The eating disorder field has spent decades asking families to trust it. Trust the treatment center. Trust the intake coordinator. Trust the website. Trust the words “evidence based.” Trust the branded clinical model. Trust the promise that the program knows what it is doing because the patient is too sick, the parents are too frightened, and the stakes are too immediate for careful comparative shopping.

But trust is not a standard of care. And neither are marketing, credentials, nor an impactful website. In a medical and psychiatric illness with substantial mortality risk, high relapse rates, serious medical complications, and profound psychiatric comorbidity, the absence of enforceable, generally accepted standards of care is not a theoretical defect. It is an operating condition that places patients in danger.

The eating disorder community has long understood the problem, even when it has not solved it. In 2008, the Academy for Eating Disorders Credentialing Task Force produced draft recommendations for residential and inpatient eating disorder program accreditation. Some of the most respected, knowledgeable professionals participated in this collaboration.

The document did not read like an aspirational brochure. It read like a blueprint for patient protection. It called for standards in assessment and treatment planning, treatment delivery, quality improvement, specialized protocols, outcome measurement, and accreditation. Its stated purposes were to safeguard patients and families seeking inpatient and residential care, improve the quality of care offered by programs, and provide a benchmark for third party payers. That language is important. It shows that the field knew, at least by then, that eating disorder treatment required more than general mental health licensure and more than ordinary institutional accreditation.

The AED standards also identified the core duties that any serious eating disorder program should recognize. Screening and intake should assess medical stability, psychiatric status, nutritional status, substance use, special needs, and developmental appropriateness. Admission should be a comprehensive interdisciplinary process involving medical, psychiatric, psychological, nutritional, and biopsychosocial assessment. Treatment planning should be timely, documented, individualized, and regularly reviewed. Continuity of care should include prompt communication with appropriate providers. Discharge planning should begin at admission and include specific follow up care. Treatment delivery should include psychological, medical, nutritional, and psychiatric care. Programs should accurately describe their licensure, staffing, levels of medical care, treatment team composition, emergency protocols, costs, insurance participation, treatment duration, discharge criteria, staff qualifications, and continuing education. Outcomes should be measured, not guessed. Quality improvement should be ongoing, documented, and tied to actual patient results.

The field knew what a safety framework looked like. It knew patients needed medical screening, physician access, psychiatric care, nutrition expertise, discharge planning, family involvement, trained staff, outcome measurement, and transparent program information. It knew residential and inpatient programs were not ordinary therapy offices with beds. They were controlled treatment environments for patients with complex medical and psychiatric illnesses. Yet these standards were abandoned.  They were never adopted nor enforced. And that is the indictment.

Building up to 2008.

This was before the Mental Health Parity Act of 2008 was passed into law. It was before the Affordable Care Act was enacted. It was before the scourge of COVID. It was also largely before the private equity gold rush into the eating disorder industry began.

When a field lacks generally accepted standards of care, it does not become more flexible. It becomes less accountable. Every treatment center can claim excellence. Every program can call itself evidence based. Every operator can define “appropriate care” around its own staffing model, payer contracts, census pressures, and clinical philosophy. A family trying to decide where to send a medically fragile child or adult is left to compare slogans. A physician trying to refer a patient is forced to rely on reputation, relationships, and sales materials. An insurer can exploit ambiguity by denying care as unnecessary. A treatment center can exploit ambiguity by selling care as indispensable. The patient is then caught between two industries, each invoking medical necessity when it serves its financial interest.

The phrase “evidence-based treatment” illustrates the collapse. In any responsible medical field, evidence-based care should mean that a treatment is supported by research, delivered with fidelity, matched to diagnosis and level of care, monitored for safety, and evaluated by outcomes. In eating disorder treatment, the phrase has too often become a branding device. It may refer to CBT, DBT, FBT, exposure work, nutrition rehabilitation, medical monitoring, group therapy, experiential therapy, or a proprietary blend of whatever the program happens to offer.

