E-Mail This Article to a Friend Into thin air (continued)
	Related links Massachusetts Eating Disorder Association This Newton-based organization offers group and individual counseling, school and community-education programs, and services for family and friends of eating-disorder sufferers. National Eating Disorders Association The nation’s largest eating-disorder outreach and advocacy organization. Harvard Medical School Eating Disorders Center The center generates and disseminates research to scholars, health-care providers, schools, families, and the public. Cambridge Eating Disorders Center (CEDC) One of the CEDC’s services is an intensive evening outpatient therapy program for college students. Health Law Advocates The public interest law firm of Health Care for All provides legal assistance or attorney referrals to families that are struggling with insurance companies for coverage. Caroline Knapp, Appetites: Why Women Want A searing personal memoir filled with astute social and cultural observation. Kathleen Burns Kingsbury and Mary Ellen Williams, Weight Wisdom: Affirmations to Free You From Food and Body Concerns Kingsbury, a licensed mental-health counselor, and Williams, a licensed social worker, are Massachusetts-based therapists whose book is considered a necessary tool for sufferers and family members alike.

"There really is a view out there that this is some sort of less-than-serious sort-of problem that involves a bunch of rich brats," says Dr. David Herzog, president and founder of the Harvard Medical School Eating Disorders Center at Massachusetts General Hospital. "Even though to some it seems like it’s a way to get attention, to be constantly thinking about weight all day long, or your body size, or what you’re not going to eat for the next meal, or eating the same meal every day — that’s not a happy lifestyle. It needs to be understood that these are individuals who deserve the same kind of attention as if they’d had a physical illness."

To that end, Herzog points to the multiple biological components of both anorexia and bulimia — namely, the lowered levels of the brain chemical serotonin, the growing evidence of genetic predisposition, and the co-existence in many patients of mental-health disorders such as depression or OCD (which are acknowledged to be biologically based). And, of course, there are blatantly physical aftereffects, such as muscle-wasting, hair loss, and weak vital signs in anorexics, and tooth-enamel erosion, esophageal tearing, and weakness in bulimics.

Then there’s the disturbing mortality rate. Harvard’s Eating Disorder Center has been studying the same group of 246 women since 1987. So far, 11 have died, 12 times the death rate among women in the general population. The majority of eating-disorder sufferers are girls between the ages of 12 and 22, though doctors are increasingly diagnosing older women (40-plus), men (particularly athletes), and younger girls (sometimes in third, fourth, and fifth grades). A new study by Flinders University, in Australia, published in the March issue of the British Journal of Developmental Psychology, shows girls as young as five to be unhappy with their weight, dieting to become thinner, and comparing their bodies to those of friends and pop stars.

Representative Khan — along with Herzog, the Massachusetts Eating Disorder Association (MEDA), and a coalition loosely assembled by Health Law Advocates, a nonprofit, public-interest law firm that operates as an arm of Health Care for All — presented all this evidence and more in a petition last summer to the DMH, which is responsible for the list of covered disorders in conjunction with the Division of Insurance. According to the petition, the original Mental Health Parity Law was "not meant to be an exhaustive list of biologically based disorders."

Khan says the law gives DMH commissioner Elizabeth Childs the authority to add eating disorders to the parity list without any additional approval. In response to the petition, Childs established two groups — one to examine the eating-disorder question specifically, and another to study the process by which the DMH could amend the list of disorders covered by insurance. Khan also filed legislation in January that called for the inclusion of eating disorders in the parity law. That legislation, along with Wednesday’s briefing, serves to keep the pressure on, she says, and to "build support for taking this very seriously."

How do you start to love yourself, to respect yourself, after all that destruction? But I guess that’s what recovery’s about, right?... Learning to love and trust myself, my body, for the first time.

— The Mind/Body Dialogues

IF THIS effort succeeds, Massachusetts will join a number of other states, including Maine, California, New Hampshire, and South Carolina, in recognizing the necessity of insurance parity for eating disorders.

Experts also hope to draw more attention to the eating-disorder problem in schools and communities, says Dr. Debbie Franko. A Harvard Eating Disorders Center program director, Franko worked with a Newton-based firm called Inflexxion to develop a prevention CD-ROM for at-risk college women. On the high-school level, part of MEDA’s classroom education program includes a "media-literacy" component that highlights the unrealistic body images perpetuated in magazines and advertisements.

"When we think about health issues for adolescent girls, we often think about tobacco and alcohol or sexual risk — rightfully so," Franko says. But, she adds, "certainly eating disorders target that age-gender group. And we really need to try to get the message out ... that we can do something to help decrease that risk, and ultimately, decrease the prevalence of eating disorders."

Work like Franko’s helps scientists and health-care providers understand more about eating disorders, their risk factors, prevention methods, and treatments. "[Insurance companies and the DMH are] not going to support this if we say there’s nothing out there for these folks," Herzog explains. "I think that it’s trying to understand the individual who’s in pain. So that they’re again not trivialized or minimized or [told] that ‘even this doesn’t count.’ "

Deirdre Fulton can be reached at dfulton[a]phx.com