Jordan McNair, Heat Stroke and Eating Disorders

Upon selecting the University of Maryland to further his football career, Jordan McNair’s future was incredibly bright. He was a 4-star recruit according to 247Sports ESPN and Scout. He was ranked in the top-25 nationally at his position by ESPN and Scout. He was the 6th-ranked player in the state of Maryland by ESPN and 247sports.com. He was a 2016 American Family Insurance ALL-USA Maryland Football Team, 2016 First Team Baltimore Sun All-Metro, 2015 Consensus Maryland All-State, First Team Baltimore Sun All-Metro and First Team All-MIAA.

He helped lead his high school to an 8-3 record as a senior … and before choosing Maryland, was also considering Ohio State, Auburn, Penn State and Rutgers.

And now … Jordan McNair is dead.

Jordan McNair collapsed at a University of Maryland football practice on May 29, 2018. After undergoing various treatments while hospitalized including a liver transplant, Jordan McNair passed away on June 13, 2018.

Published reports indicate that the state medical examiner did not conduct an autopsy. This would mean, among other things, that medical professionals likely agreed on the cause of death and that the cause was not considered suspicious. However, a lack of autopsy also means that a forensic pathologist did not examine the organs in young Mr. McNair’s body, a point that could become legally relevant when litigation is filed over who was responsible for McNair’s death.

As a true freshman, Jordan McNair’s official bio stated that he appeared in two games but is listed as a redshirt freshman heading into the 2018 season. His future was bright. His future was ahead of him. If he developed and the NFL became his future, riches and fame awaited him.

And now, 19 year old Jordan McNair is dead. Nothing can bring him back. And from now, until their last day, Jordan McNair’s parents will be left with this unimaginable, monstrous hole in their hearts that they must carry around as a daily burden… grinding them down, taking away joy and leaving them in a horrible state of emotional limbo.

Even though no autopsy was conducted on Jordan McNair, media outlets attribute his demise to heat stroke. But… that is not the end of the story.  

We know that common symptoms of heat stroke include nausea, seizures, confusion, disorientation, and sometimes loss of consciousness or coma. Other symptoms may include: throbbing headache, dizziness and light-headedness, muscle weakness or cramps, nausea and vomiting.

And with those symptoms, and without the findings and medical conclusions iof an autopsy, we conclude that death is attributed to heat stroke. A tragic and preventable death. But, is there more to this story?

 According to the ESPN report:

Current and former players also described several incidents where staff members targeted players because of weight issues. Sources said a former offensive lineman whom the staff deemed overweight was forced to watch workouts while eating candy bars as a form of humiliation.

Another former Terrapins player said his inability to gain weight resulted in members of the strength and conditioning staff sitting with him at meals to make sure he ate.

"They were trying to make me gain weight really, really fast," said the player, who left the program. "That involved me overeating a lot, sometimes eating until I threw up. They always had me come back for extra meals. Once, I was sitting down eating with a coach, and he basically made me sit there until I threw up. He said to eat until I threw up. I was doing what they asked me to do, trying to gain the weight, but at the time, I just couldn't gain the weight, and I guess they weren't understanding that."

Now, consult the DSM-V. The type of forced behavior just described, especially if repeated is textbook bulimia nervosa. And the possible side effects of bulimia include:

Severe electrolyte imbalance.

Chronic dehydration, which is not uncommon with bulimia, can cause critical health issues.

Low potassium levels in the blood can cause heart arrhythmia or cardiomyopathy. 

Calcium levels are reduced which weakens the bones. Low magnesium levels could result in dizziness, fatigue, seizures, muscle cramps, irregular heartbeat.

When a person’s sodium level is off, cells can become dehydrated which could manifest itself in muscle cramps, headaches, seizures, intracranial hemorrhage and yes, death.

