On October 30, 2016, my beloved daughter Morgan died after battling eating disorders for seven (7) long years. She was 23 years old when she was taken. At the moment of her death, when a daddy hears those dark words, “She’s gone” though he may not know it at the time, the better part of him is also ripped away.
Morgan was brilliant, kind, and fiercely determined to get well. She thought of others, often before her own needs. Her own words, “I can seem to help everyone else … I just can’t help myself” is her legacy. And yet, those very words still haunt her daddy every day.
When those words and the reality of a loss no parent should ever have to suffer are combined with the state of the eating disorder community today, you realize that there will be many more of our loved ones condemned to share the same fate which took my daughter… unless a seismic change is forthcoming.
A System Without a Compass
Even at that time, the system that claimed to know how to help Morgan had no map, no unity, and tragically, no accountability. Nearly a decade later, the eating disorder community is in even greater disarray. There are still no generally accepted treatment guidelines … no consensus on what works, no uniform standards for care, no consistency from one program to another and no accountability nor consequences. If you send your child for treatment, what happens next depends less on science and more on which center you happen to find, and what ideology dominates that space.
The Vanishing of Science and the Rise of Ideology
The dire crisis in the community has worsened as grant funding for research dries up. Federal and private funders have largely turned their attention to other mental health priorities, leaving eating disorder research chronically underfunded. Few new studies are being published, and the next generation of researchers is dwindling. Research professionals and medical clinicians on the front lines rarely collaborate. In this vacuum, ideological movements have filled the void … often louder, more absolutist, more absurd and less accountable to data or outcomes.
Militant factions within the “body liberation” movement now control far too much of the public conversation in the community. They label professionals, clinicians and even families in a gross, inflammatory manner. Anyone who speaks about weight restoration or malnutrition is labeled as “fatphobic.” White Supremacy Culture. Invasive species. Utilizing every “ism” word possible. Complex medical and psychiatric illnesses are reframed as political identity issues. The result? A silencing of nuance and a dangerous confusion between eating disorder treatment and radical social activism. Inflammatory labeling has become the substitute for reasoned professional, collaborative communication. And our loved ones suffer.
Private Equity and the Hollowing Out of Care
At the same time, private equity–owned treatment centers, once the great hope for scaling access, are collapsing under the weight of their own failed business models. Many have failed outright or are surviving only by slashing costs: laying off medical doctors who served as full time employees, replacing them with part time independent contractors and inexperienced working staff. Running skeletal programs that cannot provide the continuous, multidisciplinary care our loved ones require. The result is a race to the bottom: more marketing, fewer doctors, more “coaches,” less medicine. No accountability nor consequences.
Families are left navigating glossy websites and sales teams instead of evidence-based programs. If a family wishes to speak with the medical director of a program before entrusting their child to that program … good luck. Insurance denials come faster than ever. Inpatient stays are shorter. Step-down programs are often nonexistent.
When Morgan was fighting for her life, I wondered whether the lack of care was a failure of coordination. I no longer wonder. It has never been clearer that it was and continues to be, a failure of values.
A Community in Financial and Moral Crisis
The largest eating disorder nonprofit organizations, long believed to be the moral anchors of the community, are collapsing financially some losing more than $200,000 per year. Echo chamber thinking and associated conduct have replaced outreach to professionals who respectfully disagree with their view. Where at one time, these organizations were led by persons of vision, true giants of the community, now with very few exceptions, they are led by boards who shrink away from transparency, oversight and responsibility. These organizations host conferences and awareness campaigns, but their impact is negligible at best and failing at worst.
Their messaging has grown vacuous and timid, shaped more by the politics of social media than the needs of our loved ones. Once they were advocates for treatment access and medical rigor; now too often, they stand meekly on the sidelines … mere bystanders to the on-going carnage.
The Human Cost
The price paid for the wholesale failure of the community is measured by the dearest blood possible … the lives of our loved ones. The mortality rate for eating disorders, already the highest among psychiatric illnesses [apart from opioid addiction] has worsened. Suicide and medical complications are climbing. The promise that “recovery is possible” rings increasingly hollow to families who can’t even get a proper diagnosis, let alone a full course of the highest quality medical and mental health care. Which results in:
Behind every number is a person, a victim. Behind every person is a family like mine, standing outside a treatment center, a hospital, a counselor’s office, desperately holding on to the only thing they can … that is, the fading hope that this time will be different.
Where Do We Go From Here?
Families are entitled to transparency. Accountability. Honesty. From our doctors, clinicians, and counselors. Families should demand nothing less. But, to accomplish this reality, we not only need an evolution of thought and wisdom … we require a bold reckoning. The eating disorder community must reclaim science, ethics, and accountability. The community can only provide those necessary qualities by demanding:
The adoption of national treatment guidelines grounded in evidence, not ideology.
Federal, state and philanthropic investment in clinical research and longitudinal outcomes.
Oversight of private treatment companies that market medical care that is not forthcoming as it sheds experienced medical practitioners and licensed staff.
Strong, bold, new leadership in nonprofit organizations that prioritize patients over politics.
Measured inclusion of all reasonable, rational, intelligent viewpoints and persons.
But these steps require a courage of conviction… conviction which is sorely lacking.
Not just Morgan, but all those who have died from eating disorders cannot die in vain. But until we admit that this system and community are broken, until we expose the silence, the failures, the charlatans, thed fraud and the fear … we will keep losing more daughters, more sons, more loved ones, more years of life.
The eating disorder community once promised healing. Today, it must fight simply to survive. For survive it must. But in an evolved, intelligent, collaborative manner.
Two of the more troubling topics confronting mental health communities are: (1). Lack of Minority Representation in the Mental Health Workforce and (2). Limited Accessibility of Mental Health Care in Minority Communities.
We will be focusing on exploring real world, workable solutions instead of using inflammatory labels, pointing fingers and embracing the litany of “isms” being cavalierly thrown around.
Any solution necessarily begins with starting and having open, collaborative conversations. While recognizing that a start is just that … a start and not a solution. And yet, from that start perhaps seeds are planted from which bold, forward-thinking initiatives grow which could ultimately result in a better world.
Increasing Minority Representation in the Mental Health Workforce
No one disputes that minority representation in the mental health workforce is grossly lacking. So, let’s address some of the issues which produced this inequity and explore possible solutions.
1. Financial Pathway Support
Problem: The cost and duration of training (graduate degrees, licensure) are major barriers for minority students.
Possible Solutions:
Targeted scholarships and loan repayment programs for minority students in psychology, psychiatry, counseling, and social work (e.g., HRSA’s Behavioral Health Workforce Loan Repayment Program could be expanded or localized).
Paid internships and residencies in community-based organizations serving minority populations.
Employer-based tuition reimbursement tied to post-graduation service commitments in underserved areas.
2. Pipeline Programs (High School → Graduate School)
Problem: Minority students are underrepresented early in the pipeline.
Possible Solutions:
Create “Grow Your Own” mental health workforce programs in high schools and community colleges — exposure to mental health careers, mentorship, and clinical shadowing.
Partner with HBCUs, HSIs, and Tribal Colleges to create joint degree or accelerated pathways into counseling, psychology, and psychiatric nursing.
Establish bridge programs for paraprofessionals (e.g., caseworkers or peer specialists) to obtain advanced clinical credentials.
3. Licensure and Training Reform
Problem: Licensure barriers disproportionately impact minority and bilingual professionals.
Possible Solutions:
Reciprocity agreements among states to ease cross-state licensing for clinicians serving telehealth clients.
Allow supervised hours to include culturally competent community-based or telehealth work, not just traditional clinical settings.
Bilingual competency credits or pathways for professionals providing care in multiple languages.
4. Mentorship and Professional Networks
Problem: Isolation and lack of role models lead to attrition.
Possible Solutions:
Fund minority mentorship programs through professional associations (e.g., APA, NASW, NBCC).
Develop online professional communities for peer support and continuing education focused on serving minority communities.
There are no “zero sum game” arguments. No white people must step aside. No looking backward as to what was previously done wrong. No obsessing on the past.
Simply a possible roadmap to start discussions to increase minority mental health providers.
This is going to become even more important in the future as research scientists increasingly discover additional biological links between the brain and mental health issues. We could be at the genesis of a bold new frontier regarding how mental health issues are studied, researched and treated. We need all persons to be involved in this process.
With this reality facing us, how do we increase accessibility of mental health care?
Increasing Accessibility of Mental Health Care to Minority Communities
Mental health care providers, resources and treatment centers must become more available and accessible in minority communities. Let’s explore how we can start to address this issue.
1. Community-Based and Culturally Anchored Services
Problem: Mainstream clinical settings in minority communities are few and far between and when they do exist, can feel unwelcoming or irrelevant.
Possible Solutions:
Fund community-based organizations, churches, and cultural centers to offer embedded mental health services (e.g., co-located clinics).
Recruit faith leaders, barbers, and cultural ambassadors as mental health liaisons trained in Mental Health First Aid or peer support.
Support mobile crisis units staffed with culturally and linguistically matched professionals.
2. Telehealth Expansion and Equity
Problem: Digital divides and lack of culturally competent telehealth platforms persist.
Possible Solutions:
Subsidize broadband and devices for patients in rural or low-income minority areas.
Require telehealth platforms to support multilingual access and easy interfaces.
Train clinicians in telehealth cultural competence (e.g., cross-cultural communication online).
