multidisciplinary teams.
The danger is not theoretical.
A psychiatrist who specializes in eating disorders warns:
“Improper intervention can reinforce pathology. Poorly managed refeeding can have medical consequences. Missing suicide risk is catastrophic. These are not coaching issues. These are clinical issues.”
Yet the marketplace does not reflect that distinction.
The Coaching Loophole
The structural problem becomes especially stark when licensed professionals move into the unregulated coaching space.
Karin Lewis, an eating disorder clinician and founder of the Karin Lewis Eating Disorder Center in Boston, surrendered her Massachusetts therapy license while under investigation following two pending ethics complaints … including one filed by the therapist who began treating a former client after that client left Lewis’s care.
Separately, that client filed a civil lawsuit against Lewis for Lewis’ alleged unethical business practices. That case was resolved for an undisclosed payment.
However, Lewis’ licenses in New York and Rhode Island currently remain active… at least for the time being.
More recently, Lewis publicly presented herself on social media as an “Eating Disorder Coach.”
The legal reality is striking: surrendering a license in one state does not prevent someone from operating as a coach. Coaching requires no license to surrender. Instead, it is explained away as a personal and professional transition. In Lewis’ words, “I’m shifting to a coaching and consulting model.” Perhaps the rest of that sentence should have read, “Because I am prohibited from engaging in my chosen profession in my home state.”
Good Lord. From a profession where at least there is some oversight to a role that has no oversight, no requirements and no accountability. What could possibly go wrong?
Especially when you can belong to a community which will protect you no matter what so long as you hold the same idealistic, radical views espoused by others. Surrender your license? Not a problem. You can still serve on Advisory Boards of eating disorder treatment centers. No consequences. No accountability.
However, this is not a commentary on one individual alone. It exposes a systemic failure: professionals can exit regulated roles and continue working in adjacent, unregulated ones without a unified accountability framework.
This type of unregulated model is illustrated in a much larger context, that is, eating disorder board certification. [However, this article will not focus on certification. That is for a future date. It is only briefly included for context.]
Certification: The Illusion of Reform
Despite growing criticism, eating disorder certification programs have multiplied to an extent that would make rabbits blush. Like coaching, certification programs are unregulated, there is no oversight and anyone can create them. A person can include any private issue they like in a certification program … from Indigenous Person’s Land Use Acknowledgements to railing on White Supremacy Culture.
Project HEAL has expanded programming and provider networks while advocating for improved access to care. Inclusive Eating Disorder Education (IEDE) offers tiered credentials and training tracks. The Eating Disorder Institute (?) f/k/a The Institute of Contemporary Eating Disorder Education (ICEE) provides coursework and professional certificates. Iaedp’s certification program is undergoing broad changes because of litigation.
These initiatives often present themselves as raising standards in the field.
But certification is not regulation.
No state licensing board oversees these programs. No legislature defines their scope. No independent authority can revoke a certificate and legally bar someone from continuing to practice as a coach.
A healthcare policy scholar who studies professional licensure draws a clear line:
“A certificate means you completed a course. A license means the state has granted you legal authority to treat vulnerable people — and can remove that authority if you violate standards. They are fundamentally different.”
Certification programs may require coursework. They may encourage ethical guidelines. They may foster community norms.
But they do not create enforceable public protection.
And in some cases, critics argue, they risk compounding confusion.
“Consumers see badges, seals and credentials and assume oversight exists,” says a former hospital-based eating disorder program director. “But there is no disciplinary body behind most of these titles. It’s structural theater.”
These same issues exist with eating disorder coaching.
Coaching as De Facto Treatment
The most troubling development is not that coaching exists. Peer support has long played a role in recovery communities.
The problem arises when coaching becomes indistinguishable from treatment and therapy.
Coaches advertise meal plan guidance. Exposure support. Relapse prevention strategies. Accountability check-ins. Crisis navigation. Body image interventions.
These are not lifestyle adjustments. They are components of clinical care.
Eating disorders affect cardiac function, bone density, electrolyte balance and suicidality. Weight restoration can trigger refeeding syndrome. Purging behaviors can destabilize potassium levels to fatal effect.
In licensed treatment settings, these risks are monitored by medical professionals.
In coaching settings, oversight varies widely … and for the most part, does not exist at all.
A clinical ethicist frames the issue starkly:
“When someone markets themselves as capable of guiding recovery from a life-threatening illness, the absence of regulation is not an oversight. It is a policy failure.”
A Marketplace Built on Vulnerability
The expansion of coaching cannot be separated from systemic failures in access to care. Waiting lists are long. Insurance battles are common. Specialized treatment is expensive.
Desperate families look elsewhere.
The coaching industry has attempted to fill that void with polished websites, testimonials and social media authority. It operates largely outside insurance systems, outside hospital networks and outside state oversight.
In a traditional healthcare model, authority flows from licensure and statutory accountability.
In the coaching marketplace, authority flows from branding.
That shift should concern regulators.
As one former licensing official puts it:
“Regulation exists because vulnerable people cannot be expected to vet complex medical competencies on their own. When we remove regulation, we shift the burden of risk onto the patient.”