Without a standard which requires programs to identify which treatment is being used, why it is appropriate, who is trained to deliver it, how fidelity is monitored, and what outcomes are achieved, “evidence based” becomes a label detached from evidence.

The harm is not semantic. Eating disorders kill. They injure. They produce cardiac instability, electrolyte abnormalities, endocrine disruption, bone loss, gastrointestinal complications, renal stress, refeeding risk, suicidality, and profound psychiatric comorbidity. They also deceive systems that rely on visible severity. A patient can appear medically stable until the lab work, EKG, weight trajectory, purging history, exercise behavior, or refeeding risk says otherwise. A patient can be in a larger body and still be medically unstable. A patient can be “normal weight” and dying. A patient can be discharged because insurance will not pay, retained because a bed must be filled, stepped down because the program has no capacity, or admitted because the program has capacity even when a different level of care would be safer.

The absence of standards increases mortality risk because it removes the guardrails that prevent predictable harm. Certainly, the lack of standards does not cause every death. It does not explain every bad outcome. But it allows dangerous variation in medical screening, level of care decisions, staff training, treatment planning, discharge readiness, and continuity of care. In a lethal illness, dangerous variation is not a neutral administrative problem. It is a patient safety failure.

The mortality problem is compounded by misunderstanding. Culturally, eating disorders are still often reduced to vanity, dieting, thinness, control, adolescence, or female distress. That public misunderstanding persists partly because the professional system has not spoken with one disciplined voice. If the field itself cannot agree on what competent care requires, it cannot expect legislators, medical schools, insurers, journalists, families, or courts to understand the illness with precision. Fragmentation creates confusion. Confusion creates delay. Delay creates medical deterioration. In the space between first symptoms and competent intervention, patients become sicker.

The legal system has already exposed the danger of this absence. In the behavioral health coverage battles surrounding generally accepted standards of care, eating disorders should have been central. Yet when courts and insurers search for recognized standards, eating disorder specific standards have often appeared fragmented, inconsistent, or conspicuously absent from the sources treated as authoritative. That absence sends a devastating message. The illness is deadly enough to require intensive treatment, expensive enough to bankrupt families, complex enough to require interdisciplinary care, but not organized enough to present one enforceable standard to the systems that control access and accountability.

Nor did private equity create this issue. It simply entered a disorderly field and found opportunity.

That distinction matters. The eating disorder field’s failure to establish enforceable standards predated much of the private equity consolidation. But once investment capital entered the residential and intensive treatment market, the absence of standards became commercially useful. A PE backed platform benefits from scalability. Scalability requires replicable operations, predictable margins, payer strategy, labor control, census management, and brand extension. In a field with enforceable clinical standards, those pressures collide with mandatory staffing, outcome reporting, medical coverage, training, supervision, discharge criteria, and transparent patient safety obligations. In a field without enforceable standards, those pressures can be converted into business judgment.

The AED standards make the private equity question sharper, not softer. By 2008, the field had articulated the need for eating disorder specific accreditation, prompt medical screening, interdisciplinary assessment, four core treatment components, nutritional rehabilitation goals, trained staff, continuing education, transparent financial information, discharge planning, quality improvement, and outcome measurement. Any serious investor entering or expanding in the eating disorder treatment market after that point had industry notice that residential and inpatient eating disorder care required specialized safeguards. The blueprint existed. The failure was not a lack of imagination. It was a lack of enforcement.

Measured against those standards, private equity’s role was not merely ownership. It was the commercialization of ambiguity. PE backed entities could acquire respected clinical brands, consolidate markets, add locations, advertise comprehensive care, pursue higher levels of reimbursement, and present themselves as national solutions without being forced to prove standardized outcomes across the platform. They could market compassion while operating under financial structures that reward growth, utilization, and eventual sale. They could describe themselves as evidence based without submitting to a universally accepted, independently audited eating disorder standard that measured whether the care advertised was the care delivered.