3. Insurance and Reimbursement Reform
Problem: Minority-serving clinics often cannot sustain services due to poor reimbursement rates.
Possible Solutions:
Equal reimbursement for behavioral health and physical health under parity laws (and enforce it). [This requirement is already provided by federal law. Insurance companies have found ways to avoid or get around this requirement. These loopholes must be closed by legislative bodies.]
Expand Medicaid coverage for peer support specialists and community health workers.
Incentivize integrated care models (behavioral + primary care) in federally qualified health centers (FQHCs) and minority-owned practices.
4. Public Awareness and Trust-Building
Problem: Stigma and mistrust are major deterrents.
Possible Solutions:
Fund anti-stigma campaigns featuring diverse community voices and lived experiences.
Partner with trusted local messengers (e.g., influencers, pastors, tribal elders).
Offer mental health literacy programs in schools and workplaces, especially in minority-majority areas.
Of course, all of this is not probable unless there is greater policy, corporate, institutional and legislative support. This support could resemble the following:
Policy and Institutional Support
Data collection and accountability: Require reporting of workforce demographics, service access, and outcomes disaggregated by race/ethnicity.
Federal and state grants: Prioritize funding for programs demonstrably improving minority recruitment and retention.
Cross-sector collaboration: Involve education, housing, and criminal justice systems in joint mental health equity initiatives.
An “Integrated Implementation Model” could be structured as follows:
Minority Mental Health Workforce Accelerator (state-level example):
Provides full scholarships and living stipends to minority students pursuing behavioral health degrees.
Requires 3–5 years of post-graduation service in designated shortage areas.
Operates mentorship and continuing education programs led by culturally competent practitioners.
Partners with community-based agencies that receive reimbursement incentives for hosting trainees.
The mental health field, particularly the eating disorder community, talks of the need to increase minority mental health providers and the necessity of having greater access to mental health care for minorities. The community is absolutely correct. But that is as far as rational discussions go.
More often than not, discussions take place in an echo chamber. The community points fingers at the patriarchy, white supremacy culture, the diet culture and apply many other inflammatory labels … and nothing is accomplished. The community is defined by the past. A failed past. Instead of embracing a bold future.
Solutions to provide mental health care for our minority population can only be found by looking to the future. A future filled with hope and unlimited possibilities.
The mental health system in the United States is inundated with inequities and is hindered by limited access to care. Universal complaints about mental health include gross underfunding of services, provider shortages, fragmented care between mental and physical health, inadequate insurance coverage and widespread stigma that creates policy and opportunity barriers for people with mental illness. No one disputes that reality.
When significant cultural issues confront us and change is demanded, generally there are two types of people.
There are those people who lead, who are people of vision. They recognize and identify the problems and then commit to explore workable, rational, obtainable, collaborative solutions. These people who will negotiate with Satan himself if it leads to more people receiving the help they so desperately need.
Then there are “the ROYS.” In Texas, that acronym stands for “Rest of Y’alls.” This constitutes the vast majority of people. Those who are content with only complaining about the problems without being willing to invest in finding a rational, reasoned, collaborative solutions. When facing those issues, they immerse themselves deeper in their tribes safely ensconced in the comfort of their echo chamber. They are satisfied with whining and applying inflammatory labels to the issues. Their egos and fears drive their lack of vision. They refuse to interact with anyone who does not agree with them.
With that backdrop, how may we presume the eating disorder advocacy/therapist community responds to the daunting issues confronting mental health in general, and eating disorders specifically?
In the past few years, I have spoken with research professionals, medical doctors, therapists and advocates about the state of the eating disorder community. All seem to be unanimous in their view that things have never been worse in the eating disorder industry and communities.
As such, it should come as no surprise that the community seems largely content to address daunting, societal mental health issues by fostering divisiveness through utilizing inflammatory labels on their websites, publications and even a purported certification program. In general, inflammatory labels are cavalierly directed toward other people in the community, but only from a person’s keyboard.
So, what is inflammatory labeling? Inflammatory labeling is just as it sounds. It is when we assign highly negative or even cruel labels to people or organizations.
Focusing on inflammatory labels instead of solutions in social justice movements, or for that matter in any context, hinders progress by reducing complex issues to oversimplified caricatures. This practice intensifies social divides, alienates potential allies, and prioritizes outrage over tangible reforms. While rhetoric is central to advocacy, the way it is framed can either drive constructive dialogue or deteriorate into unproductive polarization.
Studies on social movements have found that extreme or inflammatory rhetoric, including labeling, tends to decrease public support for a cause. This is because such tactics reduce the average person’s sense of identification with the movement, making it difficult to find common ground. Inflammatory labels simplify people into negative stereotypes, making it harder to recognize their full humanity.
This reflects the sociological concept of “labeling theory,” which posits that assigning a negative label can lead to a self-fulfilling prophecy and further entrench deviance. Labeling opponents with charged terms can create a binary “us vs. them” mentality, making it difficult to challenge ideas through reasoned debate. Instead of addressing the complexities of an issue, discourse devolves into a culture war of labels, name calling, and finger pointing all of which obscures real policy solutions.
By way of example, radical eating disorder activists casually throw out inflammatory labels like:
There are so many others: White Privilege, Whitestream Research, toxic masculinity. These inflammatory terms of derision are directed at anyone who does not agree with their viewpoints as well as the mainstream medical and mental health communities. In addition, the term “invasive species” is even being used to define or refer to the same White Supremacy Culture and people and organizations which fall under that umbrella. And that is supposed to be productive?
As for any proposed practical, realistic collaborative solutions to address the inequities in mental health care? They propose none.
A few years ago, a small group of people published a letter directed at eating disorder organizations and treatment centers. Amongst the demands made in the letter included: providing reparations to Black People, Indigenous people and People of Color, (“BIPOC”) especially queer and transgender BIPOC; hiring a transgender consultant to revise your marketing material; establishing sliding fee scales for BIPOC, transgender and gender diverse clients; redistributing wealth from the for-profit ED treatment world; providing access to Hormone Replacement Therapy.
Other radical activists equate mental health research and treatment as a zero sum game. That BiPOC, LGBTQ+, fat therapists and professionals must be centered and that there is no space for white, straight and thin people to jump in. Or that white, liberal female therapists should focus more of their attention on social justice issues and political reform in all they do.
Of course, in the unlikely event the latter ever happened, those therapists would then be labeled as White Saviors and would be publicly eviscerated in the town square ala Lindo Bacon.
There must be a way. Other than inflammatory labeling, whining and complaining, what possible solutions exist which could be explored to address some of the inequities in mental health care systems?
Inequities which include far too few medical doctors, therapists, counselors and other medical and mental health professionals who are BIPOC. Minority and BIPOC communities are far underserved. Medical school training largely ignores eating disorders and BIPOC issues. Far too few BIPOC persons receive mental health care. Access to meaningful mental health care is severely limited for BIPOC persons. Research has not included significant BIPOC participation. Mental health care can be prohibitively expensive.
These complex, daunting issues require collaborative wisdom. And when progress is made on these issues, as they surely must be, this necessarily will result in a more enlightened society. So, the question must be asked again … how are name calling, tribal mentality and inflammatory labeling going to be remotely effective in addressing these serious issues? Answer … they aren’t.
A roadmap does exist for systemic mental health reform in the U.S., prioritizing enforceable, high-impact interventions first while building toward longer-term initiatives. The roadmap assumes some federal and state collaboration, leveraging funding, licensing, audits, and measurable metrics. But it is possible. It will not be easy. It will require participation, wisdom and sacrifice from society as a whole. It will require us looking past our human frailties and being bold and forward thinking. But it is possible.
2025 Weight Stigma Awareness Week (“WSAW”) is upon us. Much of what it stands for was clarified in 2023. That year, WSAW produced a white paper entitled, Impact Council White Paper (“ICWP”).
The ICWP states it, “… hosted an Impact Council roundtable with advocates, educators, clinicians, and leaders in healthcare, non-profit organizations, and media to discuss the greatest roadblocks to accessibility and inclusivity, as well as goals for the future.”
The ICWP has two major premises:
Premise 1 — “The medical community has done significant damage by promoting the idea that ‘obesity’ is a greater risk to individual and public health than weight stigma and anti-fatness are.”
Premise 2 — “Lived experience should be treated as credible data and prioritized (as much as or more than textbooks and quantitative research) for clinical recommendations and treatment plans.”
These are foundational, core premises at the heart of the weight stigma awareness movement. If these premises can be objectively proven to be accurate, then the corresponding recommendations and information arguably have more substance and merit and need to be thoroughly explored by a collaboration of organizations and professionals.
However, if the foundation, the core premises collapses, so does everything built upon them. The corresponding recommendations would be grounded in science fiction, not science, and if ever adopted, would inevitably result in doing greater harm to patients.
So, let’s explore more closely these two premises.
Premise One
“The medical community has done significant damage by promoting the idea that ‘obesity’ is a greater risk to individual and public health than weight stigma and anti-fatness are.”
There is no dispute that weight stigma is itself harmful to health. Stigma increases stress, social isolation, depression and anxiety, and can worsen cardiometabolic outcomes through behavioral (avoidance of care, disordered eating) and physiological (stress-axis) pathways. When clinicians stigmatize patients, it reduces trust and adherence and discourages preventive care (fewer screenings, delayed care).