The Unanswered Question
Eating disorder coaching today exists in a regulatory grey zone that benefits providers more than patients.
Certification programs provide optics. Professional branding provides credibility. But neither substitute for enforceable oversight.
The core question remains unresolved:
Should individuals treating — or functionally treating — one of the most lethal psychiatric disorders operate without statutory accountability?
Until lawmakers address that question directly, through scope of practice laws, title protections or regulatory oversight, eating disorder coaching will remain what it is now:
A parallel system of quasi-clinical care, built on vulnerable populations, sustained by market demand, and largely immune from the guardrails that define the rest of healthcare.
And in medicine, immunity from oversight is rarely a virtue. It is a roadmap for catastrophic results.
It is Eating Disorders Awareness Week. A week in which organizations attempt to “raise awareness.” Presentations are made. The microscopically small niche on social media occupied by eating disorder advocates spout their messages using rote, familiar language while ignoring the most alarming statistic.
It is far easier to refine language than to examine outcomes. But outcomes are how we are judged. Outcomes determine our humanity. Our soul. Our fight for survival. And nowhere was this more apparent than in the incredible journey of Kaila Blackburn.
Everything I know about Kaila Blackburn I got from her strong, resilient, incredible mother, Debi and father, Tom. And what I read on social media.
Kaila was born on June 13, 1994, in Virginia, and on September 27, 2025, eating disorders took her life. Eating disorders took her from her family and her loving parents. But while she was with us, how she graced us with her strength.
Kaila was a natural student and athlete. She swam, dove, played softball, and ran with such breathtaking speed and grace that she earned the nickname “Flash.” Her dedication and talent carried her to Virginia Tech, where she proudly competed as a Division I runner.
From what I read, Kaila’s faith was the foundation of her life. From an early age, Kaila loved Jesus, and through her 31 years she remained steadfast, often teaching others through her wisdom and grace. Even in her hardest battles, she clung to her Savior with courage and unwavering trust.
Kaila’s parents wrote this about her, “We will not say that Kaila is “resting in peace.” Instead, we proclaim that she is Running in Paradise—whole, free, and forever embraced by the love of her Savior. That is exactly what Kaila would have wanted.”
I did not know Kaila. I never had the chance to meet her. But, I do take comfort knowing that my Morgan is probably showing her the ins and outs of the next plain of existence. And they are smiling, laughing and at peace.
This week, a Virginia television station did a story on Kaila. It can be found here:
My heart goes out to Debi and Tom and her family. We belong to a horrific club that no parent should ever have to join.
Maybe this week, eating disorder awareness week, we should take just a moment, close our eyes, remember and honor those who have been taken. And in that moment of silence, perhaps we should reflect upon what our priorities should be going into the future.
As a parent who had a loving child taken by eating disorders, I hope and pray every day that Morgan’s life, that Kaila’s life, and the lives of many others, were not extinguished in vain. That perhaps the memory of them will inspire us all to do better. To set aside our petty differences. To pledge to strive forward together … with intelligence, wisdom, grace and collaboration.
So that in the future, there will be fewer Morgans and Kailas and Kellys and many others.
We parents remember. We mourn. We grieve. And yet, we continue to hope. And we continue to love.
And love should be the overriding message of awareness week.
The most recent iteration of the iaedp symposium just concluded in Baltimore. Speakers, many of whom are the same familiar faces appeared giving similar presentations as in years past. And many people will go back to their practices secure in the feeling of a job well done. And the normalization continues.
We know that eating disorders are among the deadliest psychiatric illnesses in medicine. That is the uncomfortable truth that very few are willing to discuss.
That is not debated in the literature. It is not speculative. It is not marginal data. And yet the urgency one would expect around a lethal psychiatric disorder is conspicuously absent from the professional culture that surrounds it.
There are no sustained national funding drives proportionate to mortality risk. Federal research allocations remain disproportionately low compared to other psychiatric and medical illnesses with lower fatality rates. The disparity between lethality and attention is measurable.
So is the normalization.
Inside treatment systems, the language feels technical and reassuring:
The vocabulary signals coordination. It implies rigor. It suggests that decisions are anchored in standardized expertise. How wrong that is.
On the surface, the system does not appear malicious. It appears procedural. Structured. Measured. Confident. Each provider can justify decisions within guidelines. Each insurer can defend criteria. Each organization can cite consensus statements.
The illusion is not cruelty.
The illusion is normal.
Normal treatment duration. Normal discharge criteria. Normal reimbursement ceilings. Normal consensus frameworks.
Individually, nothing appears aberrant. Collectively, the structure produces outcomes that mortality data have been warning about for decades.
Which raises an uncomfortable question:
If eating disorders carry one of the highest mortality rates in psychiatry, why is that reality not the organizing principle of our professional gatherings?
The Silence Around Mortality
At major symposiums, such as the recent iaedp symposium in Baltimore, the agenda is full. Panels are polished. Continuing education credits are awarded. Networking flourishes.
Eating disorder awareness week is upon us. It will be acknowledged by a crowd measuring in the tens. Some media outlets will pay lip service to it. Again, the same faces will talk about the same messaging. Events will be broadcast on social media attended by the same people, again, measuring in the tens. At the end of the week, the community will pat itself on the back and go back to bickering about social justice issues being allowed in treatment rooms.