If the ESPN story is remotely accurate on this issue and if Jordan McNair was one of the athletes targeted because of his weight, that treatment increases the likelihood of these tragedies being repeated. Why? Because that type of bulimic and binge eating behavior detrimentally impacts the chemical balance in a person’s blood, weakens their immune system and leaves them vulnerable for this type of catastrophe.

Now, go back and compare the symptoms of bulimia, binge eating disorder and heat stroke. The symptoms are the same.

Then consider that eating disorders amongst college athletes are on the rise. Studies have shown that 25% of female college athletes and 20% of male athletes have a diagnosed eating disorder. Proper nutrition is essential for an athlete at the college level. When a body is not properly nourished, the body functioning is at risk for injury and health issues due to the sports exercise requirements.

Was Jordan McNair subjected to the above-mentioned reprehensible conduct? For that matter, if you questioned the number of Division 1 head football coaches and trainers as to their knowledge of eating disorders and the manner in which those diseases impact the body, in all reasonable likelihood the number of intelligent answers you would receive would be the same number as those you receive from a dead man … that would be ZERO.

Jordan McNair is dead.

His mommy and daddy will have to live with that reality. And no one will ever question whether abusive training methods and lack of knowledge of eating disorders and food intake contributed to his tragic death.

More is the pity.

We Are Coming For You.

On this day, what would have been the 25th birthday of my beloved daughter Morgan, instead of celebrating her life and the growing list of achievements she would have undoubtedly accomplished, we are left with the reality of the permanence of her life being over, having been taken by eating disorders in October 2016.

And as we mourn, so too are we filled with a pure heart, a soul that is intact and a firm resolve that will never be broken.

It is our turn.

It is our time.

We are Coming For You

TT Capital Partners and the Emily Program ... Speculation has become Reality.

“Nothing strengthens authority as much as silence.”

Leonardo da Vinci

“Our aim is not to do away with corporations; on the contrary, these big aggregations are an inevitable development of modern industrialism. ... We are not hostile to them; we are merely determined that they shall be so handled as to subserve the public good. We draw the line against misconduct, not against wealth.”

          President Theodore Roosevelt

Private equity firms have proliferated and spread through the eating disorder industry like the Black Plague through Europe in the mid 14^th Century. The  issues brought about by this modern day plague include: no government oversight with no concrete legislation to curb gross excesses of financial corruption and abuse of power; no corporate accountability since PE firms can carte blanche exit a transaction after it has reached its financial goal.  In the event the transaction collapses because the very few assets of the treatment center diminish and the debt obligation cannot be met, the PE firm has no liability and all of the financial burden falls upon the treatment provider. When the treatment provider fails, our loved ones pay the ultimate price. Another issue is that the treatment provider, guided by the mandates of the PE firm, focus not upon the health, well-being and recovery of its patients, but instead must necessarily focus on generating the greatest amount of revenue and financial profit for its overlord and master.

Private equity is not invested in the eating disorder industry for philanthropic reasons. Private equity firms invest in the eating disorder industry to make the largest profit in the most expeditious manner and then divest itself of the asset.

Another issue with PE firms is that when profits are emphasized over people, those people, our loved ones, suffer. Progress in recovery is stalled or even reversed. Our loved ones, who are treated as corporate commodities, suffer grave injury. For some, the temptation exists to classify these concerns and fears as mere speculation. But what happens when this speculation turns to reality.

This paradigm shift happened in late 2017 and reality has arrived in an open and notorious manner.

The Emily Program

In 1993, psychologist Dirk Miller, Ph.D., L.P., opened a private eating disorders treatment practice. Dr. Miller named his new practice The Emily Program, after his sister, Emily, who recovered from an eating disorder. According to The Emily Program, “The Emily name has come to signify the core values behind our successes: personalized care for all individuals struggling with eating disorders.” [emphasis added]

Growth started slowly. In 1999, The Emily Program hired its first staff person, therapist Lori Peiffer, Ph.D. In 2000, The Emily Program added two additional therapists and its first administrative staff person, Shirley Gottwalt, and a consulting dietitian begins offering services.

