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The passage of a federal mental health parity law nearly a decade ago was an important step in ensuring that people struggling with mental health issues received the insurance coverage they needed. More progress came in the form of the 21st Century Cures Act in 2016, which included the first instance of eating disorders language in legislation, clarifying that it is not acceptable to exclude eating disorder treatment—specifically residential programs—from insurance coverage.

Although this meaningful federal legislation was an enormous victory in the fight for equal coverage, the effectiveness of the law has been mixed, as some insurers have failed to meet regulations.

The Labor Department’s Employee Benefits Security Administration (EBSA), which is responsible for enforcing the law, has seen a rise in noncompliance, citing 92 violations in an investigation of 127 plans. But with limited authority to take action against violators and decreased staff, the agency faces an uphill battle in terms of investigating and enforcing violations.

A recent Bloomberg Law article outlines the compliance issues associated with the legislation and what can be done to address noncompliance, reporting that despite setbacks at the EBSA, mental health parity is one of the agency’s top priorities.

The Emily Program’s Chief Strategy Officer Dr. Jillian Lampert, a long-time advocate of mental health parity, was interviewed for the article. Dr. Lampert stressed the importance of communicating guidance to help people understand the process for reporting coverage issues.

Though disappointed that the federal parity law hasn’t been as effective as she and other eating disorder advocates had hoped, Dr. Lampert remains hopeful.

“We’ve been making progress in the last two years; we’ll keep going until we get what clients and families need from parity,” she said.

Read the full Bloomberg Law article here (used with permission).

Author Jillian Lampert, Ph.D., M.P.H., R.D., L.D., F.A.E.D.
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Every day we are faced with “now or later” decisions. Should I buy that piece of clothing I want now so I can wear it right away or should I wait and hopefully get it on sale? These types of decisions involve the concept of immediate or delayed gratification. Brain research is showing that people’s tendencies in this area often end up being expressed in their eating disorder.

Below is a graphic illustrating this concept:

The limbic system is the part of the brain involved in our emotional responses and memory formation, especially when it comes to behaviors we need for survival: feeding, reproduction and "fight or flight" responses.

Executive function is an area of the brain that engages in the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. This is where we develop self-regulation skills  that enable us to set priorities and resist impulsive actions or responses.

Researchers are discovering that differences in these two areas of the brain can influence one’s reactions to food. This can be especially consequential when a person is struggling with an eating disorder. For example, a person who is feeling acute distress due to some aspect of their eating disorder might experience immediate relief through binging and/or purging, which might outweigh the long-term consequences of such behavior. However, for other individuals, their drive for order, planning and long-term goal attainment might override the immediate needs for food, sleep or other basic human needs, resulting in restrictive eating behaviors.

Being aware of our own tendencies and getting better acquainted with how our brain works can help us make sense of why we take the actions we do, and if necessary, what skills, strategies and coping mechanisms we might need to help eliminate or minimize actions that don’t serve our long-term, recovery goals.

AuthorHilmar Wagner, MPH, RDN, CD
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Eating disorder treatment is lengthy, complicated and may even take several treatment attempts for someone to fully recover.

We know early recognition and rapid intervention is the ideal standard of care and, in many instances, increases a patient’s chance for long-term success. So it’s critical that medical providers become experts at recognizing, referring and treating patients with eating disorders.

That’s why I’m thrilled to announce the Academy for Eating Disorders (AED) has released the third edition of its medical care standards guide. “Eating Disorders: A Guide to Medical Care” is available for download and is designed to promote recognition and risk management for patients suffering from eating disorders.

Written by the AED’s Medical Care Standards Task Force, this guide offers crucial information for all medical providers, including important facts about eating disorders, signs and symptoms, critical points for early recognition, comprehensive assessment, treatment goals, timely interventions, and ongoing management.

The guide been endorsed by the American Academy of Pediatrics and the American Psychiatric Association, as well as medical leaders throughout Canada and Mexico. It has also been translated into 10 different languages so that a diverse group of patients and medical providers can reference this work.

