Denver emerges as hub for eating-disorder care
By Jennifer Brown, The Denver Post 03/29/2009 When Linda Ward felt fat, she didn't allow food down her throat. She chewed it and spit it out — so fiercely that blood blisters covered the inside of her mouth. At her worst — and Ward has hit bottom and entered treatment centers six times — she weighed 71 pounds, closer to the weight of an 11-year-old girl than a 5-foot-5, 56-year-old woman. Ward's latest stint was at Denver's new Eating Recovery Center, a hospital that seems more like a spa, with white, fluffy towels and jet tubs, a plant-filled sun room, spaces for yoga and massage, and a gourmet chef.
The October opening of the center boosts Denver's profile as a national hub for treating eating disorders. The hospital east of downtown is one of only a handful in the country that treat anorexics sick enough to need hospitalization, and carries them through to residential and daytime programs. The 12-bed hospital — already undergoing an expansion to 24 beds — complements Denver Health's 5-year-old A.C.U.T.E. Center for Eating Disorders, one of the top spots in the nation for stabilizing anorexic and bulimic patients on the verge of starving to death. And for adolescents, there is care at Children's Hospital in Aurora. "Denver is sort of a mecca for eating-disorder treatment," said Dr. Ken Weiner, medical director and a founder of the Eating Recovery Center. The new hospital filled a regional void. Now, eating-disorder patients can get all levels of care without leaving the city, and a sustained support system is crucial to recovery, Weiner said. Denver Health's Dr. Philip Mehler, a nationally known specialist in the treatment of medical complications from eating disorders, stabilizes the most severe patients with intravenous nutrition, stomach pumps and food. When they're ready, some patients move to the Eating Recovery Center, where they start with 24-hour nursing care, psychiatric therapy and supervised trips to the bathroom and dining room. Among the recent transfers from Denver Health to the Eating Recovery Center were a 5-foot-8 woman who weighed 63 pounds and a 5-foot-7 woman who weighed 62 pounds. Recurring problem Ward has relapsed almost immediately after leaving various treatment centers across the country. She made it only as far as the airport upon checking out of a Philadelphia center before she starting chewing and spitting her lunch. While at a California hospital, Ward figured out how to detach her feeding tube. When nurses left the room, she squeezed the calorie-packed "re-feeding" shakes out of her stomach and into the toilet. She still recalls that the liquid packed 350 calories per cup. Ward was admitted to Denver's Eating Recovery Center a few months ago weighing only 78 pounds. Her cheeks were sunken, her frame almost skeletal. She came to the hospital because she knew where she was headed, and it was easier to go there than make herself eat. Ward lived at the center for several weeks, then progressed to staying in her apartment but spending almost 12 hours each day — all meal and snack times — at the center. She was discharged from the program this month, though she continues to see a psychiatrist there. Ward smiled as she recalled how she ate a turkey sandwich, potato chips and a fudgesicle that first night on her own — even though she wasn't hungry. "Usually, the eating-disorder voice says you can skip dinner this one time," she said. "That's a lie. Eating-disorder voice lies." For one of the first times in her life, Ward doesn't know exactly how much she weighs. Her doctor says maybe 100 pounds, though her ideal weight is 125. She feels "more hopeful" this time, like maybe this treatment will stick. But she's not cured. "I'm still dealing with my fear of food. I'm still dealing with my hatred of being full." Damaged by perceptions Rich, willowy and blond — that's the perception of anorexia. Perhaps those types of girls are the ones who most commonly can afford treatment, said Lynn Grefe, chief executive officer of the National Eating Disorders Association. The top three professions of fathers of girls with the diagnosed disease are doctors, lawyers and engineers. Treatment centers typically cost about $30,000 per month. Residential treatment at Denver's new hospital can cost even more. Insurance companies increasingly are paying for treatment but still have weight requirements — it's common that patients are turned away for not being skinny enough or are kicked out before treatment is complete because they have gained the weight dictated by their insurance company, not their doctor, Grefe said. A year-old state law requires group health insurance policies with at least 50 employees to cover treatment for anorexia and bulimia. Medicaid covers treatment if the center accepts it, which the Eating Recovery Center does not. Nor does the Denver center accept pro bono patients, although a goal of the Denver-based Eating Disorder Foundation is to someday pay for treatment for those who can't afford it. Weiner declined to discuss how much it cost to open the hospital or its expected profit margin. More than 30 investors helped secure funding for the facility at East 18th Avenue and Franklin Street. Danger signs Using a knife and fork to eat a sandwich. Counting the number of chews before a swallow. Guzzling water before a meal. Those are eating-disorder warning signs, unacceptable behaviors posted on the wall in the chandeliered dining room at the Eating Recovery Center. Chef Victor Agena gets fruits and vegetables four times each week, and he stocks 11 herbs to make his tomato-basil soup, Napa Valley salmon and gourmet omelets. His job is to serve food so good, produce so fresh, that patients can't use taste as an excuse not to eat. Meal time is high anxiety for patients, who must drink a nutrition shake if they don't eat the food on their plate. At first, staffers watch them to make sure the food goes in their mouths, not in their pockets. Near the end of treatment, patients learn to cook their own meals. "When you sit down to eat a meal and it looks like poison to you, you are going to have anxiety," said Dr. Emmitt Bishop, a psychiatrist and one of the center's founders. Anorexia and bulimia patients are disconnected from reality, emotion and relationships with others, Bishop said. Risk factors for the disease are about 50 percent genetic and 50 percent psychological or social. An estimated 1 percent of U.S. women ages 13-35 have anorexia and 2-4 percent in that age group have bulimia. It is the deadliest psychiatric illness. Public awareness of anorexia and bulimia exploded in the 1980s, when eating-disorder stories frequently made magazine covers. Media attention has chilled, yet prevalence of the disease has increased. "It hasn't gotten better," said Grefe of the National Eating Disorders Association. "Our TV screens are getting bigger, but people are shrinking. There is a superiority now, the sense of 'I'm a failure if I'm not a size 2.' There are a lot of crumbling egos around it, too." The association works to remove the stigma of shame associated with anorexia. "If everybody is in denial and they think that this is a blame disease, then they are not going to get help," Grefe said.