In 2002, with outpatient groups expanding, Jennifer (Gottwalt) Smith, R.D., L.D., became its first staff dietitian.

In 2006, it opened its first satellite office in downtown Stillwater, Minnesota. The following year, it began operating the Anna Westin House in Chaska, Minnesota’s first residential eating disorders treatment facility. Its second satellite office opened in downtown Duluth, the largest city in northern Minnesota.

In 2008, it opened its third satellite office in Burnsville, a Twin Cities suburb. Steady growth continues as in 2009, The Emily Program purchased the former St. Andrew Kim Catholic Church, across from the University of Minnesota’s St. Paul campus. They renovate the building to host the new Anna Westin House, and doubled its treatment capacity to 16.

2011 marked its growth into its first facility outside of Minnesota, an outpatient program in Seattle, Washington.

Finally, 2014 marked a watershed moment. In June, it partnered with the Cleveland Center for Eating Disorders. This happens  at about the same time as The Emily Program sells part of its interest to a private equity firm, TT Capital Partners, LLC. And with that stroke, The Emily Program joined the expanding arms race into the world of private equity.

Pre-2014 Treatment Philosophy

Prior to the entrance of TT Capital Partners, the Emily Program’s treatment philosophy was best explained by its founder, Dr. Miller.

Dr. Miller envisioned eating disorders treatment as a pyramid, with  outpatient therapy relationship as the strong foundational base and in-patient treatment as the tip. Dr. Miller stated, “The higher intensity levels of care are where the greatest profit margins are.” He further stated, “It makes sense that programs have wanted to focus on that, but outpatient is so essential to the recovery process from a theoretical, client-care, and insurance standpoint.” [emphasis added]

The Emily Program’s foundation was built upon outpatient care and involvement of the patient and patient’s family in an on-going manner. This was in keeping with its core value of “personalized care for all individuals struggling with eating disorders.”

Only in the more severe cases, The Emily Program offered partial and full residential treatment for both adults and adolescents. Dr. Miller noted that, “in-patient treatment is a small percentage of what goes on in the change process. It’s short-term symptom interruption.” [emphasis added]

Clearly, despite the fact that residential care is more financially lucrative, the Emily Program’s core values revolved around outpatient therapy and family counseling.

Enter the Dragon … TT Capital Partners

In or about June of 2014, in a very understated announcement, TT Capital Partners, LLC, the private equity arm of Triple Tree Holdings, acquired an interest in the Emily Program. This acquisition started even greater expansion for the Emily Program … with an emphasis on expanding residential treatment programming.

In June 2015, it opened a 24-7 residential program in Cleveland, Ohio. In April 2017, it expanded its residential treatment program to Seattle, Washington. On the surface, this emphasis on the “tip of the pyramid” is quite perplexing since it runs counter to the espoused philosophy of Dr. Miller and the core values of the Emily Program.

Finally, in November of 2017, the Emily Program went full circle and announced that it was dropping as many as 250 patients as it allegedly shifted toward a more intensive treatment model for people with severe or life-threatening conditions. The Emily Program announced that it was stopping outpatient therapy for many patients who had eating disorders but with a co-current mental illness diagnosis. This too is perplexing since most experts in the field believe that up to 80% of those persons suffering from eating disorders also suffer from anxiety, depression, PTSD and/or alcohol or drug addiction.

In stopping outpatient therapy, the Emily Program obviously decided to focus on the more financially lucrative in-patient residential treatment. Chief Strategy Officer Jillian Lampert said the shift enabled the firm to focus on patients with acute eating disorders who are engaging in extreme, self-harming behaviors. In an interview with the local CBS affiliate, Ms. Lampert denied that this shift was a “money thing.”

