Barriers to Care for Eating Disorders

There are many barriers to receiving eating disorder treatment. An important one is identifying the presence of an eating disorder in the first place. But, once identified, other barriers also exist. We often think of ambivalence about change as a key variable. The type of insurance and skin color are two major barriers to obtaining care for an eating disorder, according to a recent study at the University of California, San Francisco.

Researchers led by Dr. Ruby Moreno at UC-San Francisco performed a retrospective chart review of 1060 patients 11 to 25 years old who presented at an adolescent medicine specialty program between June 1, 2012, and December 31, 2019 (J Eat Disord. 2023. 11:10). All participants in the study had been diagnosed with malnutrition secondary to disordered eating. The primary outcome measure was whether a patient had been given recommended treatment within 6 months of intake. Patients with no visits within 6 months were considered lost to follow-up.

Insurance type and race/ethnicity

Racial and ethnic minority youth were less than two-thirds as likely to receive recommended treatment compared to white youths. In addition, anorexia nervosa (AN) took precedence: youths diagnosed with “other” eating disorders were only half as likely to receive recommended treatment as those with AN.

Stigma and cultural beliefs about mental health care may add additional barriers to eating disorder care for youth of color, but data are still mostly lacking in this area. Not surprisingly, barriers to therapy for this population led to worse outcomes. Across all models, hospital admissions for disordered eating within a month of intake significantly increased the likelihood of receiving recommended treatment. The authors also found that many publicly insured patients could not access family-based therapy, and instead relied on therapists with limited experience with eating disorders, who provided nonspecialized individual therapy.

Changes are needed

The authors correctly note that important changes are needed within the healthcare system to improve access to care, including addressing systemic inequalities that contribute to disparities in care for youth of color. The solution may involve a multidisciplinary approach to treatment, to help patients access appropriate levels of care. Future research would benefit from understanding perceived barriers to care for patients of color or those relying on public insurance, and their caregivers. According to Dr. Moreno and colleagues, the field of eating disorders is confronted with the need to understand institutional policies and public health initiatives, to improve health equity.

In an effort to help address health disparities among racial and ethnic minority populations, the Office of Minority Health (OMH) of the Department of Health and Human Services provides support to agencies and organizations in the public and private sectors (https://minorityhealth.hhs.gov/). Largely through grant programs, OMH is currently implementing a disparity impact strategy, which identifies and addresses health disparities to promote health equity for racial and ethnic minority populations.