Eating Disorders: The trouble finding treatment in Vermont

BURLINGTON, Vt. (WCAX) - It’s estimated some 55,000 Vermonters will suffer from an eating disorder in their lifetime.

Eating disorders are both a mental health issue and a physical health one. So how do clinicians help manage the complex intersection of those and get patients on the road to recovery?

As part of my ongoing investigation into eating disorder treatment in Vermont, I visited the Kahm Clinic in Burlington to find out.

Kahm Clinic Registered Dietician Elaina Efird always has food behind her desk. Not real food, rubber food. She uses it when eating disorder patients come in to help them show her what they’re eating.

“This is what a normal plate of food looks like, whereas someone with an eating disorder would be like a quarter of that. They’re like that’s plenty of food and I’m like no, no, no,” Efird said.

With the models, she then shows them what a healthy plate should be.

“With food, I think a lot of people feel they can do it on their own,” Efird said. “That’s actually a big misconception with eating disorders, is that you can do it on your own. And that’s why a lot of people don’t get the actual care that they need, and why their eating disorder lasts or progresses longer than it needs to.”

Coming up with their recovery strategy starts with a body baseline. One of the treatment tools the Kahm Clinic uses is something called metabolic testing. It basically tells the person what their body is doing: how many calories it’s burning while it’s at rest; what type of fuel it is using. That can tell them what an eating disorder does to their body.

Efird showed me how it works.

“This is just going to go over your head,” she said.

It feels like being in a spaceship. Once I’m in, Efird said just relax.

“You’re going to breathe for 20 minutes,” she explained.

By measuring the carbon dioxide I breathe out and the oxygen I take in, the machine shows dieticians what’s going on internally.

In my first report on eating disorders last month, one of the Kahm Clinic’s former patients, Amelia Cassidy, credited her recovery in part to the clinic’s use of metabolic testing because she said the numbers don’t lie.

“I could see the numbers clearly in front of me and Elaina took this no-BS approach where she was just like listen, these are the numbers, I’m not making something up. Because I had spent this whole year basically paranoid that people, my doctors or my parents, were out to make me fat. This fear of being overweight and it turned into this paranoia; it was them against me,” Cassidy said.

Efird says it’s common for people to doubt whether their eating disorder is serious, especially if they’ve been praised for losing weight.

A metabolic test shows them the repercussions on their body of not having enough fuel.

“It really helps with the patient’s buy-in,” Efird said. “A lot of times people come in and they’re like, ‘I don’t think it’s that bad.’ We do the metabolic test and they’re like, ‘Oh, maybe I do need help.’”

Efird says their clinic also tries to create a team for their patient: a therapist, a physician, even a psychiatrist, too.

But there are limits to what she can do seeing someone once or twice a week for an hour or so.

Elaina Efird: They might need a lot more than that. They might need meal support three meals every single day, and none of that is available in Vermont.

Reporter Cat Viglienzoni: Does Vermont need that?

Elaina Efird: Yes, absolutely.

Cat Viglienzoni: What would it do for you as someone who works in the field to have that option of care in the state?

Elaina Efird: It would actually make our care a lot better. Right now in an outpatient setting, we’re seeing people who maybe shouldn’t be in an outpatient setting, because there’s no other options. Whereas if I had an outpatient place 30 minutes away or 15 minutes away and I could say, you need to go to inpatient here or you need to go to partial here, they wouldn’t have to remain an outpatient for as long.

She says in an ideal world, Vermont would have many levels of treatment for eating disorders. From mid-level care where someone might spend part of a day at a clinic up to residential care for those who need round-the-clock meal help. But Vermont doesn’t have either of those right now.

The only inpatient care is if someone is basically on death’s door and is hospitalized. It happens to dozens of Vermonters each year.

Health department data shows 86 people were admitted to the hospital in 2019 for eating disorders. About the same in the two years before that.

But once they’re medically stable, they’re discharged and the cycle continues because their eating disorder itself hasn’t been treated.

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Does Vermont have enough eating disorder treatment for youth?

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