In an interview with local reporter, Andy Steiner, Ms. Lampert stated: “These changes are not being driven at all by financial measures. That’s all rumor and speculation.”  She later stated, “There is a lot of speculation on social media sites. We understand that the changes people are experiencing feel frustrating and difficult — we absolutely do. But these changes are not being driven from financial need. They really are driven by the need to support the latest evidence-based research on eating disorder treatment while still providing the same quality of treatment that we’ve been providing since we opened in 1993.”

Extensive research was conducted attempting to find this “latest evidence-based” research to which Ms. Lampert was referring. These attempts were fruitless and no third party, objective research study could be located supporting the hypothesis that residential treatment programs are the preferred method for battling this insidious disease. No objective, universal criteria exists for judging the effectiveness of residential treatment programs. In fact, the most reliable “evidence-based” research indicates that with adolescents who are afflicted with eating disorders, Family Based Therapy is the most effective counseling method.

Ms. Lampert's statements are further contradicted by other public statements and representations made by the Emily Program. On a recent posting on the website for the Association of Psychological Postdoctoral and Internship Center, in which The Emily Program was advertising for interns, it stated: “The Emily Program is proud of its emphasis on empirically-based treatment for individuals with eating disorders. We are the largest provider of outpatient "ED" therapy in the country in part because we believe in the need to work with clients on recovery in the context of their everyday lives. Respect for and trust in our clients is woven through every interaction that takes place at The Emily Program." [emphasis added]

And yet, the Emily Program is curtailing the out patient program that it touts as crucially important. The out patient program touted by the founder of the Emily Program as the very base of its pyramid, the foundation upon which the Emily Program was started. But, the decision to increase the more financially lucrative residential treatment program at the expense of 250 IOP and outside patients was allegedly not a financial decision?

One wonders what other decisions were not “financial decisions.” For example, since TT Capital Partners invested in the Emily Program in 2014, a search revealed that the Emily Program has filed lawsuits against approximately 150 former patients for non-payment of fees, costs and expenses. Imagine that a loved one is fighting this insidious disease, they have left a treatment program, the vast majority are still fighting for their lives only to discover that they are being sued by the program which supposedly only wants to help them. 

Of course, the high dollar value of some of the financial obligations of these “scofflaw” former patients merited this aggressive approach. And yet, according to court records, some of the original principal amounts due are: $530.28; $545.68; $577.50; $593.25; $998.00; $1,176.00. Those numbers are correct. Lawsuits were filed by The Emily Program against its former patients to recover those middling amounts.

One cannot help but speculate whether the decision to prosecute those lawsuits was made by Dr. Miller and the treatment team at The Emily Program. Or, was it made by the financial partner, TT Capital Partners. Clearly, the answer to that speculation is self-evident.

The Money Grab by Private Equity is no longer speculative.

The paradigm shift from speculation to reality has happened. Acute-level care, including residential treatment, requires more billable hours, and the reimbursement rates for intensive treatment are more lucrative. In order to obtain these financial riches, patients whose recovery cycle does not currently involve the highest level of care need to be sacrificed. And in this case, 250 patients, 250 people suffering from this insidious disease, 250 people fighting for their lives, were treated as disposable corporate commodities.

No matter how many denials are made regarding decisions being made based on financial concerns, overwhelming contrary facts predominate. No medical entity files lawsuits against its patients who are still suffering from this disease for $530.28.  Ms. Lampert is on record as stating: “We’re finding that people coming into our programs have higher acuity levels and more intensive symptoms than in the past,” she said. “They are extraordinarily ill and we want to better meet their needs.” Obviously, meeting their needs includes filing lawsuits for amounts which would not even cover ½ of one day of residential treatment.

That is what private equity has brought to the eating disorder industry. That is the reality when corporate entities become involved in the practice of medicine. That is the harsh reality that our loved one must now face as they battle this insidious disease.

Peer Review Doctors ... Under the Spotlight

Insurance providers generally include a "peer-to-peer" review program in an attempt to comply with its fiduciary duties to its insureds.  