This is also why standards are important. Standards do not guarantee recovery. They do not eliminate clinical judgment. They do not reduce complex human beings to checklists. Properly designed, they do the opposite. They preserve clinical judgment by defining the minimum conditions under which judgment can be trusted. They require that a patient be medically assessed before placement. They require that a program be honest about its capabilities. They require that treatment be individualized, documented, and reviewed. They require that medical, psychiatric, psychological, and nutritional care all exist in fact, not only in marketing. They require that programs measure outcomes in a way that survives scrutiny. They make it harder for a center to sell a level of care it cannot safely provide. They make it harder for an insurer to deny a level of care the patient medically needs. They give families a way to distinguish treatment from theater.

The eating disorder community has paid a severe price for its failure to impose those minimum conditions. Families have been left to investigate facilities while in crisis. Patients have been moved through levels of care without clear, enforceable criteria. Clinicians have been forced to operate in a landscape where “specialist” can mean rigorous training or little more than self- selection. Payers have been able to exploit inconsistency. Treatment centers have been able to exploit fear. Private equity has been able to exploit both.

The result is a field that too often asks for deference without submitting to discipline. It asks insurers to pay for care while failing to create uniform proof of what competent care requires. It asks families to trust programs while permitting those programs to define their own excellence. It asks physicians to refer into higher levels of care while failing to ensure that those levels of care meet eating disorder specific standards. It asks the public to understand eating disorders as serious medical and psychiatric illnesses while tolerating a treatment marketplace that sometimes behaves as though seriousness can be inferred from price.

Purportedly, this topic has been discussed on numerous occasions by various organizations and individuals. On a few occasions, the topic has even gone past the discussion stage. In 2022, the American Psychiatric Association drafted new Practice Guidelines for the Treatment of Eating Disorders. On February 27, 2023, the APA announced it had adopted these guidelines. But there was a proviso. The press release also stated, “APA’s own “Proper Use of Guidelines” section says the guidelines are not a statement of the standard of care, do not mandate a particular course of medical care, do not substitute for clinician judgment, and are voluntary.”

In late 2025, the DSM Steering Committee proposed new eating disorder severity guidelines to be adopted and included in the DSM-V-TR or the next derivation of the DSM.  Again, the warning language appears, The previously mentioned limitations apply equally to this proposal.

Effectively meaning … there has been some discussions. But, no effective, collaborative, broad-based action. Talk? Some. Solutions? None.

The solution is not another voluntary badge. It is not another proprietary credential. It is not another conference panel, white paper, or consensus statement that can be ignored by the next operator with a marketing budget. The solution is enforceable, eating disorder specific standards of care tied to accreditation, licensure, reimbursement, outcome reporting, and medical education. The standards must require medical risk assessment, refeeding competence, interdisciplinary treatment, trained staff, transparent levels of care, family involvement where appropriate, discharge planning, continuity of care, independent outcome measurement, and external accountability. They must apply to nonprofit programs, academic programs, independent centers, and PE backed platforms alike. They must be forward thinking taking into account the seismic changes which have occurred in the last five years impacting eating disorders.

The field does not need to start from scratch. The AED standards showed the beginning of the map. Later guidelines and center of excellence proposals added other pieces. The scientific literature has expanded. The public burden data have become harder to ignore. The litigation record has grown. Families have told the truth at great cost. The missing ingredient is not knowledge. It is institutional will.

An eating disorder treatment system without generally accepted standards of care is not a system. It is a marketplace. In that marketplace, the sickest patients are the least able to judge quality, the most desperate families are the easiest to persuade, the most expensive care is not always the most effective, and the most polished brands are not always the safest. That is not medicine. That is exposure.