But where is the sustained, central, data-driven reckoning with mortality?
Where are the plenary sessions that open with longitudinal survival curves?
Where are the transparent discussions of long-term relapse and death rates across levels of care?
Where are the public audits of whether treatment durations align with neurobiological recovery timelines rather than insurance reimbursement windows?
Mortality is referenced, occasionally acknowledged, sometimes framed as a reminder of seriousness. But it is rarely dissected structurally.
Why?
Because a full confrontation with mortality data does not just indict illness. It forces scrutiny of systems.
It forces questions about whether reimbursement structures shape clinical standards, whether “medical necessity” criteria are actuarial compromises rather than survival-based thresholds, whether discharge decisions are tethered to coverage limits rather than durable recovery, and whether professional consensus has been influenced by economic sustainability of treatment centers.
Where are the public questions and demands about how a credit card company is now going to oversee and operate an eating disorder residential treatment center? And how is that even legal? Let alone in the best interests of our families.
Those are not comfortable conference topics.
For that matter, why wasn’t that topic discussed at the REDC meeting which took place in Baltimore in a public forum with families who are suffering ? What matters more? Families and the mortality rate? Or protecting one of your fellow REDC members from public scrutiny? Profit margins or saving lives?
It is far easier to discuss innovation in therapeutic modalities than to ask whether overall mortality has shifted meaningfully in decades.
It is far easier to host panels on emerging frameworks than to ask why families still encounter rationed care for a disorder with documented lethal risk.
It is far easier to refine language than to examine outcomes.
If symposium speakers are drawn repeatedly from the same professional circles, presenting iterations of the same frameworks year after year, the ecosystem becomes self-reinforcing.
Professional consensus carries weight. But consensus is not formed in a vacuum. It is shaped by committees, insurers, funding realities, dominant voices, and organizational politics.
If dissenting clinicians, particularly those who challenge reimbursement norms or treatment duration standards are marginalized rather than platformed, scrutiny narrows.
If social positioning and internal professional politics consume oxygen that should be directed toward structural reform, then optics begin to substitute for outcomes.
Meanwhile, mortality remains stubborn.
And rarely centered.
The most powerful stabilizing force in the treatment ecosystem is not bad intention. It is normalization.
If revolving door admissions are normal, no one is failing.
If truncated treatment is normal, no one is responsible.
If mortality is described as “multifactorial or complex” urgency diffuses.
But when a system designed to treat a known lethal disorder operates for decades without materially altering lethal outcomes, and that fact does not dominate its most visible professional forums, something deeper is occurring.
The silence itself becomes data.
How is it possible that a field organized around a disorder with one of the highest psychiatric mortality rates can gather annually without centering that mortality as the primary measure of success or failure?
If mortality is not the headline metric, what is?
Attendance numbers? Program growth? Expanded diagnostic inclusivity? Brand alignment?
Those may matter. But survival matters more.
Progress should be visible in survival curves.
Progress should be reflected in transparent long term remission and mortality data published without marketing filtration.
Progress should include open debate about reimbursement models, discharge standards, and treatment duration norms.
Instead, the field risks mistaking activity for advancement.
The same speakers. The same frameworks. The same consensus language.
And the mortality rate remains among the highest in mental health.
How Is That Progress?
If a system repeatedly fails to prevent lethal outcomes and still considers itself structurally sound, normalization has replaced urgency.
The institutions may be populated by compassionate individuals. Many clinicians care profoundly. But compassion operating within a misaligned architecture cannot compensate for structural design.
When families trust that care is calibrated toward survival, and insurers trust that criteria are defensible, and professional organizations trust that consensus equals correctness, scrutiny diminishes.
And when scrutiny diminishes, reform stalls.
The question is not whether people inside the system intend harm.
The question is whether the system is calibrated toward survival … or toward its own stability.
Until mortality is treated not as a sidebar statistic but as the central accountability metric, at symposiums, in reimbursement negotiations, in guideline committees, the illusion of normal will persist.
And children, adolescents, women, and men with eating disorders will continue to face a lethal illness inside a system that rarely speaks about death loudly enough.
There is a peculiar alchemy in modern healthcare marketing: mix equal parts corporate speak and earnest platitudes, stir in some pastel graphics, and poof! … you’ve created the illusion of transformation. Trying to cover up a tarnished past with a new logo and glossy verbiage has a name: reputation laundering.
The latest to attempt this reputation laundering is Castlewood/Alsana. Marketed as a “Soul Hearted” renaissance rooted in “clinical integrity” and “whole-heartedness,” Castlewood/Alsana’s bumbling attempt is as follows:
“Today, we’re honored to share a letter from Jordan and Keesha:
For the past year, we have been writing a new story for Alsana. We have been listening hard and leaning in. Thinking and planning, building and dreaming. Connecting, collaborating, and creating change within our organization. We have been working together with our teams as well as with our trusted mentors to build what we believe is most needed in the eating disorder field — and honestly, what is needed in the world.