Certainly, focus on BMI alone oversimplifies risk. BMI is an imperfect proxy for health; it doesn’t capture fitness, fat distribution, socioeconomic drivers, or comorbidities. Over-reliance on BMI can miss metabolically healthy people who need care and wrongly pathologize others.
Social determinants and structural drivers matter. Emphasizing individual “weight control” can obscure food access, economic inequality, built environment, racism, trauma, and other upstream determinants that shape both weight and health.
Even with this reality, the obvious flaws in the first premise are legion.
First, the medical and scientific communities without exception embrace the reality that there are measurable health risks associated with higher adiposity for many people. Epidemiologic studies link higher BMI (particularly when accompanied by central adiposity) to type 2 diabetes, osteoarthritis, some cancers, and cardiovascular disease. Discounting these risks wholesale would be irresponsible.
Further, there is a false dichotomy risk at issue. Framing this issue as “either stigma is the main harm or obesity is” sets up a false binary. In reality, both can be true: stigma causes harm and excess adiposity can increase risk for some outcomes. Policies must address both.
There is the aspect of public-health communication challenges. Minimizing messages about risk could reduce motivation for preventive behaviors in those who would benefit. Public health must balance non-stigmatizing language with clear information about risk and actionable steps.
There are other factors involved. There is heterogeneity of evidence and population differences. The magnitude of adiposity-related risk varies by age, sex, race/ethnicity, and metabolic profile. Broad absolute statements risk ignoring subgroups with high absolute risk.
One of the biggest flaws and drawbacks from the ICWP, is that the people behind the ICWP represent that the medical community has caused more damage by emphasizing that obesity is a greater risk to health than weight stigma and anti-fatness. They have phrased this issue using an absolute criterion while needlessly pointing fingers to assess blame. They have placed their own beliefs and interpretation of their own life experience at the forefront of this issue. They erred.
There are different study designs and evidence strength. The obesity→mortality evidence includes very large pooled prospective cohorts and individual-level meta-analyses (GBMC/Di Angelantonio et al.) with millions of participants and long follow-up that estimate dose–response relationships and cause-specific mortality. That level of evidence supports an accepted causal inference for some outcomes.
Contrarily, much of the stigma literature is smaller, newer, and more heterogeneous: cross-sectional studies, smaller cohorts, and observational work using self-reported stigma measures. Even the stronger longitudinal analyses are far smaller in scale than the pooled obesity cohorts. This difference in scale and design limits how directly you can compare effect magnitudes.
Second, there are measurement differences and misalignment of outcomes. Studies of obesity typically measure objective exposures (BMI, waist circumference, body composition) and hard outcomes (incident diabetes, MI, cancer, all-cause mortality).
Studies of stigma usually rely on self-reported experiences (e.g., “have you experienced weight discrimination?”) or internalization scales — valuable but inherently subjective and vulnerable to recall bias and reporting differences. Outcomes often include psychological measures, behavior change, intermediate biomarkers, or, in a few cases, mortality. These are not directly isomorphic to the obesity literature’s end points.
Third, there are confounding and directionality / causality problems. People who experience weight discrimination are, unsurprisingly, often higher weight; disentangling whether worse outcomes are caused by stigma per se or by the underlying higher adiposity (or by shared upstream causes) is difficult. The study conducted by Sutin et al. adjusted for BMI and some covariates and still saw an association, but residual confounding (socioeconomic factors, comorbid illness, lifetime exposures) and reverse causation (illness leading to both weight change and discrimination) remain plausible. Further, establishing causality (stigma → disease → mortality) requires randomized or natural-experiment evidence or sufficiently rich longitudinal mediation analyses; those are scarce.
Fourth, population attributable burden has not been estimated comparably. To claim, “stigma causes more harm than obesity,” we need comparable population-level metrics (e.g., population attributable fraction of mortality or years of life lost due to stigma vs due to elevated BMI). Those metrics exist for BMI (GBMC estimated mortality burden across BMI categories), but do not exist in a comparable, robust form for weight stigma.
The study by Sutin et al. reports an HR for mortality but translating that into population attributable mortality would require representative exposure prevalence estimates, reliable adjustment for confounders, and replication across populations.
What the best current evidence shows: Weight stigma is independently associated with worse mental health, adverse behaviors (disordered eating, activity avoidance), physiological stress markers, and — in at least two cohorts — higher mortality after adjustment for BMI and some covariates.
What the evidence does not show: There is no robust, widely accepted, population-level set of criteria demonstrating that weight stigma causes more total harm to population health (e.g., more deaths, more DALYs) than obesity itself. The obesity→mortality/evidence base is far larger, multi-cohort, and quantifies dose–response relationships; stigma literature is convincing in signaling independent harm but is currently smaller, less consistent, and lacks comparable population attributable estimates.
Clearly, the goal should be to move clinicians toward respectful, trauma-informed care; strengthen social-policy responses (food access, housing, anti-discrimination); and develop interventions that improve health without weight stigma.
So, should we be asking with this shared goal, why would the people behind the ICWP frame this issue as an absolute? Especially when they have no reputable, scientific, medical or socio-economic studies to support their position that an emphasis on obesity has caused more harm than anti-fat bias?
Without any reputable, third-party studies, they framed this issue as an absolute to fit their narrative. The tragic, unfortunate reality is the solution was right in front of them. All they had to do was rephrase this issue in a strong, evidence-based, factual manner … such as …
“Weight stigma and anti-fatness are inextricably intertwined with obesity and should be collectively classified as a public health issue. This would require the medical and scientific research communities to increase their research, study, understanding and treatment of these serious health issues on an equal basis.”
What is there to disagree with in that phraseology? This would have removed the finger pointing blame game perpetrated by the ICWP and would have provided a collaborative way forward together. But that was not to be. And the reasons for that lack of vision are set forth in our analysis of Premise No. 2.
Premise No. 2
“Lived experience should be treated as credible data and prioritized (as much as or more than textbooks and quantitative research) for clinical recommendations and treatment plans.”
The second central premise—that lived experience should be prioritized above textbooks and quantitative data—turns medical practice into witch doctory and personal storytelling. This is not a serious framework for healthcare; it is activism dressed up as evidence.
The problems with this premise are legion.
There are obvious methodological problems. Anecdotes do not constitute medical evidence. Individual stories can be powerful but lack controls, generalizability, and statistical rigor. Treatment guidelines based on lived experience risk being skewed by outliers or vocal subgroups.
There are also bias and recall issues. Patients may unintentionally misreport causes, timelines, or treatment responses due to memory bias, emotional interpretation, or secondary gain.
We are also required to consider over-representation of advocates and activists. Those most active in advocacy or online discourse are often not representative of the broader patient population, creating sampling bias.
Then there is the risk of undermining evidence-based care. There is “treatment drift.” Prioritizing anecdotes could encourage clinicians to substitute “what worked for one person” for protocols validated across thousands in trials.
The medical community must also consider neglect of biological mechanisms. Obesity and eating disorders involve complex neurobiological, metabolic, and genetic components. Patient narratives may not reflect these dimensions.
There is also false equivalence. Equating lived experience with systematic research elevates subjective impressions over reproducible science, undermining evidence hierarchies critical for patient safety.
For obesity, some narratives reject all weight management as “harmful,” ignoring evidence that structured interventions improve metabolic outcomes. This can fuel distrust of effective therapies.
The medical and scientific research communities would inevitably experience ethical and legal challenges and concerns.
There is standard of care liability. If guidelines deviate from established evidence to favor lived experience, clinicians risk malpractice exposure when outcomes are poor.
There are also equity gaps. Vocal groups whose experiences get prioritized, may dominate marginalized, silent or less empowered populations.
Potential conflicts of interest exist. Patient advocates with financial or ideological agendas could influence treatment norms, displacing objective science.
The systemic consequences of this misguided belief are obvious and notorious. This belief would lead to an erosion of research investment at a time when research grants have been eradicated. If lived experience is placed on equal or higher footing, incentives to conduct rigorous trials would diminish, weakening long-term scientific progress.
It would also result in fragmentation of care standards. Different doctors, clinics and treatment centers might prioritize different anecdotal narratives, leading to inconsistent, non-comparable practices.
Most alarmingly, obesity and eating disorders already carry high morbidity and mortality; steering care away from empirically validated interventions risks worsening public health outcomes.
Again, we should be asking why would the people behind the ICWP frame this issue as an absolute? Especially when they have no scientific, medical or socio-economic studies to support their position?
The ICWP had the ability to reconcile both premises into a practical clinical and policy approach. They chose not to. Perhaps one of the co-founders of Weight Stigma Awareness Week gave us the reason for this ill-fated, Quixotic position when she said, “It bothered me that all the air was taken by a white perspective … This is no space for white, straight and thin folks to jump in … Those of us who have done the work around our internalized biases no longer trust the medical establishment to actually help us.” … Public health in this country is getting it so wrong and there is a better way, but we need to be willing to actually listen to those being harmed.”
These people are not embracing science. They are embracing science fiction.
Perhaps the answer to all legitimate questions asked above is simply … to maintain their voice, to assuage their feelings of pain, self-loathing and anger, the maladjusted, militant fat activists must embrace their own reality because society will not.
The ICWP fails
The ICWP fails at the starting line. Its first major claim—that medicine has caused more damage by warning about obesity than by neglecting weight stigma—is not just wrong, it is reckless. It is divisive. It dismisses decades of clinical evidence linking obesity to disease and early death, replacing science with ideology.