If you, a loved one, or your patient is struggling with an eating disorder, we strongly recommend you access this guide. We are very proud of how the entire eating disorder community has come together to provide this enormously helpful guide to ensure all patients suffering from an eating disorder receive the highest quality care.

For additional information on eating disorders and treatment approaches, see the About Eating Disorders section of our website.

AuthorMark Warren, M.D.
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In the fall of 2014, Mandy Gross joined The Emily Program as an intern. Soon after Cleveland Residential opened in 2015, she accepted a full-time position as an eating disorder technician at the house.

“I knew long before working for TEP that I wanted to become a therapist and work with people suffering from eating disorders,” she said. “So, I was very hopeful that my internship would lead to my dream job, and lucky for me, it did.”

Today, Mandy is the program coordinator at Cleveland Residential, where she runs groups and holds a small caseload of individual clients. On a typical day, she can be found running 1 to 3 skills groups, supporting meals or snacks, and meeting individually with a few clients.

Cleveland Residential has a variety of groups to address its clients’ needs, including group therapy, psychoeducation, skills, processing, nutrition and cooking programs.

“Some groups are more learning based, while others are more discussion based,” said Mandy.

She received her bachelor’s degree in psychology from The Ohio State University and went on to earn a master’s in social work from Case Western’s Mandel School of Applied Social Sciences.

Learn more about Mandy and why we think she stands out!

TEP: What’s one thing you hope clients take away from programming?

Mandy: I hope clients realize they are not the only ones struggling, learning or growing. We are all doing the best we can, while also striving for better. I hope they also take away tangible skills they can use in their everyday lives to help them manage more effectively.

TEP: What advice can you offer clients?

Mandy: Treatment is hard, but it’s an opportunity to make changes in your life with 24/7 support. Treatment can be an opportunity to gain awareness and insight and can offer an environment of people who understand on a different level what clients are going through, especially since eating disorders can be incredibly isolating and lonely. 

Fighting an eating disorder is very challenging and is not something we expect people to do on their own.

TEP: Any fun facts about yourself to share?

Mandy: I love Harry Potter so much that I have a Harry Potter reading room at my house.

Another fun fact is I used to dress up in a different costume every day on Monday. I did this for more than a year and a half and it became something both clients and staff looked forward to. Being at treatment is really hard so it was a fun way to start off the week
.

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This is one person's story; everyone will have unique experiences on their own path to recovery and beyond. Some stories may mention eating disorder thoughts, behaviors or symptom use. Please use your own discretion. And speak with your therapist when needed.

Katie Monsewicz is an avid writer and practicing journalist who has been through The Emily Program's residential treatment program. She wants to help others who have struggled with eating disordersand those who are still struggling—through her writing and as an advocate for eating disorder recovery.

I think a lot of young women these days believe beauty can be bottled. Or fit into little squares of colorful compacted powder. Or melted into a tube of matte wax.

Every social media feed I jump into, I’m “graced” with Kim Kardashian’s body. I’m “blessed” by Kylie Jenner’s lips. I’m “shocked” by Angelina Jolie’s striking features. I’m “mesmerized” by Jennifer Aniston’s perfect skin.

Oh, what are these words? No I’m not any of that! I’m straight-up, no-lying jealous! And that jealousy forces you to want to be like them and when you want to be like them, you start buying their products, wearing their clothes, and spritzing on their perfume.

There have been movements and still are some that push for beauty in all shapes and sizes, in all tones and tints, in all voices and values. But are they working? We are seeing diverse models front-and-center “werking” their stuff on the runway, posing fiercely in a photoshoot, or singing with voices like velvet before a whole crowd. And we applaud them. We really do.

Beauty isn’t about who is in the magazine. Beauty isn’t about ranking women or telling girls they need to have idols to grow up to be like.

I don't believe comparing ourselves to others is the right way to feel beautiful. But I won’t lie. I compare myself to other women every time I walk down the street or mosey down the walkways in a shopping mall. At some point, you have to stop yourself and ask, “Where is the mirror? I have to check this and that and this and those and..." UGH! Can we puh-LEASE stop it with the look-alike games?