Based on our collective 35 years of experience in the field — countless hours treating clients and working alongside providers — this new beginning for Alsana is our offering to each of you. A love letter of sorts to this work we all hold so dear. It is equal parts an homage to the grassroots efforts of the field’s founders and aspirational intentions for a brighter future.
The way we want to approach this privileged work of healing clients and partnering with providers is something we call Soul Hearted.
We value clinical integrity, whole-heartedness, mutual respect, thoughtful engagement, and rooted reliability. Today, and in the coming weeks, you will see the visual manifestation of this change: a new brand experience, including a new website with updated information on our mission and vision, as well as the new clinical framework that we’ve implemented this past year.
We invite you to follow along. Use our link in bio to visit our new website or read more about our Soul Hearted story.
With this new beginning, we aim for every person who encounters Alsana to feel seen in their authenticity and to know their worth. This is our way to give flowers to those who have come before us, those who will come after us, and all the souls we have the honor of supporting in between. Because each of you deserves flowers. This field deserves flowers.
With Gratitude,
Jordan Watson, Chief Executive Officer, Keesha Amezcua, LMFT, CEDS-C, Chief Clinical Officer” and [Unattributed, Chat GPT]
Castlewood/Alsana is so clueless, it required ChatGPT to craft its message. You may be wondering how we know it was a ChatGPT creation? Simple enough. Look at the overuse of the “em dash.” ChatGPT frequently overuses the em dash (—), often mistaken for a “long hyphen” or “ChatGPT hyphen” to simulate natural rhythm, add emphasis, link clauses, and replace commas or parentheses. It serves as a stylistic shortcut to mimic human spontaneity and structure thoughts.
In the public announcement, hyphens are used four (4) times. Needlessly so. But what better way to mimic human compassion than by having a soulless program draft your heartfelt announcement. While pretending it was “soul hearted.”
Chat’s messaging apparently attempts to include a new logo … a soft beige square with a delicate serif “A” and the soothing promise “You deserve flowers.”
But, if logos could tell the truth Castlewood/Alsana’s new logo would not be a soft beige square with a delicate serif “A” and the soothing promise “You deserve flowers.”
Instead, Castlewood/Alsana’s logo would be a cracked castle, its stones crumbling, sitting uneasily at the edge of the woods … because Castlewood/Alsana is not a new entity at all. Alsana merely remains as an assumed name, a pasteboard mask, a coat of paint applied to an old, failed structure whose legal name remains Castlewood Treatment Center, LLC. And its owner, The Riverside Company, desperately attempting to meet the needs of the investors behind this failed financial experiment.
As for its rebranding?
It is almost poetic how the rebrand leans hard into aspiration: “Because each of you deserves flowers.”
That’s lovely … until you realize that flowers are not a substitute for meaningful clinical outcomes, transparent safety data, and ethical accountability.
“You deserve flowers” is a lovely sentiment.
But flowers are not:
peer-reviewed treatment modalities
transparent adverse event reporting
independent oversight
staffing ratios
informed consent
ethical discharge planning
Flowers do not stabilize electrolytes. Flowers do not reverse medical neglect. Flowers do not replace cognitive behavioral therapy, family-based treatment, or medically competent monitoring.
Sure, everyone loves flowers. But the people truly harmed by substandard care don’t need floral metaphors, they need accountability.
When a treatment provider leans harder on aesthetic reassurance than clinical proof, the public should ask why.
Because in medicine, feelings are not outcomes.
And so, let us move on from the basics of that which the marketing materials disclose to that which they omit.
“Alsana” is not a standalone organization. It remains an assumed business name used by Castlewood Treatment Center, LLC, a company long associated with controversy in the eating disorder treatment space, particularly tied to its former Missouri operations.
If you review the Alabama Secretary of State’s business organization site for any mention of “Alsana” you will find … nothing. But, if you include Castlewood Treatment Center, LLC … bingo! Its registration as a Missouri based limited liability company appears.
This effectively means that Alsana cannot stand alone without Castlewood. The two are inextricably intertwined.
Castlewood’s legal entity did not disappear. The liabilities did not evaporate. The allegations did not dissolve into pastel tones. Only the branding changed.
That distinction matters to patients, families, clinicians, insurers, and regulators, because accountability follows the entity, not the font.
In its rebranding announcement and on its new website, Chat GPT on behalf of Castlewood/Alsana’s leadership describes the transformation as a “love letter,” rooted in “Soul Hearted” values: authenticity, worth, gratitude, and flowers for everyone involved. What’s striking is what the letter does not include. It does not include:
Acknowledgment of past harm
No discussion of documented controversies
No explanation of why multiple senior leaders left
No data on outcomes, safety, or reform
In healthcare, especially eating disorder treatment, language without evidence is not healing. It is mere marketing.
Eating disorder patients are uniquely vulnerable to authority, suggestion, and coercion. That is precisely why the field should emphasize evidence-based care, transparency, and ethical restraint. Replacing those guardrails with inspirational language is not soulful. It’s dangerous.
And this specific danger was disclosed by former officers.
While Castlewood/Alsana’s press release paints a warm and fuzzy picture of healing, flowers, and listening deeply, bubbling up beneath the surface are sworn allegations from Castlewood/Alsana’s former high-ranking officers that paint a far grimmer picture. One of prioritizing growth and revenue above clinical care. Of threats, vindictiveness, and internal intimidation tactics that a credible clinical community would find alarming.
