Dropping inpatient eating disorders treatment at UIHC is a failure

I have worked exclusively in the field of eating disorders for over 15 years as a Registered Dietitian. The fact that UICH is dropping the eating disorder program to “broaden mental health needs” per Dr. Peggy Nopoulos brings up problematic issues.

With most mental health illnesses, there are times when a person can do well on an out-patient basis and times they need to be hospitalized or attend a PHP to stabilize. Eating disorders as a mental health illness also use levels of care from in-patient to out-patient care. All of these levels are distinct and provide different services.

UIHC is literally the only hospital in the state of Iowa to treat eating disorders on an in-patient basis. With the loss of this program, the people of Iowa who have eating disorders will not receive any type of service in their most desperate and ill times. There are multiple other hospitals and clinics that treat other mental health disorders such as depression and anxiety which a patient can go to, but not so with eating disorders.

Eating disorders are very complex illnesses: eating disorders have the second highest mortality rate of all mental health disorders, surpassed only by opioid addiction.(1) Among those who struggle with anorexia; 1 in 5 deaths is by suicide.(2) There is a markedly elevated risk for obsessive-compulsive disorder among those with eating disorders.(3) Individuals with bulimia nervosa, binge eating disorder, or any binge eating have significantly higher rates of PTSD than individuals without an eating disorder.(4) 32-39% of people with anorexia nervosa, 36-50% of people with bulimia nervosa, and 33% of people with binge eating disorder are also diagnosed with major depressive disorder.(5) 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with anxiety disorder.(6) Traumatized people with eating disorders demonstrate high levels of dissociative symptoms, such as being unable to remember the traumatic event.(7)

Eating disorders are associated with some of the highest levels of medical and social disability of any psychiatric disorder.(8) To close the program when the people of Iowa need it to remain open seems very irresponsible and short sighted on the part of the university. I do agree that the eating disorder patient has a longer length of stay than other mental health patients due to their complexity, yet don’t they deserve care or are they too expensive to care for and therefore expendable?

As a teaching hospital, to eliminate some of the most complex mental health patients is a disservice to the medical residents and students as it decreases the knowledge and experience they will to bring to their communities when they are finished with their residency.

It is a complete failure for the state of Iowa to eliminate the in-patient program when no other program like it exists in the state. Nowhere in the mission, vision or core values stated by UIHC does it say it will serve the needs of the people of Iowa. That needs to change as Iowa tax dollars help support UIHC.

Sue Clarahan, RD, LD is a registered dietitian who has over 40 years of experience in the field of dietetics, with the past 15 years exclusively working with eating disorders. Her experience includes counseling clients in the home, hospital, and clinical settings. She received the 2007 Iowa Recognized Dietitian of the Year and was named the EDCIowa Volunteer of the Year in 2018.

1.Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13(2), 153-160.

2.Papadopoulos, F. C., A. Ekbom, L. Brandt, and L. Ekselius. "Excess Mortality, Causes of Death and Prognostic Factors in Anorexia Nervosa." The British Journal of Psychiatry 194.1 (2008): 10-17.

3.Altman, S. E., & Shankman, S. A. (2009). What is the association between obsessive-compulsive disorder and eating disorders? Clinical Psychology Review, 29, 638-646.

4.Dansky, B. S., Brewerton, T. D., O'Neil, P. M., & Kilpatrick, D. G. (1997). The National Womens Study: Relationship of victimization and posttraumatic stress disorder to bulimia nervosa. International Journal of Eating Disorders, 21, 213-228.

Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry, 61(3), 348-358. doi:10.1016/j.biopsych.2006.03.040

5.Hudson JI, Hiripi E, Pope HG Jr, and Kessler RC. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3):348-58.

"NIH Categorical Spending -NIH Research Portfolio Online Reporting Tools (RePORT)." U.S National Library of Medicine. U.S. National Library of Medicine, 3 Jul. 2017. Web. 11 Jan. 2018.

Milos, G., Spindler, A., Buddeberg, C., & Crameri, A. (2003). Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychother and Psychosom, 72(5), 276-285.

6.Hudson JI, Hiripi E, Pope HG Jr, and Kessler RC. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3):348-58.

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Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L., & von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from a large clinical database. Psychiatry Res, 230(2), 294-299.

7.Brewerton, T. D. (2004). Eating disorders, victimization, and comorbidity: Principles of treatment. In T. D. Brewerton (Ed.), Clinical Handbook of Eating Disorders: An Integrated Approach (pp. 509-545). New York: Marcel Decker.

Brewerton, T. D., Dansky, B. S., Kilpatrick, D. G., & O'Neil, P. M. (1999). Bulimia nervosa, PTSD, and forgetting results from the National Women's Study. In L. M. Williams & V. L. Banyard (Eds.), Trauma and Memory (pp. 127-138). Durham: Sage.

8.Klump KL, Bulik CK, Kaye W, Treasure J, Tyson E. Academy for Eating Disorders Position Paper: Eating Disorders are Serious Mental Illnesses. Int J Eat Disord. 2009 Mar;42(2):97-103. doi: 10.1002/eat.20589.

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