Its second central premise—that lived experience should be prioritized above textbooks and quantitative data—turns medical practice into guesswork and personal storytelling. This is not a serious framework for healthcare; it is radical advocacy dressed up as evidence.
Beyond the flawed premises, the rhetoric in the ICWP itself gives the game away. The authors rely on moralizing language and sweeping accusations, framing the medical community as a monolithic villain rather than engaging with the nuance of scientific debate. Raw emotion is substituted for data, using anecdotes and identity politics to demand deference in place of proof. This kind of rhetorical sleight of hand may stir outrage, but it does not withstand scrutiny.
When the core assumptions collapse, so does everything built upon them. The ICWP is not grounded in science but in science fiction. Far from being an authoritative white paper, it is merely a manifesto masquerading as scholarship, and it deserves to be treated as such.
Tragically … it did not have to be like that. But, when so-called leaders place the manifestations of their own mania before reputable, medical and mental health based criteria, their message is lost. The Power of the Message is lost.
And all that is left is chaos, shattered dreams, and the final, weak beats of a Tell-Tale Heart.
Recently, after expressing my views on the eating disorder community and its many dysfunctions, I was informed by an “eating disorder advocate” that I only had “righteous indignation.” In the past, this same person also opined that I was in the eating disorder community solely to make money.
Righteous indignation? Solely to make money? Let me answer both plainly: my anger is earned, and my motives are grief-forged — not mercenary. I paid my entry fee into this dysfunctional community with the dearest blood possible: my daughter’s. I did not come here to be liked, or to join the chorus of vapid, comfortable, egomaniacal voices. I came because someone I loved was ripped from life. Silence would be complicity.
Make no mistake, there are some incredible, soulful, intelligent, compassionate souls in the eating disorder community. Unfortunately, they largely remain silent, on the sidelines. Fearful of being ostracized or cancelled by the hate filled, social justice warriors.
I wish with every fiber of my being that I was not in this decaying eating disorder community. I wish that I did not know even one person in this horrifically comical, appalling community. For that would mean my daughter, Morgan lived. But since she died, I will allow my “righteous indignation” to illuminate what having a beloved child ripped from life is like.
Sunday nights in an intensive care unit in a hospital in a large city can be very quiet. But, not for you. You hear the ear shattering blaring of alarms, screaming out “Code Blue.” Death is sounding for your daughter. Death has come for you!
With panic in your eyes, you look into her room and cannot even count the number of hospital employees trying to bring her back to life. For at that moment, she is dead. Her heart is not beating. And you feel nothing at that point. The greatest fear a parent can face has you in its powerful, icy grip. Your brain has stopped working. You are not aware of anything… except the frantic efforts to bring her back to life. Finally … they detect a faint heartbeat after nine excruciating minutes.
Do you know what it’s like to have your child dead for 9 minutes while you look on helplessly? It is a lifetime. You are drenched in sweat. You are aware of nothing. Except … for the briefest of times, she is living again.
Until once again … she dies … and you again hear those horrific alarms of death. Again … her room is filled with employees doing all they can to bring her back. You are numb. Your entire world is in that room … on that incredibly dark night. And once more … they briefly bring her back.
That is when the doctors pull you aside and tell you … each time it is more difficult. You ask if she feels any pain. They cannot give you a straight answer. They tell you that in all likelihood, there is already substantial brain and organ damage. You ask them if there is truly any hope. They cannot look you in the eyes and are mumbling non-answers. And you know. You know. You are faced with the most difficult decision any person will ever have to make.
You remember one time in the past, your beloved daughter saying … “Daddy … don’t let me die.” And you know, you know, for an absolute certainty … that your life will never be the same. You wonder if you can ever forgive yourself for betraying those sacred words.
There is nothing performative about that grief. It is not a credential.
You slowly nod your head and quietly, while tears are pouring down your cheeks, say … no more alarms. No more bells. She will go in peace.
You sit next to her, holding her hand, praying for a miracle … knowing that one will not come. Finally, you hear those words which rip the heart from any parent … “She’s gone.”
You slowly walk down the dark hospital hallways. Sunday nights can be quiet in a hospital. You go to a waiting room where your daughter’s mom is waiting with friends. You can’t say the words… only shake your head. And you hear that heart wrenching scream of anguish. And yet, you feel nothing.
Your life as you knew it … is over.
You live in a fog. Making funeral arrangements, service arrangements. You feel nothing. Food has no taste. Your soul is numb. You wonder if you even want to wake up.
But you find a way, some way, to wake up and to keep living. Now, imagine that for most of your professional life, you had been a shallow, superficial, asshole. An attorney without a soul. But something has awakened within you. You begin to feel driven. Perhaps for the first time in your life, you are aware of something far greater than you.
In your daughter’s name, you only want to make a difference. You want to help others. But you are so broken. You make mistakes. You live in a constant state of guilt and shame. Nonetheless, you pledge to help others. And so, you try.
You then discover in the eating disorder community, children’s lives are being reduced to talking points, a and mortality is sidelined in favor of crowd-measuring. You read that this is no place for thin, white people to jump in. You realize that families are being betrayed by radical activists who only wish to parade their own ignorance and internal pain. Nonetheless, you continue to try. You try to serve.
You give two TEDx talks on eating disorders.
You organize and with a medical doctor, present a talk to Apple … and its 150,000 employees. The talk was broadcast on Apple’s North American network.
You organize and with that same medical doctor, present a talk to Raytheon … and its 75,000 employees. Also broadcast on its national network. This talk was so informative and compelling that the Raytheon office hosting it won a national corporate award for collaboration with the community.
You organize and present a 30-minute segment every week on a local radio station entitled, the Mental Health Moment. You have national experts on mental health appear on your show.
You appear on the local CBS and Warner affiliates talking about eating disorders.
The methodist church you belonged to does a video on your daughter and her struggles. With over 300,000 views, no other videos this church has done comes even close.
You speak to school district’s counselors and nurses. You organize presentations to communities. You visit young people in treatment programs. That is still not enough.
You are still living in a twilight that knows not joy, nor love, nor happiness.
Because you do not check the correct political and social boxes, because you frighten people, the eating disorder community turns on you. Have you made mistakes? Hell yes.
But it gets worse. Just five years ago, your father, your mother and your older brother all die within 14 months of each other. Your brother was the picture of health. And he only trusted you to tell the doctors to end his bodily functions. Imagine that much death in such a short period of time.
At that moment in time, your son and his wife have a baby. Imagine the very first time you hold your granddaughter in your arms, you have to tell your son you are flying to Florida the very next day to tell doctors to remove life sustaining equipment from your brother.
You know the eating disorder community doesn’t care. You frighten them because you do not play their pedantic games. You care about life and death not social justice and political statements.
And so, your mindset begins to evolve. You see the vile, on-going corruption in the community. You see the illness which claimed your daughter’s life being used as a platform to spew forth the community’s social justice and political viewpoints. And you reach a point where you say … enough!
Donors to NEDA come to you so angry that NEDA is being turned into a social justice and political side show by Chevese Turner and her social justice warriors. You have the ability and skill to take action. But first, you give NEDA almost 20 opportunities to talk before you file suit. An expeditious settlement is reached, a settlement which also financially benefits research into the genetic aspects of eating disorders. And yet, the very person who attempted to destroy NEDA’s purpose, skates by with no tangible consequences. She knows that her minions and cohorts in the community will continue to breathe life into her. Consequences and ramifications are foreign to the eating disorder community.
Undeterred, you go after more inappropriate conduct in the community. You see the specter of death appear in the words, “Terminal Anorexia.” Like many others, you are horrified. University-based professors write neatly composed articles opposing it, articles which accomplish nothing. Nothing tangible is being done.
So, you take action. You file a number of medical board complaints. That changed everything. You meet Dr. Jennifer Gaudiani and look her in the eyes. Much to your surprise, you do not find a monster. Instead, you find a professional. A soul. A human being. A person then in pain. You talk. And then collaborate with many others. What grew from that hard work was not triumphalism but human connection: colleagues turned collaborators, pain turned toward repair. And maybe … just maybe, you find through adversity a greater understanding about life and death. You realize that the manner in which we face death is just as important as the manner in which we face life.
Then, there is iaedp. The corruption and stupidity in that organization were and are legion. And the eating disorder community DID NOTHING. It cowered. The rot there was obvious and long tolerated. You initially do not pursue headlines and seek to meet and resolve all issues privately. That outreach is rejected. So, professionals in the community request action. The result: past due taxes, penalties and interest in the hundreds of thousands of dollars are being required to be paid. Board certification is being reformed and made more affordable. Individual chapters are gaining their independence. Thousands of therapists are now being spared needless expense. The community has improved — slightly, imperfectly — and for that action, very, very few people have said thank you. Predictable.
You are not finished. Not nearly. You expose how Chevese Turner and others of her ilk took down the Legacy of Hope. And for their misconduct, they have been rewarded and still have a voice. The community blindly accepts those who think like they do. Contrarily, you continue to exist. Living with the greatest heartache possible.
No matter how many times textbooks say, “it’s not a parent’s fault,” or some vacuous therapist tries to convince you of that, they fail. They haven’t lived it. They don’t live with the daily pain, the heartache. The anguish.
I do. Every … single … day.
I have made mistakes, and I will make more in the future. Grief is not a moral compass. But the stubborn refusal to confront corruption, the eagerness to defend the performative rather than the practical, that is the real moral failure. When children’s lives are reduced to talking points, when mortality is sidelined in favor of crowd-measuring, the community betrays the very people it claims to serve.