To find our own beauty—I mean our OWN and not some celebrity-else’s—we often have to look inside ourselves. Go ahead and take a long, hard look at a picture of you celebrating your 12th birthday. You couldn’t be happier. You’re parading around the place in your favorite dress and smiling like the whole world is watching you be you and you’re proud of it.

Did you see what I did there?

The beauty you are looking for isn’t in your appearance. It’s in how you feel. In this past photo, you felt beautiful because you weren’t haunted by this "uncaring care" that you have to fit a mold.

Kim Kardashian knows you want to be like her. Kylie Jenner knows. All these celebrities know you want to be like them. But they were once like you too, you know? They were insecure. They had idols. And you know what? They don't look just like their childhood idols. Kim Kardashian, in particular, has broken through and evolved beauty standards over her years in the spotlight. I’m not saying it will take years for you to feel beautiful. I’m saying that you can feel beautiful without comparing yourself to others and thinking you have to follow someone else’s footsteps. Because it's impossible anyway--you can only be you.

You can step off the path because that’s where your heart tells you to go. In beauty, there is love for the self. And in love, there is a heart that recognizes this beauty.

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This is one person's story; everyone will have unique experiences on their own path to recovery and beyond. Some stories may mention eating disorder thoughts, behaviors or symptom use. Please use your own discretion. And speak with your therapist when needed.

by Mitchell S. Moyer, a man in recovery from anorexia

When you have an eating disorder, the thoughts that swim in your head are dark and relentless. You ask yourself: Will I ever be the same? Will I ever stop thinking about food? How did I get here, and how do I beat this monster? You rise in the morning. But as the day progresses, your energy wanes and those thoughts continue to weigh you down. You feel adrift in frustration, confusion, and self-doubt.

My name is Mitchell Scott Moyer. I grew up in a small town in northeast Pennsylvania. I love life and live hard. I have a brother who is 2 years older than me and I was born to two loving, hard-working parents. I was recently married to a loving and strong wife. Currently, I work for a well driller and as a part-time Strength and Conditioning Coach. That is a snapshot of where I am now, but from this point on I will rewind back to my youth. I pray at least one part of my story can help you in your life.

Serving the Lord, being with family, engaging in sports, and being in the outdoors were always and still are precious aspects of my life. My discipline, determination and drive helped me earn the opportunity to start varsity football as a freshmen in high school. At the time, my brother was a senior on the team. I wouldn’t trade this experience for anything.

Things started to take a turn when I found out later my freshman year that I had a torn labrum in my shoulder as a result of wrestling. I underwent surgery in late February and began the rehabilitation process. I did not want this to happen again. The thoughts of becoming the best athlete began to rain in my head. These thoughts developed into an obsession with physical training and diet which grew into the development of anorexia. I would fight this disorder, winning and losing battles, until the end of my junior year of college. Let me share with you how I broke the chains of my eating disorder and learned to be free.

My healing began during my junior year of college, when I decided I was tired of being a slave to an eating disorder. I knew there was light on the other side. With the help of a therapist I began to take action. I disciplined myself to eat one new meal a day. I will tell you this was one of the hardest tasks I ever set upon myself. I would sit and shake during these meals and my eating disorder screamed inside of me. No matter how afraid I was, I remained disciplined and bold and continued on with the war, one meal at a time. Over the course of the next few months, my disordered thoughts grew smaller, and I started to recognize the difference between my own thoughts and the lies of the eating disorder. This was the first time in years I could truly say I had grabbed my eating disorder and thrown it to the ground. I was in control. I was back in the light and being the hard-living person I strive to be.

Being in recovery vastly improved my life. I met my wife the next fall during my senior year. I graduated with my bachelor’s degree in exercise science and also obtained my master’s in exercise science with an emphasis in strength and conditioning.

I tell you my story to show you that the road is a challenge. It is up to you, but you don’t need to do it alone. There are people in your life who will support you and be in this with you. Use them, lean on them, pray, and most importantly, dig your own feet into the ground and stand tall and face this demon. With discipline and boldness you can win and grow into the person you want to be.