The eating disorder community must decide whether it exists to protect patients or to protect the institutions that claim to serve them. If it chooses patients, it must accept enforceable standards, transparent outcomes, real accountability, and scrutiny of financial structures that place growth over care. If it refuses, then the verdict writes itself: the system knew the danger, possessed the tools to reduce it, and chose fragmentation over protection.

Dr. Jennifer Gaudiani’s first book, Sick Enough became one of the most influential medical texts on eating disorders for a mixed audience of clinicians, patients and families. Her recent Second Edition considerably expands its reach. It is broader in diagnostic scope, more explicit in its rejection of weight stigma, and more attentive to populations historically marginalized within eating disorder discourse, patients in larger bodies, those with ARFID or atypical anorexia, athletes, neurodivergent individuals and others.

The second edition is a substantial, clinically ambitious and humane book. This is an updated guide with a wealth of information for patients, families, and clinicians. It has an expanded coverage of weight-inclusive care, “unmeasurable” medical problems such as Positional Orthostatic Tachycardia Syndrome (POTS) and Mast Cell Activation Syndrome (MCAS) and includes specific populations such as athletes, people in perimenopause, and those with PTSD or ADHD.

Its table of contents also shows a broader scope than a narrow anorexia only manual. The Second Edition covers purging, BED, ARFID, atypical anorexia, recovery and several special populations.

It is one of the strongest medically oriented eating disorder books for a mixed audience. Especially if the reader wants a text that combines clinical seriousness with anti-stigma framing. Its greatest strength is that it repeatedly emphasizes that eating disorders are medically dangerous across body sizes and presentations. However, one of its limitations is that it can be too expansive, too clinician-shaped, and at times too structurally diffuse for readers who want either a purely patient facing guide or a tightly organized medical handbook.

What the book does very well

The Second Edition directly attacks the “not sick enough” myth. This is the book’s central moral and medical achievement. Dr. Gaudiani makes the case that eating disorders are not validated by emaciation alone and that serious risk can exist in larger bodies, in atypical anorexia, in purging disorders, and in undernutrition that is not socially legible. The Second Edition’s explicit emphasis on weight stigma and weight inclusive philosophy is one of its defining strengths.

That matters because many books on eating disorders still smuggle in a hierarchy of seriousness. Sick Enough pushes against that hierarchy. It is corrective in the best sense, not merely compassionate, but clinically corrective.

The book also bridges medicine and lived experience better than most clinician authored books. The book emphasizes case presentations, stories, metaphors, practical strategies, and approachable science. That combination seems to be the key to the book’s reputation. An independent professional reviewer noted that Dr. Gaudiani combines expertise with a compassionate tone and keeps the book accessible without drowning newer readers in jargon.

This is important because eating disorder medicine can quickly become alienating. A text can be medically accurate yet useless to frightened patients or exhausted families. Dr. Gaudiani appears to avoid that trap by translating physiology into understandable language without trivializing it.

The table of contents shows a book that does not stop at restrictive anorexia. It includes chapters on purging, BED, ARFID, atypical anorexia, recovery, neurodiversity, diabetes, athletes/REDs, males, gender and sexual minorities, sexual and reproductive health, substance use, older age, and gastrointestinal or autonomic complications.

That breadth makes it unusually useful in real world practice where some patients rarely present as textbook stereotypes. The Second Edition seems designed to reflect the heterogeneity of eating disorders rather than forcing everyone into one familiar clinical script.

The Second Edition explicitly includes a section on “The Unmeasurables,” including MCAS and POTS. Whether every reader will agree with the framing, this signals one of the book’s core virtues. It approaches in a professional manner, the messy borderlands of eating disorder medicine where symptoms may be debilitating even when medicine has not produced neat explanatory boxes.

That gives the book emotional and clinical credibility. Patients with complicated, long-standing illness often feel erased by handbooks that only recognize what fits clean laboratory or diagnostic boundaries.