So — righteous indignation? It is paid in blood and sleepless nights. It is the only honest response left when an industry cloaks politics in the language of care and ignores the medical science in front of it. If you are offended by my anger, consider why the community has earned it.
I do not wish to be part of this community. I wish — every day — that I did not know anyone in it. I wish my daughter, Morgan, were alive. I mourn her constantly. My activism is not grandstanding; it is grief turned toward accountability, toward saving the next life.
If you call that righteous indignation, so be it. I am guilty as charged. And I will keep speaking and acting until this feckless culture chooses truth over theater.
So … righteous indignation?
A brilliant light was extinguished in Dallas on October 30, 2016. That tragedy is the ledger against which I measure every day. Righteous indignation is paid with the dearest blood possible — and I will not apologize for the balance I keep.
Weight Stigma Awareness Week should be an opportunity to confront one of the most damaging forces in healthcare: bias against people in larger bodies. This should be a week for data, clinical rigor, and constructive collaboration. Done well, it can highlight evidence-based solutions, elevate medical leadership, and foster collaboration across disciplines. And families who are suffering are the ultimate recipients of this shared wisdom.
Next week’s agenda includes sessions that could help shape our response to stigma and patient care. For example:
Rebecka Peebles, MD, FAAP, DABOM, & Lauren Hartman, MD — “Healing Without Harm: Ending Weight Stigma in Healthcare.” Practical, evidence-based strategies for clinicians who treat real patients in real exam rooms. The goal is not slogans but practical training rooted in science.
Leslie L. Williams, MD — “Navigating Eating Disorder Risks in the Age of GLP-1 Medications: A Weight-Inclusive Clinical Approach.” With GLP-1 drugs reshaping public conversations about weight and health, the need for clear, medically sound guidance has never been greater. Families deserve facts, not fearmongering.
Abigail Pont, MD — “Anti-Fat Bias in Medical Education Through the Eyes of a Medical Trainee.” Change must begin with training. Reforming curricula to prepare physicians to treat all patients with dignity and competence is not optional — it is essential.
These are the conversations that deserve attention, funding, and follow-through. They are the ones that have the potential to save lives.
But here lies the danger: while some leaders are advancing medicine, others are actively working to undermine it. Instead of fostering collaboration, maladjusted activists reject it. Instead of engaging with science, maladjusted activists ignore and dismiss it. Instead of building trust between patients and the medical community, maladjusted activists sow division, reject science, reject collaboration, and replace patient-centered work with grievance theater.
The weapons they use are fatuous ideology and vacuous grievances void of real substance and merit. This leaves patients and families caught in the crossfire.
This is the dark side of the ledger: militant, maladjusted, angry activists, wallowing in such internal pain, who reject collaboration, denigrate clinicians, and weaponize grievance for influence. This sadly is not theoretical.
It played out in 2021 at the Legacy of HopeSummit — a convening of some of the field’s foremost experts intended to build consensus and advance patient-centered solutions. Instead of joining that work, some radical activists not only opposed it, both before and after, but they tried to burn it down.
The most vocal critic was Chevese Underhill Turner, co-host of Weight Stigma Awareness Week, who also serves on the Board of Advisors of Within Health and is “Queen of the Ashes.”
Regarding the Legacy of Hope, Turner wrote:
“The entire ED community is getting ‘upskirted’ by certain men and we cannot put our own FOMO aside long enough to see it. Instead, we attend these men’s meetings and give them power to continue their gaslighting and lack of any willingness to see the intersections affecting our field. I’d love for other women to join me (and a few others) in being difficult when it comes to these people.”
This was not a critique grounded in evidence. It was not a call for better data or stronger collaboration. It was a deliberate attempt to sabotage a convening of experts — through crude language, ad hominem attacks, and an open invitation to disrupt and destroy.
Turner’s misguided viewpoints do not end there. On various podcasts and in social media, Turner has attacked clinicians, mocks evidence, and replaces medicine and science with grievance politics.
Her own words make it clear:
“It bothered me that all the air was taken by a white perspective.”
“My heart is in the higher weight community, whether a person has an eating disorder or not.”
“I believe bodies are political.”
“Everything is political.”
“I came out of the womb as a political beast.”
“When I hear “marketing” in the context of ED services to marginalized communities I hear white folks not learning from colonization and slavery. We need to stand down.”
“We must also be centering and supporting BiPOC, LGBTQ+, fat therapists and professionals. This is no space for white, straight and thin folks to jump in.”
“When we constantly protect the feelings of those who are oppressing then we never actually get to the work needed to undo the oppression.”
Turner, in writing stated that she supported and was working toward the following: “ … providing reparations to Black People, Indigenous people and People of Color, (“BIPOC”) especially queer and transgender BIPOC; hiring a transgender consultant to revise your marketing material; establishing sliding fee scales for BIPOC, transgender and gender diverse clients; redistributing wealth from the for-profit ED treatment world; embracing and incorporating non-western treatment practices; providing access to Hormone Replacement Therapy.”
These extremist radical views come from ignorance and distrust of the medical community. In Turner’s own words:
“The DSM [Diagnostic and Statistical Manual of Mental Disorders], it is what it is … it’s not great.”
“Those of us who have done the work around our internalized biases no longer trust the medical establishment to actually help us.”
“That has only grown into a place where we are now. Body Positivity Movement. We don’t want to be judged on our looks and our size. The medical community said, ‘Ok. We’re going to judge you on your health.’”
“Most of the country is at a higher BMI, but when you begin to talk about people above a 35 who are visually fat, the oppression increases — plenty of data on that. People in the 50, 60 etc (superfat) range experience even more oppression. These are the folks who are publicly chastised and harmed continuously by the medical profession. Oh, the stories I could tell. Public health in this country is getting it so wrong and there is a better way, but we need to be willing to actually listen to those being harmed.”
“There may be some things with eating disorders that are brain issues … I don’t know.”
Turner’s harmful, illogical, extreme points of view do not constitute insight – they are ignorance masquerading in cartoon regalia, strutting as wisdom. They demonstrate contempt for medical science disguised as activism, reckless to the point of sabotage. And yet, somehow, they earn you the golden ticket to co-host Weight Stigma Awareness Week. Turner’s very presence doesn’t elevate the cause; it cheapens it, hollowing the message until nothing credible remains.
In the past, Turner redirected organizational platforms away from patient-centered care and toward political crusades. As a former officer of NEDA, one of the largest eating disorder organizations in the country, she proudly declared, “We won’t be deterred in our social justice work.” Under her “leadership,” donors were encouraged to contribute to the Minnesota Freedom Fund — an organization later revealed to have posted bail for accused murderers, rapists, and other violent offenders.
Ask yourself: who benefits from public disruption? Certainly not patients. Nor families. Nor clinicians attempting to balance complex risks and benefits. Disruption for its own sake only produces a cacophony of racket instead of clarity. It produces division where we need partnership and collaboration.
And yet, Turner is annually trotted out as a co-host of Weight Stigma Awareness Week even though her message never changes. She is still handed the microphone. Still made co-host. Still rewarded.
Turner’s destructive, insidious pattern is consistent and consequential. When so called leaders prioritize ideological purity tests over rigorous science, they do more than dispute ideas — they undermine care. When organizational platforms are repurposed for partisan causes, and donors are steered toward politically charged funds with questionable implications, the field’s credibility erodes. When individuals who oppose expert collaboration are nonetheless rewarded with boards, speaking invitations, and opportunity, the message is clear: rhetoric is encouraged; results are irrelevant. And yet, that is the reality in the eating disorder community.
In any other professional community, such conduct would bring harsh consequences. Suspension. Banishment. In the eating disorder world, it brings greater influence and opportunity. But it does not have to be that way.
The way forward is clear but it requires courage and resolve:
Elevate science-first voices. Medical experts who ground their work in data and clinical care should be at the center of not just this week, but every week and this field.
Insist on collaboration. Medicine is not the enemy. Progress depends on partnership between clinicians, researchers, and advocates willing to engage constructively.
Enforce accountability. Organizations must set standards of conduct. Those who undermine collaboration with reckless rhetoric cannot continue to hold leadership roles.
Protect patient-centered care. Eating disorder treatment should not be a platform for partisan politics. The focus must remain on evidence-based approaches that save lives.
Patients deserve better than empty slogans. Families deserve better than spectacle and disruption. The eating disorder community deserves leaders who are accountable, collaborative, and grounded in science.
Weight Stigma Awareness Week should not be a stage for any one person’s hate filled ideology. It should be a platform for medical and science based workable solutions.
The choices confronting us are simple.
Evidence based treatment over drama and dysfunction.
Clinicians and researchers who do the hard work of translating evidence into care over charlatans who sell social justice snake oil.
Collaboration over spectacle.
Accountability over impunity.
Lives are at stake. Families are desperate for solutions grounded in competent, humane care. Patients cannot wait for ideology to sort itself out. If we allow disruption to replace discourse, we become complicit in the harm that follows.
Since prolific anti-semitism directed toward Jewish therapists by non-Jewish therapists is an appalling reality, it was predictable that the assassination of Charlie Kirk would reveal the worst in humanity … including of course, eating disorder therapists and family liaisons. More’s the pity.
When a loved one has an eating disorder, families are already living in a war zone. Every meal feels like a battlefield. Every doctor’s appointment feels like judgment day. And when parents turn to therapy, they are not looking for ideology, slogans, or someone’s Twitter feed come to life. They are looking for life saving help.
