Does Vermont have enough eating disorder treatment for youth?

BURLINGTON, Vt. (WCAX) - Does Vermont have enough resources to treat young people with serious eating disorders? Some clinicians and people struggling with disordered eating say no.

The age group with the most severe eating disorder cases requiring hospitalization is young women.

Vermont hospital admissions data from 2016 to 2019 shows the number of 15-to-24-year-old women needing inpatient treatment went from 16 up to 28.

Sometimes those cases are prolonged or severe enough that the young person needs a level of residential care the state doesn’t have.

“I did a lot of sports. I think that was a really big thing for me,” said Amelia Cassidy of Colchester.

Cassidy says her goal heading into her senior year of high school was to have the best cross-country season possible.

“I think it had always been the kind of skinnier is faster idea,” she said.

But the stress and anxiety turned into an obsession over what she ate.

“It’s like addictive almost,” Cassidy said. “It pulls you in and it’s like, oh my gosh, I had an extra piece of toast at breakfast. And then the panic sets in.”

By the time summer ended and the season started, she had developed anorexia. It might have gone untreated longer if Karen Bates hadn’t noticed her daughter wasn’t eating enough.

“I was like, oh my goodness. She should be eating 2,000 calories a day and I don’t even know if it’s 1,000,” Bates said. “She just looked skinny, really skinny and so I called her doctor actually.”

A doctor’s visit confirmed Cassidy had lost an unhealthy amount of weight. She was told she needed to gain it back.

“I was frustrated because I was like, well I’m doing this for my sport and it’s OK,” Cassidy said. “And seeing these influencers on Instagram who are skinnier than me and I was like what are you talking about? They’re literally worshipped for their bodies. Why are you upset with me for losing all this weight?”

“She didn’t want to eat and she had anxiety around eating,” Bates said.

They went to book appointments with nutritionists and therapists. And that’s where Bates says they realized the gaps in eating disorder care for young people in Vermont.

“I’d heard that dialectical behavior therapy was probably the best approach for her as an anorexic, and there’s no one that was available,” Bates said. “So that was frustrating because I knew what might work and I couldn’t get it for her.”

Their story is one Kate Morris hears all too often. She’s a licensed clinical social worker and intuitive eating counselor based in Central Vermont.

Morris says often practitioners will try to form teams to help a patient, but: “Those are piecemeal. And that’s a lot of work for someone who is not at their best.”

She says Vermont lacks the wraparound care-- nutrition, therapy and counseling-- provided by inpatient and residential eating disorder treatment centers.

“That’s a big hole in care,” Morris said.

Having that hole here forces youth struggling with serious eating disorders, and their families, out of state.

“I think being away from a support system, being away from the comforts of even the landscape that you recognize, all of that can feel both pathologizing and just incredibly uncomfortable scary,” Morris said. “If you can get into one... people are reaching out to treatment centers more than ever. There are waitlists longer than ever.”

One example of the increased demand: In a letter to Vermont Sen. Bernie Sanders last spring, the executive director of the Multi-service Eating Disorder Association (MEDA) in Massachusetts said the number of individuals they served went up 700% since March 2020. And over the last two decades, 20%-25% of their patients have been from Vermont, including 59 at the time of the letter.

Morris says she sees people on waitlists getting sicker.

“They get on a waitlist and they say, ‘I’m just going to wait to get better until then,’” Morris said. “But that might not be coming for another month or two and the eating disorder can wreak a lot of havoc in the meantime.”

Reporter Cat Viglienzoni: What would you want to see Vermont do?

Kate Morris: Best-case scenario is we do it here.

She wants to see a residential treatment option for youth here in Vermont, and she thinks with COVID relief money, the state could make it happen.

“We have that opportunity for people to stay here and to benefit not only from the wisdom and expertise of Vermont clinicians but also the beauty and serenity of Vermont landscapes that are their home,” Morris said.

Cat Viglienzoni: Do you think there needs to be more options in Vermont for people who are looking for help with an eating disorder?

Amelia Cassidy: Definitely. I think that I was really lucky in that my mother had me on all these waitlists. But there aren’t enough doctors for everyone. I mean, I was on a waitlist for weeks, almost a month or more.

Cassidy says if her eating disorder had gotten much worse, she might have sought residential care out of state. But just in time, she started working with the Kahm Clinic in Burlington to overcome her anorexia. Their approach worked for her.

“I genuinely don’t think I would have recovered to the point that I have without that clinic. And the fact that so many people don’t have resources like that is sad that they’re going to be stuck in this cycle forever,” Cassidy said.

It took time and effort but she’s now fully weight-restored, and a member of the varsity girls rowing team at the University of Toronto.

“I don’t see food as a number now which is incredible,” Cassidy said.

Both she and her mom wanted to share their family’s story to encourage more people to talk about eating disorders to break the stigma around them. And they want to see a centralized resource for eating disorder patients and their families with supports that are easy for everyone to access.

“The family has to be able to go to these places, as well, and get the training they need,” Bates said.

How long are young people waiting now to get care? Good question. The state doesn’t track it at all. I asked both the Health Department and Mental Health Department that question and they told me they had no data.

The Agency of Human Services said during their recently completed wait-times study there were several anecdotal patient reports of long wait times for pediatric eating disorder treatment, but again, no one collected data to get a sense of how widespread the problem is.

And no one offered up any solutions the state might be pursuing either.

I reached out to a couple of clinics in the Chittenden County area to try to get a sense of the demand for care. The Kahm Clinic in Burlington got back to me. They say right now they have 20 pediatric patients being treated for eating disorders. They say it takes about a month for a new eating disorder patient to be seen, and that’s even with prioritizing them because they say those patients “simply need care the most.”

While young women may struggle the most, the Academy for Eating Disorders and other advocates estimate that overall, nearly one in 10 Vermonters, or 55,132, will have an eating disorder in their lifetime. It can affect people of all ages, genders, races and socio-economic backgrounds. But as Kate Morris told me in the video below, there are many misconceptions about eating disorders.

So how do clinicians work with people to change their attitudes toward food? Kate Morris explained to me in the video below what intuitive eating is and why it’s a goal for people in recovery from eating disorders.

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