A number of medical treatises are technically solid but ethically thin. Sick Enough seems to understand that care is not just about identifying bradycardia, electrolyte derangement, endocrine suppression, or GI dysfunction. It is also about how bias delays treatment. The weight stigma material is not simply ornamental. That makes the book more than a manual. It is also an intervention into how clinicians think.

Room for Improvement or Greater Clarity

As with all books, papers, studies and treatises there are areas for greater explanation and clarity.

The organization of the Second Edition may frustrate readers who want a classic systems-based handbook. One independent review from a dietitian praised the book but made a sharp structural criticism, that it did not organize material primarily by body system, so a reader trying to track for example, cardiovascular or GI consequences across diagnoses may need to jump between chapters.

That is a meaningful weakness. For a clinician in a hurry or a student trying to build a clean mental map, a systems based structure can be more efficient. Dr. Gaudiani’s presentation-by-presentation approach may feel more human and clinically realistic, but it is not always the fastest for cross-referencing.

The Second Edition also may be too medical for some patients and too general for some specialists. This is a classic hybrid text problem. By trying to serve patients, loved ones, and clinicians at once, the book likely lands a little imperfectly for each subgroup. For patients early in illness or recovery, the sheer amount of medical detail may feel overwhelming. For subspecialists already steeped in eating disorder medicine, some sections may read as broad synthesis rather than cutting edge dispute. That does not make the book weak. It makes it broad. But broad books inevitably trade some depth for reach.

One of Dr. Gaudiani’s strengths is having a strong clinical voice. The downside of that voice, in any physician authored guide, is that it can sometimes produce a subtle asymmetry. The reader is being expertly guided, but nonetheless guided. For some readers, especially those wary of medical paternalism, this can feel comforting; for others, it can feel managed.

There are also some topic choices which may invite debate. [Debate has never been a weak spot for Dr. Gaudiani.] The inclusion of conditions such as MCAS and POTS under “unmeasurables” will resonate deeply with some readers and prompt skepticism from others, especially readers sensitive to how contested syndromes are discussed in medicine.

That is not necessarily a flaw. But it does mean the book is not purely conservative in scope. It steps into areas where interpretation, causality, and framing are complicated. Some will see that as brave and patient honoring. Others will worry it risks overextension.

Sick Enough does underscore the lethality of eating disorders and makes clear that anorexia nervosa carries the highest mortality rate of any psychiatric illness, citing markedly elevated death rates relative to healthy peers and a significant contribution from suicide. However, the book does not organize this point as a sustained comparative analysis across diagnoses. Instead, it embeds the explanation within its broader medical framework. The cumulative effects of prolonged undernutrition, multi-system physiological deterioration, and heightened suicide risk. In this way, Dr. Gaudiani establishes the mortality hierarchy clearly, but explains it implicitly through the biology of starvation and clinical risk rather than through a dedicated, diagnosis-by-diagnosis examination of mortality mechanisms.

The best features and biggest improvements in the Second Edition appear to be: a stronger emphasis on weight stigma and weight-inclusive care; broader recognition of ARFID, atypical anorexia, BED, and diverse patient groups; added treatment of neurodiversity and psychiatric complexity;  inclusion of POTS, MCAS, and complex digestive issues, and; more explicit attention to athletes, males, gender/sexual minorities, sexual and reproductive health, and older adults.

That is exactly the sort of expansion a Second Edition should make. Not just “more studies,” but a wider and more current model of who gets sick and how illness presents. The Second Edition may be structurally imperfect as a reference manual, occasionally vulnerable to being too broad for specialists and too dense for lay readers, and open to debate in some of its more complex “unmeasurable” territory.

However, it is authoritative, compassionate, modern in its anti-stigma stance, broad in diagnostic scope, and far better than most medical books at explaining why a person can be very ill without “looking sick.” It seems especially strong on translating eating disorder medicine into language usable by non-specialists.

Although not flawless, [what book is?]  it is the kind of book that can genuinely change how people understand eating disorders: medically, morally, and diagnostically.