Eating disorders don’t care about politics. They don’t care about hashtags. Eating disorders only care about shutting down organs, hijacking minds, and killing people. But too many therapists, treatment centers, and professional organizations are importing America’s divisiveness into treatment. The result? Families are left paralyzed, distracted, and betrayed.
More and more therapists and family liaisons are peddling something else: politics disguised as treatment. Some wave the flag of “Free Palestine” with militant zeal. And yet, most could not even remotely explain the complex nuances of Middle East politics going back thousands of years. When the phrase, “From the River to the Sea,” is spewed forth with all the hatred and horror which exists within the soul, many therapists and activists cannot even identify which river or which sea is being referred to, let alone identify the dark significance of that phrase.
These militant therapists and family liaisons sneer that the death of Charlie Kirk, a conservative commentator was deserved, and in their ignorance and room temperature IQs, slap “ism” labels on him and then rejoice that his life was tragically cut short. These providers and activists are intentionally obliterating the line between activism and care. Families should take this as the clearest possible warning sign: walk away. As fast as you possibly can. Do not trust those people or their organizations.
It is bad enough that families seeking help often find therapy rooms that sound more like activist seminars than clinical spaces. Instead of guidance on food and recovery, they get:
“Diet culture is colonialism.”
“Anorexia is a symptom of white supremacy.”
“Thin privilege is the real disease.”
These are not treatment strategies. They are slogans, ripped from Twitter and recycled in therapy sessions. When families should be hearing about family-based treatment (FBT), CBT-E, or medical stabilization, they’re handed culture-war scripts that do nothing but fracture trust.
Eating disorders thrive on chaos and division. They feed on families who are fractured, therapists who are distracted, and organizations that are broken. Every minute spent arguing over slogans is a minute not spent on saving a life. Every resource squandered on activism is a resource stolen from recovery.
Therapy is supposed to be a sanctuary from the chaos of the outside world. It is supposed to be a space where pain is met with compassion, not political litmus tests. Injecting social justice battles into that space doesn’t just distract — it actively harms.
Here’s how:
It replaces healing with indoctrination. Patients and families arrive desperate for answers about food, weight, fear, and survival. Instead, they may be handed lectures about geopolitics, race, or privilege. The family’s suffering becomes a prop for the therapist’s personal crusade. That is gross exploitation, not care.
It breeds division when unity is essential. Eating disorders tear families apart. Recovery depends on pulling together. A therapist who filters everything through activism risks turning family members against each other based on political or cultural identity. That kind of manufactured division is gasoline on the fire.
It signals contempt for dissent. A therapist who proudly mocks the death of someone they dislike politically is broadcasting one thing: if you disagree with me, I do not respect you. How could any family trust such a provider to respect their child, their family bond, or their values? Trust collapses before therapy even begins.
It encourages rigidity instead of curiosity. The most effective therapists know they don’t have all the answers. They ask, they listen, they adapt. But the activist-therapist thrives on certainty: oppressors vs. oppressed, good vs. evil, us vs. them. That rigidity suffocates the flexibility patients desperately need for recovery.
It undermines professional ethics. The ethical codes of every counseling profession warn against imposing personal beliefs on clients. Therapists who cannot resist bringing their political militancy into the room have already failed the most basic test of professionalism.
Let’s be clear: cultural awareness and respect for diversity are good things. But respect is not the same as ideology. Sensitivity is not the same as indoctrination. Families need therapists who can meet them where they are, not therapists who drag them into battles they never signed up to fight.
Eating disorders are the second most lethal mental health illness, outpaced only by opioid addiction. This is life-or-death work. Families should demand nothing less than evidence-based treatment, humility, and compassion. When a therapist instead advertises their political rage as part of their practice, they are showing you what matters most to them — and it isn’t your child’s recovery.
The therapy room should be sacrosanct and must never be allowed to become another front line in America’s political battles. Families: if your loved one’s treatment starts to look like activism instead of medicine, get out. Your child’s survival depends on science, unity, and clarity — not the noise of a broken country bleeding into a broken field.
Your 18-year-old daughter, who is struggling with severe anorexia, desperately needs a higher level of care. Biologically, her organs are failing. You make a claim with your health insurance company. And you receive a denial.
You quickly research and then discover an Ai program utilized by the insurance company made the decision to deny saving your daughter’s life.
Welcome to the world in which we live. Where Ai programs may be making life and death decisions about your loved ones. That is the very harsh reality. So, let’s explore that reality.
First, what is “artificial intelligence?” The term itself is so vague as to be mystifying. What makes it artificial? The fact that human beings invented it? That it is silicone based instead of carbon based? Is the programmed intelligence, which is designed to learn at a rate far faster than humans can possibly comprehend, deemed artificial because it lacks a sentient existence?
Is Ai artificial because whereas it may “learn,” it does not experience the subtle nuances and life experiences which make us all unique? Does Ai have a soul? For that matter, do we?
Regardless, with Ai still being in an early stage of development, and with Ai’s developing interaction with humans, we must find ways to build guard rails so that Ai is not in a position where it could singularly make life and death decisions. Decisions which are often made by health insurance companies when deciding to pay, or not pay, for life saving surgeries or treatment. Or is it already too late?
Imagine if you will, an Ai program being utilized, without human interaction, to review and decide a claim or an appeal of a claim for a higher level of care, or to receive necessary treatment or to receive a life-saving procedure. An Ai program with no human experiences, no ethics, no soul, no subtlety, no morality. To leave our very existence in the hands of a machine, a machine that cannot love, cannot experience sorry, or joy, or happiness, or despair. And yet … that is happening. Today.
In 2020, UnitedHealth Group division Optum acquired naviHealth and its algorithm for predicting care, called nH Predict, which UnitedHealth uses and contracts out to other insurers, including Humana. Multiple industry sources estimate that Optum paid at least $1.1 billion dollars and when considering debt and related financial structuring—the purchase price is estimated to be as high as $2.5billion. When asked by the Guardian, a spokesperson for UnitedHealth Group denied that the algorithm is used to make coverage decisions. [Like when UBH denied it ran its guidelines through its accounting and finance departments?]
UnitedHealth, Humana and Cigna are facing class action lawsuits alleging the insurers unethically relied upon Ai generated algorithms to deny lifesaving care.
One of the lawsuits alleges that Cigna denied more than 300,000 claims in a two-month period. This equates to spending approximately 1.2 seconds for each presumably physician-reviewed claim. Such a practice is aided by algorithms, the lawsuit alleged.
The Cigna lawsuit also alleged that nH Predict had a 90% error rate, meaning nine out of 10 denials were reversed upon appeal – but that vanishingly few patients (about 0.2%) appeal their denied claims, leading them to pay bills out of pocket or forgo necessary treatment.
Appealing denied claims means big business. The US Centers for Medicare and Medicaid Services estimate that when insureds appeal initial denials administrative costs for insurance providers exceed $7.2 billion annually.
According to a United States Senate Report issued in October 2024, UnitedHealthcare, CVS and Humana – the three largest providers of Medicare Advantage, together provide almost 60% of all Medicare Advantage coverage – but reject prior authorization claims at higher rates using technology and automation. That report can be found here:
To support the implementation of Ai, health insurance companies argue that Ai programs streamline claims processing, more effectively flag fraud, and promise greater speed, efficiency and cost savings. They claim that by automating routine claims, Ai frees up human reviewers to focus on complex or borderline cases that require medical judgment and nuance. (For that matter, don’t all claims require medical judgment?)
Despite its alleged advantages in claims processing, Ai has faced fierce criticism, especially when its role extends to denying coverage or appeals for essential care. Ai is not immune to flaws, as its decisions depend on data quality and programming — both of which can perpetuate mistakes or systemic biases. Garbage in Garbage out.
Many Ai systems operate opaquely, leaving patients, providers, and even insurers unsure how specific decisions are made. This undermines trust and impedes meaningful appeals.
Numerous lawsuits allege that Ai tools prioritize cost-saving over medical necessity. In some cases, Ai has overridden physician recommendations, resulting in denials of rehabilitation, mental health services, or life-saving treatments.
There is a widespread perception—and often a harsh reality—that health insurers prioritize profits above the needs of their insureds. Ai tools, by automating denials or aggressively limiting coverage, can exacerbate this distrust, especially when decisions feel impersonal or unjust.
Critics argue that Ai systems are often deployed as “rubber stamps,” with little or no meaningful physician review—contravening legal and ethical obligations.
Meanwhile, states like California have moved to ban Ai-only coverage denials, signaling a wave of regulatory intervention.
As for those health insurance companies which utilize Ai alone to decide claims or appeals, the major issues focus on:
Risk of Profit-Driven Bias: Ai tools influenced by financial priorities may embed cost-saving incentives that override medical necessity, echoing problems revealed in the Wit v. UBH case.
Lack of Clinical Nuance: Ai lacks the ability to fully understand complex medical contexts or patient histories that human clinicians evaluate.
Transparency and Accountability: Patients have a right to clear explanations and meaningful appeals, which Ai-alone systems often fail to provide.
But that is where we are. Ai is being utilized by insurance companies to decide claims and appeals. Although the insurance companies may deny this fact, it is a reality. Especially since widespread use of Ai in denying claims and appeals will result in much greater profits for these companies.
