Barriers to holistic treatment exist for Eastern Iowa eating disorder patients

Providers and advocates ask for mental and physical treatment of eating disorders

A group therapy room at the Behavioral Health Services department is shown at the University of Iowa Hospitals and Clinics in Iowa City on Wednesday, Sept. 14, 2016. (Adam Wesley/The Gazette)
A group therapy room at the Behavioral Health Services department is shown at the University of Iowa Hospitals and Clinics in Iowa City on Wednesday, Sept. 14, 2016. (Adam Wesley/The Gazette)

When Michelle Kuster was a 21-year-old Iowa State University student battling an eating disorder, her heart began fluttering one day.

The numbness in her fingers and toes and other symptoms were severe enough that she went to the emergency room.

Though she hadn’t told anyone else, she was in the throes of restricted eating, bingeing and purging. Kuster told the doctor about it. The doctor treated her dangerously low potassium levels — then sent her on her way.

“I thought, ‘I told them, they know what to do,’” said Kuster, now a 29-year-old dietitian at a Hy-Vee in Burlington. “They didn’t know how to address an eating disorder. They wrote it down, but that was about it. They didn’t ask more questions, didn’t address it.”

It was then that Kuster — since recovered and a board member at the Eating Disorder Coalition of Iowa — said she learned there is a disconnect between physiological and mental health treatments for eating disorders.

“It’s just mind blowing that they don’t have the training in it,” she said. “That’s something that we need to change so patients can get proper care.”


An estimated 101,480 Iowans — about 3 percent of the state’s population — have an eating disorder, according to the Eating Disorder Coalition of Iowa.


A team of local researchers agrees with Kuster — that there has to be a better way of treating them and then persuading health insurance companies to get on board.

A group at Cornell College in Mount Vernon is using results of a study on the cardiac functions of eating disorder patients to push for treatments that merge both the physical and mental for the patients.

Melinda Green, an associate professor specializing in eating disorder research in the psychology department at Cornell, and her team partnered with Tanager Place Research Center, an offshoot of Tanager Place Mental Health Clinic, for multiple eating disorder studies.

For one study, soon to be published in European Eating Disorders Review, Green and her team of Cornell faculty and students focused on searching for cardiac markers, since cardiac disease is the leading cause of death for eating disorder patients.

Green’s team found that for eating disorder patients, the bottom two ventricles of the heart — those that push blood out into the body — have a force of contraction much lower than healthy patients. Their heartbeats were irregular, too.

The Cornell study also concluded that adverse symptoms improved for eating disorder patients who received the full treatment.

Green said she hopes this study provides guidance for adequate treatment so mental illness and physiological conditions are addressed in the same treatment plan.

Eating disorders are classified as a mental illness, but Green said a national emphasis exists on research showing its physical toll.

“We’re about a century behind in medicine,” Green said. “There’s this whole notion that the mind and body are separate. We know today that’s completely untrue, but the stigma persists that somehow mental illness is different.”


Michelle Roling, co-founder of the Eating Disorder Coalition of Iowa, said it’s important to treat life-threatening physiological effects — but then also to address anxiety, depression or other mental disorders that may have caused the physical effects.

“Eating disorders don’t develop independent of other struggles,” Roling said. “Most of the time, there’s some form of dual diagnoses. The goal for anyone is holistic recovery. It’s important that everyone (involved in a treatment plan) has understanding of what the overall goal is. That promotes a lot of readiness for change.”

Patients could receive the merged treatment next year in the same facility where research is done.

George Estle, head of the Tanager Place Research Center, said the center is working on a collaborative effort between Green’s team at Cornell College, Coe College, Mount Mercy University, St. Ambrose University and the University of Iowa to have a research and treatment center within Tanager Place Research Center.

“We don’t have a very good involvement of active research that’s going on, nor do we have much ability to drive or direct where that research goes that can be applicable in day-to-day practice,” Estle said. “The goal behind the center is a research-based treatment program.”

But health insurance companies also must see the necessity of holistic treatment so reimbursement rates for medical professionals treating mental illness are adequate enough.

“This is a push to try to create a structure where there can be better reimbursement for conditions that are at the interface of behavioral health and physical health,” Green said.


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As it stands, the UI Eating Disorder Treatment Center is the only inpatient treatment center in Iowa.

“There really aren’t enough organized programs in the state, and there aren’t enough providers to work with the number of people who develop an eating disorder,” said Dr. Wayne Bowers, clinical director of the treatment center.

The center has 10 spaces available for a treatment program in which patients come for physical and psychiatric care on weekdays.

The center’s inpatient treatment center — for those with severe enough symptoms to require hospitalization — houses 15 beds for children and adolescents and eight beds for adults.

Before the mental aspects of a disorder can be treated, professionals first treat life-threatening medical issues, Bowers said.

But insurance companies reimburse providers much less for mental health treatment, even if part of the treatment is for physiological issues.

“We’re initially treating the effects of starvation,” Bowers said. “What tends to occur is (insurance companies) see a psychiatric diagnoses first, and then they say it’s (only) psychiatric as opposed really treating starvation or a cardiac problem.”

Though only 0.5 percent of Iowans suffer from anorexia nervosa and 1.5 percent have bulimia nervosa, eating disorders are the most deadly of mental illnesses.


“Not that eating disorders are the only specialty that needs some focus, but there certainly needs to be support from the state of Iowa to focus on mental health issues period,” Bowers said.



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