Within Health expands options for eating disorder treatment

On Nutrition

One of the many things the pandemic has brought us is a serious uptick in eating disorders. But even before we ever heard of COVID-19, many people with eating disorders such as anorexia, bulimia and binge eating disorder never received the treatment they needed, for a multitude of reasons. That’s a big problem when you consider that eating disorders have the highest fatality rate of all mental illnesses.

Psychiatrist Wendy Oliver-Pyatt was doing telepsych consultations with people all over the country before the pandemic even started — and observed how beneficial they could be. She decided to use her experience creating traditional in-person eating disorder treatment programs to provide modern and clinically sophisticated virtual eating disorder care.

Shortly after COVID did enter our lexicon, Oliver-Pyatt had a serendipitous meeting with entrepreneur and digital marketer Abhilash Patel, who had experience with addiction recovery and behavioral health organizations. Their visions of high-quality virtual eating disorder care aligned, and they launched Within Health in June 2021, offering treatment to people with eating disorders who wouldn’t otherwise receive care because “brick and mortar” treatment centers aren’t right for them.

Some patients reach out to Within Health because they come from rural areas with no treatment options, or because they can’t or won’t leave their families — or work or school — to go into residential treatment. “We have some patients under our care who have young kids at home and they don’t have a way to go away to treatment,” Oliver-Pyatt said. “We had one patient who’s a massage therapist, and if she doesn’t give massages, she doesn’t pay rent.”

Within Health also offers a safe space for people who simply might not feel comfortable in traditional eating disorder treatment settings, including people in larger bodies, Black, Indigenous and people of color, and males. Patients can work individually with staff and find a common thread with someone else with a similar lived experience so they don’t feel isolated or stuck in a group with no one they can relate to. When Within Health launched, one patient had “atypical” anorexia — when someone has all the symptoms of anorexia except for being underweight — and another had binge eating disorder and was in a larger body. Oliver-Pyatt said neither patient was willing to consider traditional treatment.

Within Health’s treatment uses a biopsychosocial approach — looking at how biological, psychological and socioenvironmental factors interact to cause eating disorders — but Oliver-Pyatt said what really makes Within Health different from many eating disorders treatment centers are their other guiding principles. “Our program is grounded in an understanding of Health at Every Size and of what weight stigma is and how traumatizing it is — the alienation and the isolation and the despair is so profound,” she said. “As much as specialized treatment and specialized programming is important, it’s also important that the treatment center and all the people who work there are aligned on these issues. There’s treatment, and there’s philosophically grounded treatment. It’s not just checking off boxes.”

Within Health offers intensive outpatient (two to four hours per day, three to five days per week) and partial hospitalization programs (six to 12 hours per day, seven days per week), with patient treatment teams that include nurses, psychiatrists, therapists and dietitians. These teams collaborate with each patient’s preexisting health care team, with family and loved ones, and with care partners who can help patients do things in their own community. Patients eat meals and snacks on camera to replicate the supported meal environment of in-person care — they receive delivered meals to start, then eventually receive recipes and ingredients so they can learn how to cook their own meals. Families can access the patient’s schedule — as well as their own schedule for family coaching, therapy sessions and support groups — via the program’s app.

Oliver-Pyatt points out that Within Health is intentionally virtual — this isn’t a watered-down version of in-person treatment. “We think there’s a place for in-person treatment and we think some people do better with in-person treatment. But we also think there are some advantages to working in the home.” For example, she said her program can effectively interrupt the progression of an eating disorder in adolescents and provide family education “so it doesn’t become a fire that parents have to try to put out on their own.”

She said Within Health’s intake team does refer people to in-person treatment when it’s appropriate, and some patients use virtual care as a step down from more intensive in-person treatment, so they have help translating the treatment they received within the structured environment of residential care into their home environments. “We can be there with them and do things with them in their homes and in their community,” Oliver-Pyatt said. Care partners can do pantry checks to make sure patients have the foods they need to cook and be with them when they eat in a restaurant for the first time post-treatment.

For some patients — including those who feel traumatized by a previous bad experience with in-person treatment — Within Health serves as a pathway to traditional treatment. “It could be that coming to us is the first step to going to a brick and mortar,” Oliver-Pyatt said.

While Within Health offers traditional levels of care, they don’t adhere to the traditional model that all the hours have to be back-to-back. “We provide service that can kind of wrap around the patient’s life,” Oliver-Pyatt said. “We really have seen the effectiveness of the type of care that can be kind of sliced and diced into their day.” For example, a student who needs six hours of partial hospitalization might have breakfast virtually with their team, then go about their day and reconnect in the evening for sessions and supported meals and snacks. “There’s a lot of ways to sort out the treatment,” she said. “It’s really important, because where things are working in their life, where things are going well, we don’t have to take that away.”