These days, when potential patients call Katie Bell, an Anchorage therapist whose specialty includes treating eating disorders, she tells them that she’ll probably have an opening in about three months at the earliest.
Then she gives them the names of three other providers they can call because “three months is too long to wait,” she said.
Over the past year, Bell’s waiting list has grown. She said it may be a sign of a trend that’s happening nationally and across Alaska: an increase in eating disorder diagnoses that have been fueled by the pandemic.
The pandemic was “this sort of catastrophic event that increases stress, and threat of the unknown,” Bell said. The “unknown” can be triggering for those with eating disorders, who often rely on rules and regulations to help cope with their stress, she said.
Frequent and triggering talk about pandemic-related weight gain also hasn’t helped, she added.
Nationwide food shortages at the beginning of the pandemic, food insecurity brought on by economic upheavals and job losses, and being home more often with constant access to food could also be contributing triggers to the rise in eating disorders over the last year, experts say.
Eating disorders are defined as serious behavioral conditions that “are characterized by severe and persistent disturbance in eating behaviors, and associated distressing thoughts and emotions,” according to the American Psychiatric Association.
Nationally, there are about 30 million Americans who will be diagnosed with an eating disorder at some point in their lives — including more than 60,000 Alaskans. Eating disorders are among the deadliest mental illnesses — 10,200 deaths each year in the U.S. are the direct result of an eating disorder, and about a quarter of those diagnosed will attempt suicide, according to national statistics.
Rising demand for limited resources
The challenge of accessing treatment for eating disorders in Alaska is not a new problem, providers say. Alaskans seeking treatment for eating disorders, and many other conditions, have long had limited options for care.
But the pandemic-related rise in disordered eating has strained an already limited pool of resources — and has made seeking care for eating disorders in Alaska even harder.
“We have some incredible providers who are doing some incredible work with eating disorders,” said Jenny Loudon with the Alaska Eating Disorders Alliance, an organization that she helped create in 2019.
“But the demand for services is consistently outpacing the supply,” she said. “And what we’re seeing is that the outpatient treatment is ... being a little bit overwhelmed in Alaska right now.”
Part of the problem is that Alaska doesn’t have any in-state inpatient treatment options for those needing the highest level of care — and options for outpatient care are extremely limited. That means that often, the best and only option for many people is leaving the state to seek care.
Nationally, the waiting period for those residential centers has gotten much longer during the pandemic, Loudon said. Pre-pandemic, the wait may have been a couple of weeks or a month — and now it can be up to five or six months.
“And you can imagine that if you’re waiting for access to that higher level of care, you really, really need to have good outpatient care to support you in the meantime,” Loudon said. “In Alaska, where the access to outpatient care is more limited, that can cause just additional exacerbation of existing shortages.”
Residential care can also be expensive — and loopholes in insurance coverage mean that not everyone can afford the life-saving treatment. In some cases, Alaska Medicaid does cover residential care for eating disorders.
But Alaska contracts with just one facility in Utah, which only serves girls 13 and older. And for anyone on Medicaid who’s older than 21, those benefits are no longer covered, said Grace Schumacher, a nutritionist in Anchorage who specializes in helping treat eating disorders.
The problem with long waiting periods, and barriers to accessing care, is that treating eating disorders is most effective and fastest when it is diagnosed and treated early — before dangerous behaviors can become engrained, said Loudon.
The problem of access in Alaska has gotten so bad, Loudon said, that she’s recently spoken with two separate families who are considering moving out of the state because they feel it’s the only way to get access to treatment for their daughters.
“They’re just wondering, ‘How do we make sure that our child is getting the treatment that they need?’ ” Loudon said.
Bell, the therapist, said she has also spoken with people who have given up on getting care, “who have essentially said, ‘We can’t find a medical doctor who knows what they’re talking about here. We can’t find a therapist with openings. We can’t find a nutritionist to support us, and we’re just done.’ ”
Schumacher, who moved to Alaska from the Midwest when she was young, said she thinks part of the reason for the limited in-state options is there’s a misconception that Alaskans don’t experience eating disorders as much as people in other states.
“I remember — when my family came up here for our first trip — looking out of the airplane window and wondering, ‘Where are all the swimming pools?’ And I think at some point, there’s kind of this idea that Alaskans are less concerned with body image because they don’t have to worry about having a beach body,” she said. ‘Which just isn’t true.”
Seeking help from ‘somebody who understands’
The problem of not enough care is pervasive in many places, providers say, describing eating disorders as an often misunderstood and underdiagnosed condition.
“Eating disorders can happen to anyone,” no matter one’s weight, age, gender or race, Loudon said.
Heather Moon, a residential nurse at Central Peninsula Hospital in Soldotna, helps run a local support group for Alaskans recovering from eating disorders.
Moon, who is 42, said in a recent interview that she first developed an eating disorder when she was about 14 living in Kenai. As a teenager, an intense focus on nutrition and exercise felt like a way for her to cope with stress. She started running and lost weight quickly, and the people around her started to notice and compliment her.
“These behaviors that I was engaging in that were my coping mechanisms, that were ultimately very destructive, were being heavily reinforced by people who meant very well but didn’t know better,” she said. “All they saw was that I was losing weight, looking trim and running fast.”
The non-specialized talk therapists Moon saw when she was a teenager and in the years that followed did help, she said. But a full recovery still seemed out of reach.
“There was definitely a period, probably in my late 20s, when I thought to myself, ‘I’m never going to not have an eating disorder. And I will not ever be fully recovered,’ ” she said.
It wasn’t until she was 40 — and finally able to see a therapist who specializes in treating eating disorders — that she truly started to consider that recovery was possible.
Looking back, “I think I should have been immediately referred to a medical specialist who specializes in the medical management of people with eating disorders,” she said. “Somebody who understands the side effects of having an eating disorder, and what starvation and binging and purging does to the body metabolically.”
Now, all these years later, she wants others to know that getting better is possible. She said the therapist she sees now helped her connect with and love her body in a way she couldn’t before.
Moon remembers the first time she realized that she was truly on a path to recovery.
“When food, and thinking about food, and thinking about my body, and thinking about how my body felt was not central to my day,” she said. “When I realized, ‘Oh, wow, I haven’t thought once about how many calories are in this, and I haven’t obsessed today on how many calories I have consumed.’ That’s when I felt like, oh my God, there’s hope.”
For support, resources or treatment options, call the National Eating Disorder Association’s toll-free, confidential helpline, 1-800-931-2237. The line is open Monday-Thursday from 5:00 a.m. to 5:00 p.m., and Friday from 5:00 a.m. to 1:00 p.m. The association also offers an online screening tool for ages 13 and up to find out if it’s time to seek professional help.
For more information about the Alaska Eating Disorder Alliance and resources in Alaska, visit their website at akeatingdisordersalliance.org.