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Dieting is ubiquitous in our culture. Everywhere we turn, there’s another commercial for a weight loss pill, an article about a new “miracle” diet, or a show like The Biggest Loser reinforcing the perception that society values thin bodies and respects those who are willing to go to extremes to lose weight.

Unfortunately, this cultural pressure leads a lot of people to try the latest fad diets. But the truth is, most of these diets aren’t healthy or effective. Diets often demonize certain kinds of food and even cut out entire food groups that our bodies need to properly function. Also, many people fall into a stressful cycle of yo-yo dieting—losing weight for short periods of time, only to gain it back.

Dieting is also a significant risk factor for developing an eating disorder. That’s because diets almost always involve restrictive behaviors. When we restrict what we eat, we deny our body something that it’s signaling it needs. Engaging in extreme restriction can result in malnutrition and starvation, which, at a neurobiological level, could trigger an eating disorder.

Of course, not everyone who diets will develop an eating disorder. Some people have a biological predisposition that puts them at much higher risk for an eating disorder than others. Restricting food intake, dieting or otherwise changing the way someone eats can trigger this genetic predisposition. This trigger, on top of environmental factors, can lead to anorexia nervosa, bulimia nervosa, binge eating or other eating disorders. So, if you happen to be vulnerable to an eating disorder, beginning a restrictive diet could lead to an illness that was not previously present.

Even if you aren’t at higher risk for an eating disorder, it’s important to be aware of the risks associated with dieting. An approach to food, eating, and weight based on a balanced self-care perspective rather than external, diet-based perspective will promote health and well-being. If you know you may be susceptible to disordered eating because you have a family history of eating disorders, this is especially true. Overall, fad diets have very little upside, but a large potential downside.

If you have questions or concerns about weight or nutrition, consult a dietitian or other health care professional for guidance. Changes in diet and weight can drastically affect physical and mental health. A professional can help you cut through the noise of a diet-obsessed culture and develop a healthy relationship with food.

AuthorMark Warren, M.D.
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This is one person's story; everyone will have unique experiences on their own path to recovery and beyond. Some stories may mention eating disorder thoughts, behaviors or symptom use. Please use your own discretion. And speak with your therapist when needed.

by Katie Monsewicz, an avid writer and practicing journalist who has been through The Emily Program's residential treatment program. She wants to help others who have struggled with eating disorders - and those who are still struggling - through her writing and as an advocate for eating disorder recovery.

I’m an adult now. (Insert image of me shouting from the top of a cliff like in “The Lion King” movie.) Wow. That was tough to get out.

I just turned 21 last month, marking nine years of the harrowing illness that has taken over much of my life, much of my memory, many of my relationships. An eating disorder is like moss on a rock. Some people think it’s beautiful (which is pretty strange) and most see it as a nuisance, an invasion. But it takes you over and you can’t shake it without any help from an outside force.

Flip the numbers in my age and you have the number 12. That’s the age my eating disorder began. Perhaps I’ll go into detail some other time because that story feels much older and much more complicated than moss on a rock. I think a lot about how I’ve survived these past nine years. I think about the years it took me to finally get treatment. About the major role my own mother played in pushing me to get better. I think about my friends siccing the guidance counselor on me in school. I think about my more recent stay at The Emily Program in their residential treatment and the healing I experienced there. But I never acted in getting better without someone else telling me I had to.

I want to share with you some words of encouragement that I would tell my past self nine years ago today. I hope you can relate and choose your own words of encouragement that we all so desperately need.

1. You were right.

“Whoa. Wait a minute. You’re telling a person with an eating disorder that he or she is RIGHT?!”

Let me explain.

The negative way you talk about yourself or see yourself in a mirror isn't right. But we all seek validation in some sense that we are right. I was right about how I felt. How I saw myself ten years from then. I was right about saying how this eating disorder was going to be a lifelong battle. It’s gotten easier with age, but I’m still fighting. And it’s made me strong.