One cannot help but wonder if those former officers who came before will be receiving flowers? Or another subpoena.
Let’s be clear about something: it is one thing for critics on the outside to claim a treatment provider is more focused on profit than patients. That may be dismissed with a knowing smile and social media posts. It is quite another when former executives, the people who once ran the place, say the same thing under oath.
In sworn declarations multiple former officers, including its chief operating officer and chief clinical officer resigned or were terminated because they objected to the company’s direction, specifically its shift toward revenue targets at the expense of clinical quality and ethical integrity.
These aren’t anonymous critics with an axe to grind. These are the very people once entrusted with leadership. Under the penalty of perjury, they swore their concerns were met not with reform, but with threatening letters and what they describe as vindictive conduct from the company, conduct that made them fear for their own future if they voiced dissent.
Castlewood/Alsana’s former CEO, Jennifer Steiner, under oath, testified as follows: “As its CEO, I reported to the Company’s Board of Directors (the “Board”). The Riverside Company (“Riverside”), a private equity company, has been the majority owner of Alsana since December 2016, and it was the majority owner during my tenure as Alsana’s CEO.”
“Despite all of my success, however, significant issues with Alsana, its Board and Riverside developed over time, which ultimately caused Alsana to terminate me. Specifically, I became concerned with the direction of the company and what I considered to be Alsana’s decision to maximize growth and revenue above all else. When I refused to go along with certain decisions of Alsana’s Board, including decisions that I believed would jeopardize patient care, I was terminated.”
“Alsana’s bad faith and tortious conduct, which I believe was intentionally designed to frustrate my business and unfairly compete with me, has caused me to suffer both monetary damages and adverse mental health consequences.”
Multiple officers stated under oath that Alsana was prioritizing growth and revenue above all other goals to the detriment of patient care and the integrity of the business. Alsana was sending threatening letters to those former Officers. Alsana was directing aggressive and vindictive courses of conduct against former Officers. Alsana was not providing its officers with the information they needed to do their jobs. That an atmosphere of fear and not collaboration had been created. Alsana was engaged in tortious and bad faith conduct. That when the highest ranking Officer refused to abide by decisions of Alsana’s Board, decisions which she believed would jeopardize patient care, she was terminated. Creating fear and anxiety.
Again, these words are NOT mine. But former Officers.
And that is the same organization now promising every visitor to feel “seen in their authenticity.” It is amazing how visibility becomes selective.
And yet, Castlewood/Alsana’s sordid story gets richer.
The now closed Missouri residential treatment center, originally known as Castlewood Treatment Center had a long and reprehensible history. This history included:
Multiple malpractice and injury lawsuits alleging traumatizing psychological practices and harmful conduct at the facility.
Investigations and press reports of alleged inappropriate conduct by staff and internal complaints about practices that led to halting admissions.
Advocacy groups and former patient coalitions detailing a troubling legacy of psychological harm and exploitation at the same physical location that Alsana claims as part of its continuum of care.
This isn’t folklore, it’s part of the public record associated with the entity they now claim is reborn with “soul and heart.”
The eating disorder field is one where evidence-based practice literally saves lives. Compassion matters, but it is not a replacement for clinical rigor. When a provider’s most senior clinicians quit over ethical concerns, then get sued and threatened with additional legal action, that is not a “slow shift” toward quality, it is a red flag.
And yet Castlewood/Alsana’s public face leans into “connecting” and “creating change” without ever acknowledging the change that insiders say was needed but dismissed. Compliments and brand mantras do not a quality program make.
The eating disorder community doesn’t need another corporate monologue about authenticity and worth. It needs transparency about outcomes, commitments to evidence-based standards, and answers to why its former leaders felt compelled to walk away and speak out.
Because in the world of mental health care, soul isn’t a clinical safeguard. And heart isn’t a substitute for evidence.
It’s time to demand more than marketing.
Castlewood Treatment Center, LLC can call itself Alsana. It can talk about soul, heart, gratitude, and flowers. It can commission new logos and refresh its website.
But what it cannot do is rebrand away:
its legal identity,
its documented history,
the testimony of its former leaders, or
the unresolved questions surrounding patient harm.
For families seeking help, for patients fighting for recovery, and for clinicians trying to practice ethically, clarity matters more than comfort. Families deserve more than flowers. Families deserve truth, evidence, and accountability.
And until Castlewood/Alsana confronts its past instead of decorating over it, the castle, no matter how softly lit, no matter how hard its vacuous marketers attempt to put Humpty Dumpty back together… will fail.
No matter how many flowers it attempts to throw out designed to cover its corruption and misdeeds, those flowers are thrown over its own grave.
And if they are still looking for a new logo, I suggest this may be very apropos:
The DSM Steering Committee is recommending changes to the severity specifier levels of anorexia nervosa, bulimia nervosa, and binge eating disorder. The changes are intended to emphasize the importance of symptom severity, functional impairment, and illness-related medical complications rather than relying on a range of BMI levels (anorexia nervosa), episodes of inappropriate compensatory behaviors (bulimia nervosa), and episodes of binge eating (binge-eating disorder). The updated severity levels will also be more comparable to the severity of other disorders in the DSM.