A peer-to-peer review is typically done as a scheduled telephone call between the Peer Review physician acting on behalf of the insurance provider, and the healthcare professional who requested the review. The Peer Reviewer applies the health plan’s medical coverage guidelines to the clinical information, uses clinical judgment, and renders a decision. Although the Peer Reviewer is a delegate of the insurance company, allegedly the Peer Reviewer receives no financial incentive to deny or to approve a request. And yet, even a cursory investigation reveals that numerous peer review companies exist and market themselves with some even touting its transparent, competitive pricing. 

If you were to ask your physician, or a residential program's physician, how often the Peer Review physician has reviewed all of the medical records, or if they specialize in eating disorders or if they are aware of the latest medical articles dissecting eating disorders the answer you would receive would be … never.  Undoubtedly, the Peer Review physician is acutely aware of the insurance company's policy language since that language is guiding the decision they are making.  The Peer Review Physicians are ipso facto, making medical treatment decisions on behalf of the insurance company ... and for their insured, the patient, our loved one.

In every state, the insurance provider has a fiduciary relationship with the insured. It has the duty to act in good faith and to deal fairly with its insured. You are paying for a service. It stands to reason that the insurance provider must then also employ Peer Review physicians in good faith, physicians who are competent and who must hold the insured's needs paramount but only within the context of the insurance policy. By its very nature, the Peer Review physician is occupying an adversarial position to  your treating doctor. And you are paying for it! Part of the premium dollars you are paying are necessarily allocated to pay for Peer Review doctors who are denying treatment that your treating physician says is medically necessary.

Review your health insurance policy. The insurance provider, without any input from you, has the right to determine what  guidelines, procedures and protocol are included in its policies  With regard to claims review and the necessity of treatment for eating disorders, you will not find any reference to the American Psychiatric Association or the American Medical Association guidelines, or the DSM-V. This means that the insurance provider and its Peer Review physician are not using generally accepted medical standards in making treatment decisions. And if the Peer Review physician is not taking into consideration the APA guidelines set forth by the American Psychiatric Association or the American Medical Association guidelines, or the DSM-V, how can their opinion of medical necessity be anything but suspect and in fact, could be approaching medical malpractice.  

The Peer Review physician can attempt to qualify her remarks by stating that pursuant to the policy language, the insurance provider is refusing to pay for future treatment. But, interpretation of insurance policy language necessarily is left to legal minds ... not medical minds. What experience does the Peer Review physician have with legal interpretation of contracts? Or, is the insurance provider feeding the Peer Review physician its own legal interpretation and merely asking the Peer Review physician to color by numbers with regard to denying treatment under the policy?  This illustrates the harsh reality that compliance with the generally accepted medical standards of care for an insured is secondary to the substance of the insurance policy.

A Call for Accountability

As the insured, you have a right to the records your insurance company and its Peer Review physician reviewed regarding your claim ... including the identification and credentials of that very Peer Review physician.

I am not suggesting filing a medical malpractice claim against the Peer Review physician.  You very well may not even have “standing” as the judicial branch defines that term to file a malpractice lawsuit.  Further, malpractice laws in some states can seem almost draconian in their application and if you file a malpractice lawsuit in bad faith, you could be subjected to costs and attorney’s fees. 

However, each state does have it own Board of Medical Examiners.  These Boards are appointed, or voted in, to oversee the medical profession in its respective state. These Boards are designed to protect the health, welfare and safety of its citizens against the unprofessional, improper, and unauthorized practice of medicine by ensuring that those who practice medicine and other allied health professions under their jurisdiction are qualified and competent to do so.   In addition, the Boards serve in an advisory capacity to the public and the state with respect to the practice of medicine.