2. You are loved.

That's more like it.

I thought too much about not loving myself and ignored the fact that other people love me. My mother. My father. My brother. My friends. They all love me and they all have their own way of showing it. Sometimes that meant yelling at me to get better, and making me cry over a teaspoon of butter. Now, I recognize their love and I celebrate it with every hug, kiss, and laugh.

3. You are not alone.

You may have seen there is a community of those suffering from eating disorders. Maybe you’ve been to a residential or an inpatient program and that’s how you met your ED friends. Or, you have an Instagram account and use hashtags like #eatingdisorderrecovery. In both of these ways, I have learned that there are girls (and boys), women (and men), going through very similar struggles that I have. I used to think I was just this weird kid who couldn’t bring herself to eat more than a few crackers without having a panic attack. It’s nice to know there are people in this world to share these feelings with.

4. You have purpose.

Believe it or not, your eating disorder does not have to take over every aspect of your life. My eating disorder has always made me feel unmotivated, unwanted, and undeserving. But there has always been one thing that ripped me out of that world, put me at a desk, and laid my hands on a keypad: writing. That is my purpose because I’m not too shabby at it and it makes me feel useful. You have a purpose in this life. You might have many. Look deep into yourself, your talents, what you enjoy doing, and put that eating disorder energy into that for a few minutes and see how you feel.

5. You deserve to be happy.

Ever since my eating disorder started, I never thought I could be happy. Diagnosed with clinical depression, I have a tough time looking at the brighter side of things. I get sad, angry, frustrated, and absolutely miserable. But in those moments that I am happy - and they can be small or big - I now feel like I deserve it. I’ve been suffering for so long, and praying for so long, that happiness feels worked for. I believe in working everyday toward one goal: happiness. You deserve to be happy.

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This is one person's story; everyone will have unique experiences on their own path to recovery and beyond. Some stories may mention eating disorder thoughts, behaviors or symptom use. Please use your own discretion. And speak with your therapist when needed.

Lisa Whalen, a former Emily Program client, has a Ph.D. in postsecondary and adult education, and an M.A. in creative and critical writing. She teaches writing and literature at North Hennepin Community College in Brooklyn Park, Minnesota. Her essays have been featured in An Introvert in an Extrovert World, WorkingUSA: The Journal of Labor and Society, and MotherShould? Whalen is working on publishing her memoir, Taking the Reins. In the meantime, she is a regular contributor to The Feisty Writer and maintains a blog called, Writing Unbridled.

On April 6, 2018, I stood in a college auditorium and scanned rows filled by my faculty colleagues, students, family, and friends—the people I most admire and want to respect me. Then I said something I never thought I’d utter aloud: “For more than a decade, I battled an eating disorder and depression.” That sentence began my faculty lecture series presentation, where I discussed a memoir I’d written about recovering from the eating disorder with the help of an Emily Program therapist and 12 special horses.

That I could address an audience—any audience—showed just far I’d progressed in my recovery. The perfectionism that drove my eating disorder had also made me terrified of speaking in classrooms from kindergarten through graduate school. Similarly, when my therapist suggested group therapy, I’d panicked and almost stopped seeing her.

In hindsight, I wish I’d been more open-minded. I’ve discovered in the years since completing individual therapy that the more open I am about my eating disorder, the less power it wields. But I’d never have talked about it if I hadn’t written about it. And I’d never have written about it if I hadn’t stumbled into a life-changing discovery by signing up for what I thought would be a handful of horseback riding lessons. From my first introduction to a Thoroughbred named Angie at Seventh Farm riding school in River Falls, Wisconsin, interacting with horses became a practicum where I embodied what therapy taught me. Six years later, I’m still garnering insights from every lesson.

My first insight was that horses don’t care how I look; they only care how I treat them. Whether I roll out of bed and head straight to the barn or arrive in makeup and mousse from teaching classes, they regard me the same. Their constancy soothes like a balm from the second I step into the barn. It also encourages me to practice new and better ways of being in my body.