That is rare.

Which makes the Second Edition a must read for medical and mental health professionals and not just those in the eating disorder community.

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.

Awareness.

Awareness.

Have you ever wondered what comes after awareness?

In any event, once again it is Eating Disorder Awareness Week 2025. Almost all eating disorder organizations and treatment providers will be mentioning this on their social media outlets.

Some buildings will be lit in the blue and green colors adopted by NEDA. This is the St. Louis Planetarium complete with statue in the shape of what society deems an anorexic body type:

Did I just body shame a statue?

Some therapists and advocates, treatment centers and organizations will hold special “virtual” sessions highlighting their pet eating disorder interest. People self-identifying as experts will pontificate on many and varyed aspects of eating disorders. The same radical tired voices will repeat the same radical tired messages to the same radical tired crowd measuring in the tens of people.

As in year’s past, the eating disorder community will feel good about itself for the week, will pat itself on the back and then … will slink back to its customary irrelevancy in the medical and mental health fields. Next year will be rinse and repeat. Or as Herman’s Hermits once sang, “Second verse same as the first.”

However, this year is different. For a number of reasons. These reasons threaten to not just shake but could very well crumble the very foundation of the eating disorder community. Not surprisingly, these reasons and issues will not be discussed this week and the community will ignore its awareness of these issues.

These issues will not be discussed in part because the issues are just too difficult. They are uncomfortable. In addition, the firmly entrenched corruption and rot in the community will mandate that some of the issues be ignored. When for a price, even the most reprehensible predator can buy a place at the table.  Regardless, the issues are incredibly serious and require serious people with serious IQs to ponder and then take rational, serious action.

Let’s review some of these serious issues.

NIH funding collapsing

On Friday, February 7, 2025, the National Institute of Health (“NIH”) announced it was pausing all grant funding pending review and placing a 15% cap on funding “indirect research costs.” Indirect costs, also known as facilities and administrative (F&A) costs, are used to cover research expenses such as equipment and facilities maintenance, IT services, and administrative support.

The freeze has impacted the funding of all continuing grants at NIH. These grants fund ongoing research, including many studies involving human subjects in clinical trials. Universities are already reacting in a manner consistent with believing that those funding grants will not be reinstated. Some universities have already frozen hiring and taken other budgetary measures. These measures include a spending freeze on travel, procurement, capital projects and events.

So, how will this impact the eating disorder community? University based eating disorder professionals are likely to have their budgets slashed making travel to conferences unlikely. This includes travel to San Antonio for the ICED conference. This could also include a reduction in membership in AED. With AED’s financial woes already being very deep, a steep decrease in membership and low attendance at its ICED event could be the death knell for that organization.

But more importantly, this issue means that there will be significantly less research conducted into our understanding of the biological and genetic aspects of eating disorders. Possible state of the art treatment requiring a research basis will not be experimented upon and implemented. “Evidence-based” will become an even greater cartoon slogan.

Which will result in the mortality rate continuing to climb.

At least we now have awareness on that issue.

Iaedp

Iaedp’s many issues and problems have been highlighted for over a year. Tax fraud. Forgery on official documents. An overall lack of transparency. Possible violations of antitrust laws regarding the certification process. I understand that attendance at the recently concluded Symposium was disappointing.

A class action lawsuit hanging over its head.

A number of chapters have dissolved.

Rumors that the 2026 Symposium will be virtual.  Perhaps because of a lack of funds? After hosting an in-person conference for a number of years, a virtual conference means virtually nothing.

All of which makes iaedp’s continued survival problematic. And if iaedp does not survive, what of the certification process? Would that mean we are left with another certification process which starts out with an idiotic Indigenous Persons land use acknowledgement? Because nothing says “eating disorders and the highest quality certification process” like an Indigenous Persons Land Use Acknowledgement!

At least we have awareness on these issues now.