To counter this reality, the future must be shaped by the following:
Stronger Regulatory Frameworks
States and potentially federal regulators are developing rules to ensure Ai complements—not replaces—human medical judgment. Requirements for physician involvement, transparency, and appeal rights are expected to expand.
Increased Legal Scrutiny
As lawsuits proceed, courts will clarify the legal boundaries of Ai’s role in coverage decisions, particularly under ERISA, Medicare Advantage rules, and consumer protection laws.
Pressure for Transparency and Explainability
Insurers may face mounting demands to disclose how Ai tools function, how decisions are made, and how patients can challenge automated denials.
Smarter, More Ethical Ai Development
Future Ai systems may incorporate safeguards to avoid wrongful denials, improve alignment with medical standards, and enhance explainability.
Ai’s exploding involvement, or interference in our lives will only increase. That is inevitable.
There is the potential that Ai can make health insurance claims processing faster, fairer, and more efficient—but only if deployed responsibly. It must address not only human fallibility but also the systemic distrust stemming from the reality that insurers prioritize profits over patients. Lessons from Wit v. UBH remind us that financial influence over clinical decisions can have devastating consequences, a cautionary tale for Ai implementation.
As courts, lawmakers, and the public demand accountability, the health insurance industry faces a pivotal choice: embrace Ai as a tool to support—not supplant—human expertise, or risk eroding trust and facing costly legal consequences.
The future of Ai in health insurance is not just a technological issue—it is a legal, ethical, and societal issue. Right now, the live of your loved one may very well depend on a machine. On Ai. A lifeless, soulless computer program devoid of all emotion, mercy and humanity.
That is our reality right now. Allow yourself to contemplate that reality and perhaps yes, be afraid. For our future depends on wisdom far greater than humanity has ever demonstrated. Our health depends on it. Our very lives depend on it.
June 2, 2025, was World Eating Disorders Action Day. (“WEDAD”) According to the organizers, “… over 300 organizations … stepped up—hosting events, launching social media campaigns and podcasts, conducting interviews, and working across borders and disciplines to make an impact on this one crucial day.”
Dra. Eva Trujillo, (whom I like and respect) was one of the drivers of WEDAD. Her quotes included:
“When we act together, our impact is stronger. We are looking for new voices, perspectives, and passionate professionals ready to serve.”
“Are we, as a field, ready to begin healing the divides within our own community? Or are we too overwhelmed trying to survive?”
“It’s a question that haunts many of us, and it’s time we face it with courage and honesty. We can’t build meaningful change externally if we remain fragmented internally. This is a moment for us—clinicians, educators, researchers, advocates, sufferers, and caregivers—to come together—not in perfect agreement but in shared purpose.”
“We must start connecting. Not by taking sides, but by building bridges, amplifying what unites us, listening more than speaking, and doing the hard work of healing, both within and beyond our professional circles.”
An officer from another organization stated:
“So, how do we begin to heal our community?”
“As organizations, we begin by reaching out to one another, recognizing each other’s strengths, sharing our own, and uniting our efforts to broaden services and support.”
“Together, we are stronger.”
Fine words. Grand words. But … just words. So, how do we put into action the concept behind those words and turn them into reality?
A few weeks ago, I attended ICED 2025 in San Antonio. [As an aside, ICED 2026 is scheduled for June 3 – 5 at … The Hague. And by wonderful coincidence, the Formula 1 Grand Prix in Monaco is scheduled for June 5 – 7! Can you say Bucket List? Super yachts in Monaco Bay. Black tie casino gambling. Incredible parties. But … I digress.]
Most of my time at ICED 2025 was spent darkening the Exhibit Booths, listening to a few presentations, swilling whiskey and having my tail handed to me playing chess in the hotel lobby. But, in my wanderings, I noticed the following organizations did not have a booth, or for that matter, any presence: NEDA, iaedp.
They were not listed as sponsors. They were not listed as exhibitors. Their CEOs were not there. (or if they were, they kept out of sight).
Perhaps that is where we must start. Or does it go deeper than that?
Let us pose some questions which surely must be asked:
Does the eating disorder community really need three (3) independent organizations, AED, iaedp and NEDA?
If so, why? Especially since all three appear to be flailing if not failing.
Isn’t it in the best interest of the families suffering from this illness that one unified, strong entity comprised of the best of those organizations be formed?
The problems and issues at each of the organizations are alarming.
iaedp is engulfed in a lawsuit which, if successful, will result in its demise and possibly the end of board certification. Iaedp also has a very large financial burden for past due taxes, penalties and interest. On its last F0rm 990, it showed a loss of $284,806.00. Since membership is no longer required to maintain board certification, its membership is dwindling. A number of iaedp individual chapters have dissolved. Its next symposium is being held in Baltimore … in the middle of winter. Iaedp’s “Members at Large” a/k/a Board of Directors is comprised of persons with no outside corporate or legal experience.
The issues at AED are also troubling. From 2020 through 2023, AED reported a total combined loss of -$658,156.00. The cancellation of billions of dollars in NIH grant funding resulted in many university professionals unwilling and unable to attend AED’s ICED and not renewing their membership. A contentious relationship with international chapters plagues AED.
NEDA, unlike AED and iaedp, showed a profit on its last Form 990. On its 2023 Form 990, it showed net revenue of $1,836,601. However, in the three prior years, it showed three consecutive losses in a combined amount of $1,913,492.00. NEDA sold its telephone helpline to the National Alliance. But, besides conducting its fun walks and awarding some grants, (for which it should be commended), has time eroded NEDA’s impact in the community?
Therapists are intimidated by research professionals. Research professionals do not have the wisdom gained from being on the front lines, that is, in the actual therapy rooms. Medical clinicians are frustrated waiting for research findings to be released. Uninformed and misguided fat activists are just causing chaos. And the wheel turns round and round with little, if any progress being made.
Dra. Trujillo acknowledged the divides which exist in the community. So, where does progress start?
Perhaps we begin with transparency. An element so missing in the eating disorder community. No organization or person in the community is inventing a cure for cancer or devising the next generation of Ai/Robotics technology. Certainly, private organizations and companies generally do not disclose financial information or voluntarily broadcast future expansion or retraction plans. But we are dealing with a mental health illness with a high mortality rate. Families are severely impacted every day. It seems as if eating disorder organizations and entities have lost sight of that reality.
And so, transparency and collaboration must start at the organizational leadership level. To start to accomplish this, accommodation and grace must be given.
Starting with iaedp’s next Symposium to be held in Baltimore in February 2026, iaedp must allow NEDA, AED, FEAST to have exhibit booths and have at least their three highest ranking officers to attend … at no cost. During the Symposium, the leaders from all organizations must meet to discuss all issues they have in common. Issues unique to each organization. The future is discussed. Planning is shared. Finally, at the end of the meeting, an open forum is convened both in person and via zoom. A forum that any concerned person can attend and ask questions, live or via the internet. The leaders share with everyone the topics of discussion and the plan of moving forward.
In 2027, at AED’s ICED to be held in Phoenix, Arizona, it is AED’s turn to host the other organizations utilizing the same format.
In 2028, these collaborative meetings may not be necessary. That is because by 2028, hopefully all major organizations will have realized that the tribal way they have done business in the past is not effective and does not work. In fact, the piecemeal, isolationist way each organization currently attempts to operate has failed. The six figure financial losses every year. Membership dwindling. As has been noted, people leading organizations have admitted that division exists in the community and needs to be healed. But these divisions cannot be healed singularly.
The old way of doing business has failed. The mortality rate worsens. The number of loved ones and families suffering continually increases. Each organization in their own way has failed and contributed to worsening the situation. So, how can we possibly proceed in the future?
The best way, the path which provides the greatest likelihood of success is to have these organizations merge into one entity. One large, collaborative organization. Therapists, medical doctors, research professionals, advocates all under one tent. Talking together in the spirit of professionalism and respect. Combining the greatest minds of different tracts to share knowledge, wisdom and ideas. Casting individual egos aside for the greater good. Bringing in corporate and legal experts to assist in reorganizing and providing many additional outlets for fundraising.
One large, all-encompassing yet diverse organization. An organization which would be able to lobby more effectively to address the true needs of the community. An organization which would be able to approach large corporations and foundations to engage their substantial resources for the purpose of working toward true breakthroughs in our understanding and treatment of eating disorders.
Now make no mistake. The obstacles are many and the challenges are great. There are those who will oppose this collaborative entity merely because it threatens their self-importance. There is a faction in the eating disorder community which actively fights against progress unless that progress exclusively involves their own pedantic points of view.
Nonetheless, the handwriting is on the wall. The commendable accomplishments of individual organizations in the past have been relegated to the past. The old way of doing business no longer works. It is not effective. That is shown by the deteriorating financial condition of these organizations, the deep divisions which exist in the community and most importantly, the number of our loved ones who continue to be taken.
Our loved ones who continue to die in ever increasing numbers.
That should be the first, middle, last and only concern of these organizations. The time is now. The future awaits. Collaboration beckons.
I was recently advised that articles about IAEDP and Acadia were getting redundant.
So, why continue ?
Regarding Acadia, the answer is quite simple. Because its systemic corruption continues seemingly unabated and its vapid denials and inane posturing have reached an absurd level.
But before going into the most recent damning New York Times investigative article on Acadia, let’s look into the eyes of some of their victims:
Christopher Gardner
Five year old Christopher was left for 8 hours in a transport van at a West Memphis, Arkansas daycare facility owned by Acadia. Workers tried to cover up their gross negligence by signing documents showing that Christopher was taken inside the West Memphis day care center, even though he remained on the van. At least one media outlet reported the temperature in that van rose as high as 141 degrees. Christopher died in that van.