Horses communicate with their bodies: Every tail swish, ear flick, and lip lick makes a statement. To converse with them, I must pay attention. I must stay present and listen with my eyes and heart so I can hear what they say.

Horses establish relationships by giving and taking personal space. To partner with them, I must set and maintain boundaries. That means claiming—and even expanding—my physical presence. It means staying calm and projecting confidence—whether I feel it or not. It means convincing each horse that I will take charge, lead, and keep him/her safe. As I learned during my first groundwork session with Angie, earning a horse’s trust can create magic: I can get her to move when, where, and how I ask without physical contact. I simply aim my core (solar plexus area) at the part of her body I want her to move, channel my energy through the space between us, and step forward. Just like that, Angie moves. She also licks her lips—a signal that she feels connected to me and trusts my leadership. I, in turn, feel powerful. The more I lead horses on the ground this way, the more comfortable I become leading students in the classroom.

Climbing on a horse’s back has shifted my bodily priorities. To control a 1200-pound animal with a mind of her own, I must be healthy. Feeling weak, lightheaded, or nauseous puts both the horse and me in danger. Early in my lessons, when I struggled to care about myself enough to get well, I always cared about Angie. That care bolstered my efforts toward recovery. Soon, I cared about myself, too. And I became more interested in being strong than being skinny.

Learning to jump fences on horseback requires me to be in my body, to pay attention to how it feels, because it tells me everything I need to know to stay safe: our speed, approach, takeoff, jump height, and landing. The only close calls I’ve had while jumping resulted from getting lost in my head—a holdover from the eating disorder and a pitfall of working in academia. But when I stay grounded in my body, the horse and I not only remain safe, we have fun—a lot of fun.

Horses remind me with our every interaction that being in my body can serve as a source of pleasure rather than pain. They also show me how good it can feel to be myself. Now that I know, I want to help others discover how good it can feel to be themselves, too.

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Since joining The Emily Program last March, Amy Allyn has worn different hats to meet the various needs of her clients.

She began as a case manager at Seattle Residential, working closely with the treatment team to coordinate discharge and connect clients with helpful resources. Today, Amy now serves as The Emily Program’s program support coordinator, where she manages admissions to the Seattle facility.

Though she has enjoyed both roles, she is honored to facilitate the tremendously difficult decision to choose treatment and recovery.

“I’m motivated by the work we do, helping clients achieve lasting recovery from their eating disorders — EDs are a beast!” she said. “One of my favorite quotes is, ‘The first step towards getting somewhere is to decide that you are not going to stay where you are.’ The initial decision to choose treatment is one of the hardest decisions to make in recovery, but such an important step!”

Amy graduated from Western Washington University in Bellingham, WA, with a bachelor’s degree in psychology and now is working toward a Master’s of Science in Mental Health Counseling at Capella University.

Learn more about Amy and why we think she stands out!

TEP: What can clients expect from programming?

Amy: From residential programming, clients can expect 24/7 support from experienced staff who are always there to help them when they’re struggling.

Clients will have appointments with an individual therapist twice a week, dietitian twice a week, psychiatric provider once a week and medical provider once a week. The goals in residential are symptom interruption, nutritional and medical stabilization, and learning new coping skills to replace eating disorder behaviors when they eventually discharge back home and/or to a lower level of care.

TEP: What’s the most common concern you hear from clients?

Amy: I am at the front lines when clients make the decision to pursue residential treatment, so I hear many concerns! The most common question I get is: “How can I possibly put life obligations on hold?”

For work, our providers help clients fill out FMLA and short-term disability paperwork. For school, we help clients make arrangements with their instructors to complete courses remotely/online or some clients take medical leave or utilize tuition reimbursement.

We understand life can’t exactly be put on hold and the world doesn’t stop just because they’re in treatment, but at the same time, eating disorders take away from the full potential of their life.

TEP: What do you enjoy doing in your free time?

Amy: School takes up much of my free time, so I take opportunities to do self-care and vacations as much as I can. I attend concerts and live music whenever possible, and photography, yoga and meditation are also ways that I take care of myself.

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