Residential Treatment Center issues

The great eating disorder residential treatment center experiment appears to be floundering.

Recently, Castlewood (Make no mistake, it was Castlewood all along. Alsana was merely its pasteboard mask.) closed its operations in the State of Missouri … where it all began. Now, Alsana may find itself having issues with the California Medical Board for the unauthorized practice of medicine in that state.

Acadia shuttered Timberline Knolls after numerous issues and abuse came to light.

Cielo House.  Shoreline Center. Fairhaven. Evolve. All closed.

Some of the residential treatment centers which remain open seem to be exploring adopting an addiction treatment model.

Accanto Health’s CEO, Dr. Tom Britton is the former CEO of American Addiction Centers. Accanto Health owns the Emily Program. Information has been circulating that medical doctors at Accanto Health/Emily Program have been laid off or asked to take lesser roles.

Virtual treatment programs, with no independent, third-party studies supporting their efficiency have sprung up and their growing presence cannot be denied. They are less expensive to operate. Purportedly, the growing influence of virtual programs is impacting attendance at residential treatment centers.

At least we have awareness of these issues now.

Acadia Healthcare

Then, there is Acadia Healthcare.  I once wondered why treatment centers and organizations were not incensed at the harm being perpetrated by Acadia. Why they did not stand up for the vulnerable and hold Acadia accountable. Of course, the answer is obvious.

They have accepted money from Acadia Healthcare. They are bought and paid for consorts for Acadia.

Since iaedp did not have enough troubles, at its recent symposium, one of its primary sponsors was Acadia Healthcare.

The National Alliance on Eating Disorders lists Acadia Healthcare as one of its “Diamond Supporters.” [its highest level]

Montecatini, McCallum Place and Carolina House are not going to stand up. They live on their knees subservient to the whims of its overlord and master, Acadia.

Acadia, knowing the eating disorder community is long on radicalism and short on common sense, embedded itself by throwing money around. It was an effective strategy. And it still is.

And to think at one time, AED would not accept money from any pharmaceutical company or health and wellness company because of concerns about conflicting interests.

Sadly, when an organization accepts dirty money, it acquiesces to whatever heinous acts are being perpetrated by the predator.

And so, we have that awareness now too!

Many other issues about which we need to be aware

Many other serious issues exist which plague the eating disorder community.

No generally accepted standards of care. 

No collaboration with any medical or mental health communities to speak of.

No collaboration within the eating disorder community.

When was the last time NEDA, iaedp, AED and the other entities got together and stated, “Enough is enough. We are going to hold a joint conference. We are going to collaborate. We cannot have true progress if we remain separate and instead, we must collaborate. But, egos prevent that.

Ai is to be feared and cancelled.

Eating disorder legislative bills to increase research funding?  Nope.

Then there is the beating of the drums by the Militant Fat Activists who have been allowed to poison the community with their own unique brand of craziness.

How many times have we read or heard that pediatricians, medical doctors and other medical professionals do not understand eating disorders and do not know what to look for? That lack of awareness falls on the shoulders of the eating disorder community.

The eating disorder community has had over ten (10) plus years to accomplish that! Instead?  They failed. Completely. Miserably.

So, we go back to awareness?  Awareness of what? Our own failures?

A focus on awareness has only resulted in failure. And this failure is measured by the lives of more children, adolescents and loved ones being taken.

The next step in awareness is … taking action. Since awareness without action is only cowardice and ignorance.

Ordinarily I would hope that at this time next year, we will be embracing Eating Disorder Action Week. But when as a community you instead embrace the known predators in the community, you have destroyed the hope which must exist within families.

So, ring in the new year. I am sure Eating Disorder Awareness Week 2026 will be the same vacuous song and dance.

The same radical tired voices will repeat the same radical tired messages to the same radical tired crowd measuring in the tens of people.

As the predators increase their profit margin, our children will continue to die.

Happy Eating Disorder Awareness Week 2025.