These Boards also have a complaint process in place wherein persons who are aggrieved may seek assistance.  Most Boards can publicly or privately censure a physician, suspend them from the practice of medicine or in some cases, revoke a physicians’ right to practice medicine.  Assuming a Peer Review physician is rendering a medical opinion regarding treatment that is not based on generally  accepted medical practices or what is in the best interest of the patient, but instead, the opinion is simply based on insurance policy interpretation, then arguably the Peer Review physician’s opinion could and rightly should be construed as improper, unprofessional and not in compliance with the medical standards in the community.

Upon proper complaint, the Board should open an investigation into that Peer Review physician and review the process utilized by the Peer Review physician in reviewing claims for that insurance company.  The Board could dismiss the complaint out of hand.  It could choose to investigate.  Ramifications could include dismissal of the complaint, private or public censure of the peer physician or even a revocation of that Peer Review physician’s license to practice medicine.

It stands to reason that as these claims against Peer Review physicians increase, the Peer Review physicians themselves would have cause to complain against the insurance providers employing them. In order to maintain the integrity of their profession and reduce the number of administrative claims, the Peer Review physicians would necessarily have to exert pressure on insurance providers to amend policy language to conform with the recognized and accepted medical practices utilizing APA guidelines.

Therefore, a recommended course of action could be:

1. Obtain the complete ruling and peer physician determination letter;

2. Review the determination letter to ascertain whether the Peer Review physician utilized APA Guidelines, the standards set forth in the DSM-V or any other objective guidelines, other than the insurance policy language;

3. Assuming the determination letter does not so comply but instead, is focused on requirements under the insurance policy, then demand from the insurance company, the identity, business address and credentials of the Peer Review physician;

4. Contact the State Board of Medical Examiners in the state where the Peer Review physician practices;

5. Most State Boards have complaint documents on line. Download the complaint form, review, complete the documents in a meticulous manner, attach all documents and evidence you have which implicate the Peer Review physician;

6. If possible, contact an attorney and have him/her review the documents;

7. File the complaint documents;

8. Advise the insurance provider you have instituted a complaint against the Peer Review physician and demand his/her recusal from any further proceedings;

9. Prepare your reply to the expected response from the Peer Review physician.  The Peer Review physician and his attorney may attack you or your loved ones. That is the nature of the adversary system;

10.Be prepared to give testimony if called upon by the Board to give further information.

11. Continue to seek faith and strength from your support system and keep fighting for your loved one.

This process may seem laborious. In some ways, it may be. But, you are fighting for the life of your loved one. You are fighting an inherently flawed system. And you are not fighting alone.

Your voice is growing in volume and intensity. Stay the course.

Prevalence of Eating Disorders Among Adults ... The Newest Study and the Numbers Say ...

If we knew what it was we were doing, it would not be called research, would it?

            Albert Einstein

I believe in innovation and that the way you get innovation is you fund research and you learn the basic facts.

            Bill Gates

The most recent edition of the Journal of Biological Psychiatry just published the most comprehensive research study ever conducted on eating disorders. It is significant that the research findings took into  account the most recent version of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition which was published in 2013. The DSM-V varied the definitions of eating disorders and was more authoritative and inclusive of the symptomology.

The research study was based on extensive interviews of 36,309 adults which was by far the most broad, far reaching study ever conducted with regard to eating disorders. The methodology and measurement techniques were designed to eliminate as many false variables as possible. For each Eating Disorder diagnosis, weighted means, medians, and frequencies were computed for age, BMI, age of onset, years with episode, persistence of ED, and ED-related impairment; analysis of covariance was used to examine whether current age, current BMI, age of onset, and years with episodes differed between AN, BN, and BED after adjusting for sociodemographic variables.

The analysis of the raw statistics, findings and results support the belief and speculation held by most experienced practitioners in the ED field.