Deborah Cobbs
In May 2024, 20-year-old Deborah Cobbs, died after she threw herself down a staircase. At Timberline Knolls. Police reports indicate that she attempted to run away from the campus twice that very day. Which makes it quite curious as to why she was not being closely supervised.
Tiley McQuern
In January 2023, Tiley McQuern, 50, was found dead in her bed at Timberline Knolls after swallowing too many pills.
Those are just three of the many Acadia victims. Look at their faces. Never forget their faces. Because the faces in those photos are all that is left for their loved ones.
On April 22, 2025, the New York Times published an article about Acadia’s now shuttered and infamous facility, Timberline Knolls. It is entitled, “Suicides and Rape at a Prized Mental Health Center. Timberline Knolls, a mental health center owned by Acadia Healthcare, skimped on staff. Then came a series of tragedies.”
Although behind the New York Times paywall, the good people at the Salt Lake Tribune published the article in its entirety here:
“But dangerous conditions persisted for years at Timberline Knolls, an investigation by The New York Times found, in part because of pressure to enroll more patients without hiring enough employees.”
“Two former residents sued Timberline Knolls last year, claiming that an aide had raped them. Acadia had hired the aide despite a criminal record that included domestic violence and gun charges.” [emphasis added]
“Another resident — a child who was a ward of the state — nearly died after she overdosed on medication that had been left out in a common area, according to former staff members. And two other women died by suicide after being left unsupervised, a rare occurrence at mental health facilities.”
“We were extremely understaffed,” said Cecilia Del Angel, who worked as a behavioral health aide at Timberline Knolls until last July. Several other former employees echoed that sentiment. The patient deaths, Ms. Del Angel said, were “entirely preventable.”
“Illinois regulators had not looked into the suicides. A spokesman for the state’s health department said it did not regulate Timberline Knolls, and the state’s Division of Substance Use Prevention and Recovery had not visited the property since 2019.”
“The problems at Timberline Knolls were part of a nationwide pattern of lapses at Acadia, one of the country’s largest for-profit providers of mental health services, with more than 260 facilities in 39 states, The Times found.”
“Acadia has closed facilities over the past decade after reports of sexual abuse. More than a dozen patients reported sexual assaults at an Acadia psychiatric facility in Utah. At a youth treatment center in New Mexico, patients claimed that staff had sex with them and pushed them to participate in “fight clubs.” And in Michigan, three women said they had been sexually abused by a supervisor at a youth treatment center.”
“In the summer of 2018, patients complained to Timberline Knolls employees that a therapist, Michael Jacksa, had sexually abused them on Timberline’s campus. The facility waited more than three weeks to call the police, doing so only after the patients complained to the state’s substance abuse agency, court records show.”
“Timberline’s leader at the time, Sari Abromovich, said an Acadia executive had told her not to alert the authorities, according to a deposition she gave in a lawsuit later filed by one of the women who was raped.”
“Ms. Abromovich, who was fired in 2018, said she was under daily pressure from corporate managers to fill beds and keep expenses low by skimping on staff.”
“Patient enrollment fell with the news of Mr. Jacksa’s arrest. In the ensuing years, Acadia pressured staff to find new ways to fill beds, according to eight former employees, who spoke on the condition that The Times not publish their names because they still work in the mental health industry.”
“Staff struggled to prevent patients from fighting, harming themselves and escaping the facility. In 2020, the Lemont police were called to Timberline Knolls 222 times, police said. By 2023, that number had soared to 519. No one else in Lemont made more emergency calls.”
“In a brief telephone call with The Times, Eiliana Silva, the director of J.P.’s [rape victim] residential unit, acknowledged that she had heard concerns from staff about Mr. Hampton [the rapist/employee] but said she could not properly supervise him because she was one of only two directors overseeing five lodges. As soon as she heard about J.P.’s complaint, she said, she relayed it to Timberline Knolls’ leadership.”
“At the time Timberline Knolls’ leadership heard the accusations against Mr. Hampton, the staff was still reeling from three other disasters.”
“In January 2023, Tiley McQuern, 50, was found dead in her bed after swallowing too many pills. A staff member told police that although employees were supposed to check on patients, those checks were “not thorough,” police records show.”
“Seven months later, a child, who had been placed at Timberline Knolls by the state’s child welfare agency, was rushed to the hospital after overdosing on medication that a staff member had left in a common area.”
“Then, in May 2024, another resident, 20-year-old Deborah Cobbs, threw herself down a staircase while no one was supervising her and died. She had tried to escape Timberline twice that day, police records show. Ms. Cobbs had also told several people that she was feeling suicidal, according to former employees who worked there at the time.”
So, what was Acadia’s response to this legion of corruption and harm to those entrusted to their care?
“Tim Blair, a spokesman for Acadia, said in a statement that the company had a zero-tolerance policy for behavior that could put staff or patients in danger. “We reject any notion that we put profits over patients,” he said, adding that “complaints and incidents are investigated and addressed.”
“Mr. Blair denied that Timberline Knolls had dangerous conditions and said it had adequate staffing levels.”
Another unidentified Acadia spokesperson said, “The recent New York Times story about Timberline Knolls, a closed Acadia facility, includes material inaccuracies and cherry-picks and conflates historical incidents to paint a false and inaccurate picture of the safety and quality of the care our facilities provide.”
Acadia’s corruption is vast. A report by the National Disability Rights Network detailed allegations of inappropriate physical restraints, sexual abuse, and emotional abuse at for-profit treatment centers, citing examples at Acadia facilities including an incident where a 9-year-old was injected with antihistamines as punishment at an Acadia facility in Montana.
In March 2025, three adolescents filed a lawsuit against Detroit Behavioral Institute, LLC and its owner, Acadia. The plaintiffs allege widespread sexual, physical, and psychological abuse inflicted on dozens of children. In fact, more than 35 people have come forward after they were reportedly abused as children at the Detroit Behavioral Institute between 2005-2022. The lawsuit alleges that the children were groomed, sexually assaulted and those that spoke out were retaliated against.
Acadia’s response to that lawsuit? “The well-being of all patients is of the utmost importance to Acadia Healthcare and its affiliated facilities. We take these allegations seriously. While we can’t comment on specific allegations and patient situations due to privacy regulations, the picture being painted of Acadia and the quality of care provided by our facilities is inaccurate. We intend to defend this case vigorously.”
It is enlightening that Acadia’s public response to both the Timberline Knolls scandals and the horrific allegations against Acadia’s Detroit facility utilize almost identical language … “the picture being painted of Acadia and the quality of care provided by our facilities is inaccurate.
In addition, the same day the New York Times published its story, Acadia released its own statement entitled, “Setting the Record Straight: Acadia is A Leader in Quality, Safe Behavioral Healthcare.”
It should come as no surprise that Acadia once again uses its old stand by line, “Regrettably, a recent media report cherry picked and conflated historical incidents at a closed Acadia facility to paint a false and inaccurate picture of the safety and quality of the care our facilities provide.”
So apparently, medication overdoses causing death while under the watchful eyes of Acadia, two suicides in the facility within a year, a minor taken to a local hospital because of a drug overdose, numerous young women being sexually assaulted and raped, five hundred nineteen (519) 9-1-1 calls within one year all fall into the category of “false and inaccurate picture of the safety and quality of the care our facilities provide.”
So, painting an inaccurate picture? Like this?
Or is the painting inaccurate because it does not nearly portray the numerous additional instances of abuse, misconduct and neglect perpetrated by Acadia?
It seems as if Acadia anticipates these lawsuits and issues the same trite defensive language dripping in lawyer ick. For Acadia, it is merely the cost of doing business with our loved ones being nothing more than corporate commodities.
Acadia’s profiteering at the expense of its patients results in the dirtiest kind of money. And yet, our eating disorder organizations continue to close their eyes and continue to accept Acadia’s dirty money. In February, it was iaedp at its annual symposium.
Next month in San Antonio, it is AED’s turn to turn a blind eye and accept Acadia’s dirty money. In doing so, AED arguably becomes complicit in the following odious, reprehensible acts perpetrated by Acadia and its feckless employees:
Multiple rapes in their treatment facilities located in a number of states;
Multiple sexual assaults in their treatment facilities located in a number of states;
Multiple attempted suicides in their treatment facilities located in a number of states;
Multiple successful suicides in their treatment facilities located in a number of states;
Having your lack of oversight result in the death of a 5 year old child left under your care;
Acadia’s officers and Board of Directors engaged in a scheme to defraud and mislead investors concerning patient care, staffing levels and legal compliance issues;
Acadia and its employees submitting false claims for payment to Medicare, Medicaid and TRICARE for inpatient behavioral health services that were not reasonable nor medically necessary;
There are many other woeful, reprehensible, unethical, illegal and criminal acts being perpetrated by this rogue organization. But even all of this is not enough to make eating disorder organizations take notice, stand up, and say enough, no more, no longer will we permit you to abuse the most helpless, vulnerable people in society. We refuse to be part of your misconduct.
Instead, like a common street walker, these organizations stand by with their hand extended willing to participate in any act no matter how vile, demeaning or degrading for its 30 pieces of silver.
A DAD'S JOURNEY WITH EATING DISORDERS 