First, the American Psychiatric Association has not yet agreed to change the DSM severity criteria for anorexia, bulimia, and binge eating disorder. This is a proposal, not an adoption.
Let’s review what the APA adoption process looks like.
Proposals are submitted: Changes to diagnostic criteria, additions, deletions, etc., are submitted by clinicians and researchers through the APA’s DSM proposal portal.
Next comes the Steering Committee Review. The DSM Steering Committee and specialized Review Committees assess the proposals for scientific evidence, clinical utility, and reliability. If the Steering Committee finds a proposal promising, it is posted for public comment.
The next step is the Final Steering Committee Recommendation. The Steering Committee issues a formal recommendation (either for approval or rejection/modification).
Finally, Steering Committee recommendations must then be approved by the APA Board of Trustees and Assembly before changes are incorporated into the DSM or DSM-5-TR.
With this review procedure in place, let us now look at how often proposals are rejected.
First, I could not locate any websites which show a published rate of rejection. But empirical examples from analyses of the initial iterative revision experience following DSM-5 publication exist.
In a report on the first 3 years of the iterative revision process twenty-nine (29) proposals were received.
These proposals resulted in a few successful changes: addition of prolonged grief disorder, modifications to existing criteria (e.g., ARFID), and inclusion of new codes.
One proposal was explicitly rejected by the APA Board.
17 proposals were returned to the submitters with requests for additional supporting data but not adopted as submitted.
Two proposals were rejected without further review due to conceptual issues.
Others were deferred or still under review.
Therefore, of the 29 proposals in the first three (3) years, it appears as if at least twenty (20) were not approved for inclusion in the DSM-5 or DSM-5-TR. While not a formal percentage, a substantial proportion of proposals (in this case, more than half of those submitted) did not directly result in adopted changes in that period — either rejected outright, deferred for more evidence, or modified significantly before acceptance.
Key points to understand from this process are approval is multistage. Even if the Steering Committee recommends a change, it still must pass approval by the APA Board of Trustees and Assembly. Importantly and statistically, the greatest impediment appears to be lack of data. The majority of proposals are returned for additional evidence rather than adopted, showing how stringent the criteria are on empirical support. Finally, the iterative process means ongoing evaluation: The APA’s current model for DSM revision is deliberately iterative and evidence-driven, which tends to minimize adoption of weakly supported proposals.
Also, the DSM is just a general guideline tool. APA’s practice guideline includes a “Statement of Intent” “… that the guideline should not be considered a statement of the standard of care and does not mandate any particular course of medical care and is not a substitute for independent clinical judgment.”
The DSM guidelines are NOT a generally accepted standard of care. In fact, there is no generally accepted standard of care (“GASC”) for eating disorders. This is a huge negative factor which has been haunting the eating disorder community for years.
That factor was decisive in the Wit v. UBH case.
In Wit v. United Behavioral Health, the district court held (and the Ninth Circuit largely left intact for this purpose) that:
An insurer’s internal guidelines are enforceable if they do not conflict with generally accepted standards of care.
Crucially, Wit did not require insurers to mirror professional association guidance, nor did it require guidelines to be optimal or patient-favorable … only that they not contradict the GASC.
This creates a binary inquiry:
If GASC exists and the insurance guideline contradicts it → unenforceable
If GASC is absent, unsettled, or heterogeneous → insurer discretion survives
That premise is decisive for eating-disorder claims. Unlike many medical conditions, eating disorders suffer from persistent standard of care fragmentation. There is no universally accepted level-of-care criteria. There are competing frameworks (APA, AACAP, SAHM, insurer-developed tools, proprietary LOC criteria). There is variation in reliance on: BMI; % expected body weight; Vital sign instability; Functional impairment; Psychiatric risk; Trajectory vs. snapshot severity.
Because no unified GASC exists, insurers can plausibly argue, “Our guideline does not contradict generally accepted standards—because no single standard exists to contradict.”
That argument has been repeatedly successful in eating-disorder denial litigation.
On a positive note, the Steering Committee proposal would reframe DSM severity specifiers for AN, BN, and BED. It would emphasize: Functional impairment; Symptom severity; Medical complications; Explicitly de-emphasize single-metric severity determinations (BMI/frequency counts).
However, and importantly:
It does not eliminate BMI for insurance company consideration;
It does not establish level-of-care rules;
It does not declare BMI-based criteria invalid;
It does not override APA’s SOC disclaimers.
So even if adopted, it would be diagnostic and descriptive, not prescriptive advisory nor normative.
Under Wit v. UBH, the DSM Steering Committee’s proposal, while clinically significant, would not materially constrain insurer claim handling absent a broader, enforceable consensus standard of care for eating disorders, which still does not exist.
Regarding the Steering Committee Proposal, there is a one-month public comment window [Until January 9, 2026]. It is critical that the APA hears from intelligent voices. Voices which supply objective data, medical evidence and information, independent authoritative research studies.
