Philadelphia isn’t exactly a small city; in fact, it’s home to over 1.5 million people– that’s over 11,000 people living in each square mile. Eating disorders are a serious issue likely affecting individuals and families across every community in the city. Based on statistics, 9% of the city’s population, or 142,566 people, will struggle with an eating disorder at some point in their lifetime. Incidences of eating disorders such as bulimia nervosa may also be even higher in large cities.
There are several options and resources for people seeking eating disorder care in the Philadelphia area. However, there are also many barriers in place that prevent people from receiving affordable, accessible, and timely treatment. COVID-19 has presented its own unique issues for those in need of treatment, but there are many other barriers and roadblocks for people struggling with eating disorders that have existed long before the pandemic.
In 2018, more than 7% of Philadelphians lacked health insurance. Without insurance (and sometimes with it), the cost of eating disorder treatment can be well into the thousands. Even those who have insurance and consider themselves financially stable may have difficulty finding affordable treatment options in the city.
Jeanne Stokes is the director of and psychologist at the WELL Clinic at Drexel University, which offers evidence-based treatment to people with eating or weight disorders.
“The typical eating disorder specialist in this area does not accept insurance, which means that patients are only able to access treatment if they have either the ability to afford to pay for treatment out of pocket or using out-of-network benefits,” Stokes said. “It’s a huge issue, and I would say the insurance industry in the Philadelphia area is worse than any other city I’ve seen or worked in.”
Linda Schmitz, a practicing therapist from Dresher, Pennsylvania, notes how college-aged individuals are often the least financially stable, yet have been struggling with eating disorders at increasingly higher rates in recent years.
“It’s hard because a lot of times it’s, you know, like teens and 20-somethings where it’s a real issue, and that’s not a population that has a lot of money,” Schmitz said. “So, unless they come from more of an affluent background, I think it really is difficult to get good treatment.”
The WELL Clinic has trainees who provide treatment at a lower cost for people who need it. For those who really cannot afford treatment, there are still options available.
“Generally, the best way to get low-cost treatment is through research studies, so, clinical treatment trials,” Stokes said. There are several places in the city conducting these free or lower-cost trials: CHOP, the Center for Weight and Eating Disorders at Penn, and the WELL Clinic at Drexel. However, the capacity in these programs is limited and many people are in need of more immediate treatment.
Personal Resistance to Treatment or Getting Help
One of the barriers to treatment people don’t often consider is an individual’s own hesitation to get help for their eating disorder.
“I think the number one reason is that people don’t want to get treated,” therapist Schmitz said. “They want to hold on to the disorder, so it’s usually external people pushing the treatment. I think the first issue to get past is people’s own resistance to getting healthy.”
Kristin Szostak, the site director at The Renfrew Center’s Center City location, agrees that an individual’s friends and family are often the ones who end up encouraging their loved one to seek help.
“An eating disorder is an emotional disorder and it’s going to thrive in isolation; it’s going to thrive in secrecy,” Szostak said. “It may take a couple of times of the support bringing up their concern before the person agrees to actually follow through.”
Schmitz and Szostak both said they believe it’s important for friends and family to exercise patience when nudging someone onto the path of recovery.
Waitlists/Overcrowding at Treatment Centers
Unfortunately, there are not enough openings in treatment centers as there are patients who want help, especially in a city as densely populated as Philadelphia.
“In the Philadelphia area, there’s a handful of good providers, but they get booked up really fast because they’re good,” Stokes, WELL Clinic’s director, said. “It means that it’s really hard to find good placement opportunities for everybody that needs help.”
Sydni Young, a former patient at Monte Nido Eating Disorder Treatment Center, said that although resources exist, there could always be more.
“There’s limited space in therapy or treatment centers,” Young said, speaking from personal experience and observation. “They can only have so many patients at a time. So, at the end of the day, there’s a waitlist for programs like that unless you are super health-compromised.”
One of the issues leading to overcrowding in treatment centers is a lack of therapists and clinicians who are trained to work with people with eating disorders.
“Eating disorders is such a specialized area of treatment,” Stokes said. “Eating disorders come with a lot of complexities and a lot of really severe dangers, and so in order to be able to work well with eating disorders, a lot of training and education is needed.”
Young said that although she had been fortunate enough to receive treatment in times of lower patient volume, it can be incredibly detrimental for individuals who cannot receive immediate help or treatment.
“I know for some residential programs, there’s like a four-week waitlist right now, and you know, in four weeks, things can get truly bad,” Young said.
It is a race against the clock when someone’s physical and mental health is deteriorating; that’s why it’s so important that when someone is finally reaching out and ready for help, they’re able to get it.
COVID-19 restrictions have made transportation less of an issue for those seeking treatment since many of the programs have now switched to partially or fully online.
“I’ve had patients who have had to drive three hours round-trip to come into the city for therapy before telehealth was a thing,” Stokes said.
Virtual treatment options can also help reach more patients who may not have found care to be accessible before. However, now that many clinics have put a halt to in-person treatment, many people are receiving treatment less frequently or waiting too long to get help.
“We’ve seen a significant increase in the number of individuals who are seeking treatment,” Stokes said. “We’re also getting much more severe cases than a year ago, perhaps because, you know, there’s some distance.”
Virtual treatment may not work for everyone, especially those in need of more intensive care because their health or life is at risk. Most of the programs currently offered in the city are also intensive outpatient or partial hospitalization programs, but many eating disorder sufferers need more intensive care.
Young hopes to see more local residential treatment programs since only one exists in the city.
“It limits people who have HMO, and really can only go to treatment centers in-state,” Young said.
Although switching to a virtual setting has improved treatment accessibility in some ways, it leaves others with more extreme eating disorders with few local options.
Eating disorder care in Philadelphia has a long way to go until treatment is accessible to every individual suffering. If you or a friend needs immediate help for an eating disorder, please call the NEDA helpline at 1-800-931-2237 (1-800-NEDA) to learn about your options.
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