General Findings

The general findings of the study estimate that 0.80 percent of US adults will be affected by anorexia nervosa in their lifetime; 0.28 percent will be affected by bulimia nervosa; and 0.85 percent will be affected by binge eating disorder. To translate these percentages to raw numbers, using the estimated current US population of 325,000,000 reveals the following:

1.    2,600,000 US adults will suffer from anorexia nervosa;

2.   910,000 US adults will suffer from bulimia nervosa;

3.   2,762,500 US adults will suffer from binge eating disorders.

It is unknown to what extent the numbers for bulimia and binge eating disorders overlap. But, the two most important conclusions that can be drawn from this report are:

1. Eating disorders are far more prevalent than earlier estimates, especially when one considers the second point;

2.  This study only involved adults 18 years old and older. It did not take into account our children who, every study has shown suffer from this disease on a higher percentage than adults.

Tomoko Udo, PhD, of University at Albany, New York who conducted the study alongside Carlos Grilo, PhD, of Yale University School of Medicine stated: "Our study confirms that eating disorders are common, are found in both men and women and across ethnic/racial groups, occur throughout the lifespan, and are associated with impairments in psychosocial functioning."

John Krystal, Editor of Biological Psychiatry, stated: "The prevalence and impact of eating disorders continues to be underestimated in society. This definitive study should guide both research and policy development."

Findings Taking Into Account Various Factors

The study also took into account various factors and drew conclusions based upon those factors. The study indicated:

“Adjusting for age, race and/or ethnicity, education, and income categories, odds of lifetime and 12-month diagnoses of all three EDs were significantly greater for women than men, particularly for AN and BN.”

“We also found that:

1) the risk of lifetime AN diagnosis was significantly lower for Hispanic and non-Hispanic black respondents than for non-Hispanic white respondents;

2) the risks of lifetime and 12-month BN diagnoses did not differ significantly by race and/or ethnicity;

3) the risk of lifetime BED but not 12-month BED diagnosis was significantly lower for non-Hispanic black than non-Hispanic white respondents;

4) the risks of lifetime and 12-month BED diagnoses for Hispanic and non-Hispanic white respondents did not differ significantly; and

5) the risk of lifetime AN diagnosis was associated with higher income.”

“Overall, it is important to recognize that EDs occur across all ethnic/racial groups and that the rates for some diagnoses (e.g., BN and BED to a lesser extent) are comparable across groups. However, 12-month AN diagnosis was most prevalent among non-Hispanic white respondents, women, and respondents 18 to 29 years of age. The findings are broadly consistent with previous DSM-IV–defined EDs in their analysis of 24,124 adult respondents from the World Health Organization World Mental Health Survey, reported roughly comparable prevalence estimates for BN and BED diagnoses across 14 countries.”

“Collectively, such findings highlight the importance of actively considering all forms of diversity across prevention and intervention clinical and/or research work, which to date appears to be at odds with our findings.”

“Findings regarding the mean ages of onset for AN, BN, and BED were  ages 19.3, 20.0, and 24.5 years, respectively.”

“The chronic nature of EDs was suggested by long illness durations and rates of 12-month persistence, which highlight the importance of early recognition and intervention.”

The Study’s Conclusions

“Our findings for DSM-5–defined EDs, based on the largest national sample of U.S. adults studied to date, indicate these are prevalent disorders distributed across age groups, across both men and women, and across different ethnic and/or racial groups. Although substantial differences between EDs exist, overall, they appear to be persistent and associated with substantial rates of impairment in psychosocial functioning. EDs show differential associations with obesity, and our findings highlight substantial associations between BED and extreme obesity. Thus, our findings indicate that DSM-5– defined EDs represent an important public health problem.”

Post Script

Ordinarily, at this point in most of the articles I have written, I would end with a pithy remark, a challenge to some group or an outpouring of emotion.

In this case, the very disturbing findings and conclusions of this study stand alone.

And as our loved ones continue to be treated as mere corporate commodities,  to be disposed of and discarded in the name of profits and skewed EBITDA numbers, one cannot help but wonder when the "carousel of death" fueled by private equity firms and insurance entities will slow down.