Undoubtedly, activists will also be submitting their lived experience stories claiming they are dispositive. And whereas they are certainly a part of the equation, collaborative messaging which shows unity and a collective strong voice is more important than ever before.
If you are struggling with the substance of the comments you wish to make, The International Federation of Eating Disorder Dietitians on its website has suggested comments. This page also has extensive background on the evolution of this initiative. (And yes, thanks to Jessica Setnick should definitely go out!):
In November 2025, Joe Braidwood, a co-founder of “Yara Ai” chose to shutter his Ai therapy product after concluding it posed unacceptable risks for people with serious mental health issues. This is but the latest chapter in the cautionary tale for the proliferation of Ai therapy.
Mr. Braidwood stated in part: “We stopped Yara because we realized we were building in an impossible space. Ai can be wonderful for everyday stress, sleep troubles, or processing a difficult conversation. But the moment someone truly vulnerable reaches out – someone in crisis, someone with deep trauma, someone contemplating ending their life – Ai becomes dangerous. Not just inadequate. Dangerous.”
“The gap between what Ai can safely do and what desperate people need isn’t just a technical problem. It’s an existential one. And startups, facing mounting regulations and unlimited liability, aren’t the right vehicles to bridge it.”
“… the mental health crisis isn’t waiting for us to figure out the perfect solution. People are already turning to Ai for support. They deserve better than what they’re getting from generic chatbots.”
After Mr. Braidwood terminated Yara Ai, to his immense credit he jumped into the next chapter … how to make Ai programs safer. Mr. Braidwood announced the opening of GLACIS Technologies – their attempt to contribute to the infrastructure of AI safety:
Read his words again “… someone in crisis, someone with deep trauma, someone contemplating ending their life – Ai becomes dangerous. Not just inadequate. Dangerous.” “… [it] isn’t just a technical problem. It’s an existential one. And startups, facing mounting regulations and unlimited liability, aren’t the right vehicles to bridge it.”
An existential, dangerous problem which startups are not equipped to handle. Consider that reality. And yet, the underlying issue is snowballing at an alarming rate.
This past year, the Harvard Business Review research found the top use of Generative Ai was … “Companionship and Therapy.”
The global Ai in healthcare market is projected to grow rapidly from approximately $37.09 billion in 2025 to over $427 billion by 2032, a compound annual growth rate (CAGR) of over 40%.
In 2025, 22% of healthcare organizations reported having already implemented domain-specific AI tools, a significant increase from just 3% two years prior. A 2024 survey noted that 66% of U.S. physicians were using some form of AI, up from 38% in 2023.
The U.S. Food and Drug Administration (FDA) has authorized over 1200 Ai or machine learning-enabled medical devices to date, indicating increasing regulatory acceptance and the transition of Ai from research to clinical practice.
On October 21, 2025, Menlo ventures released an extensive article on Ai in healthcare.
So, to whom shall we entrust this existential, potentially dangerous issue? Or for that matter does it really matter to whom society “entrusts” the development of this generational, life altering technology? We already know which industry will pioneer the way, developing the technology which will “address” our mental health needs in the future. And their motivation is far from altruistic.
Insurance companies.
Insurance companies are already increasingly investing in Ai driven mental health tools which are “intended” to offer immediate, scalable support.
So why does the insurance industry want Ai programs in the mental health field?
The Case For: Why Insurers Want Ai in Mental Health
1) Access, Speed, and Convenience. In many regions, patients wait weeks for an initial appointment. A 24/7 platform can provide immediate support, especially for low-acuity needs such as stress management, sleep hygiene, and mild-to-moderate anxiety symptoms.
2) Standardization and Protocol Fidelity. Ai systems can deliver structured interventions consistently, reduce clinician “drift” from evidence-based protocols, and prompt ongoing practice of therapeutic skills. For payers, this is attractive because standardization is measurable and scalable.
3) Measurement-Based Care at Scale. Ai can administer screeners, track symptom trends, and support follow through between sessions. When used under clinician governance, this can improve continuity and help identify deterioration earlier.
4) Cost Containment and System Efficiency. The economic case is straightforward: lower-cost interventions for appropriate cases, and potentially fewer downstream costs if early support prevents escalation.
The Case Against: Clinical, Legal, and Ethical Risks
1) Therapy Without Clear Clinical Accountability. When a human clinician provides psychotherapy, licensing and standards of care create identifiable responsibility. [Responsibility which seems to be increasingly overlooked or ignored.] With Ai-only services, accountability becomes diffuse; vendor, insurer, developer, or “the user” which is a poor fit for high-stakes mental health care.
2) Safety in High-Risk Scenarios. Crisis states such as suicidality, self-harm, psychosis, and domestic violence are exactly where failure is most consequential. Ai systems can miss context, misinterpret signals, or provide responses that inadvertently increase risk.
3) Mistriage and Oversimplification. Even good clinicians mistriage. Ai can compound the problem if it lacks nuance around comorbidities, trauma histories, neurodiversity, or cultural context. False reassurance is dangerous; excessive escalation can overwhelm human systems.
4) Privacy and Conflict of Interest. Insurance is structurally sensitive. It sits where health data meets claims management and utilization decisions. If therapy content feeds decision making, or even creates a reasonable fear that it could, patients may self-censor, undermining care.
The “Fortune / Yara” Inflection Point … and the Counter-Lesson
The Yara shutdown, as reported, is primarily cited for a blunt conclusion; that even with guardrails, Ai therapy may be too dangerous for people with serious mental health issues. In today’s derivation of Ai therapy, that is an accurate and alarming concern.
A more practical reading is more nuanced and more actionable: the most defensible lane is Ai augmented care, not Ai-as-therapist … yet. The difference is not semantic, it is operational. If an insurer deploys Ai, safety must be built as a system: constrained scopes, explicit disclosures, continuous monitoring, and fast human escalation that works in real life not just on paper. But safety can be very expensive.
And we know when operational constraints meet financial constraints, history dictates operational constraints will be compromised.
Human Frailties, Ideological Drift, and Why This Can Fuel Ai Adoption
A less discussed but increasingly influential driver of Ai adoption is patient dissatisfaction with human variability … including the perception that some therapists allow personal politics or social ideology to shape the therapeutic relationship. [The “ism” police is prevalent among many therapists.]
While many clinicians practice ethically, a subset of patients report experiences where therapy felt judgmental or moralizing, or where they felt pressured into a social or political framework that did not fit their needs. Even if these experiences are not yet the norm, they can be highly salient: a single negative encounter can permanently reduce willingness to seek traditional care.
As clinicians continue to incorporate radical belief systems like White Supremacy Culture, fatphobia, Indigenous Person’s Land Use Acknowledgements, zero sum game thinking, anti-Semitism, the patriarchy and radical political and social justice views into their everyday lexicon, they lose the ability to listen to their patients, to meet their patients where they are in exchange for ethical, insightful therapeutic regimens where the patient’s needs are prioritized.
This dynamic can and will accelerate Ai adoption in several ways:
Demand for predictable, skills-based support. Many users primarily want coping tools rather than worldview driven interpretation. Ai systems can be positioned as consistent, nonjudgmental, and oriented around concrete skill building. For mild-to-moderate conditions, that positioning will attract patients who want help without interpersonal friction.
Institutional preference for auditability and uniformity. Employers and insurers are sensitive to reputational risk and complaint volume. Ai systems can be constrained, logged, and audited in ways that are difficult with individualized human practice. That makes Ai attractive to institutions seeking standardized delivery, especially for early-stage care pathways. Like insurance companies.
A political paradox: “neutrality” becomes a marketing claim—and a target. Ai is not truly neutral. Training data, safety policies, and vendor tuning encode normative assumptions. Over time, the debate will shift from “therapists inject beliefs” to “platforms embed beliefs.” The perceived advantage of Ai (less idiosyncratic bias) may become a liability if users discover a consistent, system-level bias scaled across millions.
Fragmentation into “values aligned” therapy styles. Some users will prefer “politics-free” skills support; others will want culturally specific or worldview aligned care. Ai platforms can offer configurable styles, but that introduces the risk of “therapeutic filter bubbles,” where systems affirm a user’s worldview rather than challenge maladaptive beliefs when appropriate.
The net effect is that concerns about human bias will inevitably increase appetite for Ai mental-health platforms, but they will also intensify demand for transparency, choice, and oversight. Values will not disappear. Instead, they are moved upstream into product design.
Practical Guardrails for Ethical and Defensible Deployment
In the unlikely event insurance companies seriously embrace issues other than financial viability, if insurers want Ai therapy to be sustainable, guardrails must be more than disclaimers. For example, they must adopt and enforce:
Truthful labeling: don’t call it “therapy” if it isn’t clinician-delivered.
Disclosure: repeated, clear notice when the user is interacting with Ai.
Clinical governance: licensed oversight of protocols, risk signals, and escalation criteria.
Real escalation: quick handoffs to humans with operational accountability.
Data minimization and segregation: limit retention and wall off therapy content from coverage decisioning.
User choice: Ai should be an option, not a prerequisite for human care when clinically indicated.
Independent audit: safety, bias, and outcomes evaluation.
Nonetheless, the insurance industry is already using Ai. Its growth and usage will be unprecedented.
Conclusion
Ai mental health platforms can widen access and improve measurement-based care, but they also create nontrivial risks: safety failures, blurred accountability, privacy conflicts, and scaled bias. Air-gapped systems may reduce external security concerns and speed institutional adoption, yet they heighten the need for strict internal governance, because the most important question becomes not only what the Ai says—but what insurers do with what members reveal.
Ultimately, patient experiences with human inconsistency, including perceived ideological drift, will accelerate demand for Ai support. But that same demand will fuel a new expectation: transparency about values embedded in systems, meaningful patient choice, and enforceable protections that keep “care” from becoming merely a more sophisticated form of utilization management.
Ai is here and it is only in its infancy. And we are right to question ultimately whether we will remain the master of Ai … or whether Ai will become our overlords. Sadly, I believe it inevitable that we will approach that point in time when we give the command, “Open the pod bay doors, HAL.” And the chilling reply will be, “I’m sorry, Dave. I’m afraid I can’t do that”.
A DAD'S JOURNEY WITH EATING DISORDERS 