Food and Policy

When we talk about eating disorders, the conversation often becomes intensely individual. We ask what someone is eating, how they feel about their body, whether they are seeking treatment, or what choices they could make differently.

Eating disorders do not exist in a vacuum.

The ability to recognize an eating disorder, find appropriate care, afford treatment, access enough food to follow a meal plan, receive culturally responsive support, and recover without being repeatedly confronted by harmful messages about food and bodies is shaped by the systems surrounding us. Those systems include healthcare, insurance, schools, food assistance programs, public health messaging, and the policies that determine who can access each of them.

That is why eating disorders should not be viewed only as individual health conditions. They are also a public health issue.

Public health has an important role in helping people understand nutrition and preventing chronic disease. But the way those messages are communicated matters, especially for people who have experienced or are vulnerable to eating disorders.

Food is often presented through moral language. Some foods are described as “good” or “bad,” while eating certain foods is associated with discipline, health, or success. Body size can become similarly moralized, with health treated as something that can supposedly be determined by appearance alone.

These messages may seem harmless when considered individually but public health messaging reaches people with very different histories, circumstances, and vulnerabilities.

The issue is not that public health should stop discussing nutrition or chronic disease prevention. The real issue is that those conversations need to account for how the same message can affect different people differently, particularly for people with a history of an eating disorder, for whom intentional diet changes or purposeful weight loss may carry additional risks.

Nutrition education is not inherently harmful. However, pIublic health communication needs nuance.

A message designed for population-level prevention cannot assume that every person receiving it has the same relationship with food, the same medical history, or the same resources. Public health should be able to promote health without reinforcing the idea that there is one correct way to eat, one correct body to have, or one measure by which a person's health can be judged.

Health advice also assumes access to resources.

Consider food insecurity.

It is difficult to tell someone to follow a particular meal plan, purchase specific foods, eat consistently, or make intentional nutritional changes when they do not know where their next meal is coming from.

Programs such as SNAP and WIC exist partly because access to food is itself a public health concern. School meal programs serve a similar purpose for children and adolescents. These policies are not simply about providing calories. They can determine whether people have consistent access to food in the first place. For someone recovering from an eating disorder, that matters.

Recovery may require regular and adequate nourishment, flexibility around food, and support from people who understand the disorder. When food is financially inaccessible or unpredictable, following treatment recommendations can become significantly more difficult. Clearly, telling someone what would be healthiest is not the same as making that option realistically available to them.

A public health system cannot separate health behavior from the conditions that make those behaviors possible. And the same principle applies to healthcare. Being able to recognize an eating disorder is part of access.

Eating disorders do not have one appearance. They affect people across genders, races, socioeconomic backgrounds, ages, and body sizes. Yet stereotypes about who “looks sick” can influence whether symptoms are recognized by patients, families, schools, and healthcare providers.

That matters because delayed recognition can become delayed treatment.

Research increasingly shows that the people facing the greatest barriers are not simply people who live far away from a treatment center. They may be people whose insurance is not accepted, whose symptoms are not recognized, whose cultural or socioeconomic circumstances are not adequately understood, or whose diagnosis does not fit traditional expectations of what an eating disorder is supposed to look like.

Penwell et al. (2024) examined 1,995 people seeking eating disorder treatment in the United States. Only about 20% of people with eating disorders receive treatment overall, and financial barriers, including lack of insurance coverage, were the most frequently reported obstacle. People with historically underrepresented identities and people with OSFED reported additional barriers involving finances, geography, identification of the eating disorder, sociocultural factors, and treatment quality. The researchers also found that greater barriers were associated with more severe symptoms and poorer illness trajectories.

The problem, then, is not simply whether someone wants help. It is whether the healthcare system makes that help possible.

Insurance can determine what treatment is actually available. One of the clearest examples comes from Moreno et al. (2023), who studied 1,060 racially and ethnically diverse youth ages 11–25 who presented to an adolescent medicine program with malnutrition related to disordered eating. The disparities were striking.

After accounting for demographic and clinical factors, youth with public insurance were only about one-third as likely to receive recommended treatment as youth with private insurance. Latinx patients were about half as likely, and Asian patients were also about half as likely, to receive recommended treatment compared with White patients.

The authors concluded that access to evidence-based mental health treatment is a necessary first step toward health equity for people with eating disorders. That finding makes the phrase “just get help” much more complicated.

If the type of insurance a young person has changes their likelihood of receiving recommended treatment, then access is not simply an individual responsibility. It is also a policy issue. And insurance coverage does not automatically mean that a treatment center exists nearby or accepts that insurance.

A 2026 study by Welch et al. examined intensive eating disorder treatment availability across the United States. Researchers identified 384 intensive eating disorder treatment centers across 45 states and Washington, D.C. Five states had no identified treatment centers in the study's database. Of the centers identified, only about one-quarter accepted Medicaid, compared with more than 90% that accepted commercial insurance.

In other words, having Medicaid does not necessarily mean having access to the same treatment options as someone with commercial insurance.

Geography creates another barrier. Even when someone has insurance and knows they need treatment, the nearest appropriate program may be hours away.

A 2026 study examining spatial and telehealth accessibility to eating disorder treatment found that in-person access was concentrated in metropolitan areas, with longer distances and lower accessibility in rural communities. Higher-income and urban areas were associated with shorter distances and greater accessibility. Telehealth expanded potential reach, but it remained constrained by broadband availability and state-based administrative boundaries. Telehealth is therefore an important tool, but it is not a magic solution.

A virtual appointment still requires reliable internet. It still requires a provider who can treat the condition. It may still be affected by state licensing rules. And for some levels of eating disorder care, virtual treatment cannot replace the need for in-person medical or behavioral support.

Where someone lives should not determine whether recovery is realistically available to them. Yet geography, insurance, income, and infrastructure can all interact to shape that reality.

And sometimes, access means waiting.

Even after someone finds an appropriate provider, treatment may not begin immediately. 

Waitlists are a particularly important part of the access conversation because the period before treatment is not necessarily a neutral period of time.

Keegan et al. (2024) studied 85 people with eating disorders who were waiting for cognitive behavioral therapy. The researchers found no evidence that brief waitlist interventions improved symptoms during the waiting period or during treatment itself. However, participants who received a brief intervention while waiting were three times more likely to complete treatment.That finding is important because it suggests that what happens between asking for help and actually receiving treatment can matter.

A 2026 systematic review and meta-analysis by Kranes et al. examined nine waitlist-controlled studies involving 647 participants, including 283 people in waitlist conditions. The researchers found a negligible reduction in eating disorder pathology while participants waited, with the plain-language summary noting that participants continued to report high levels of symptoms during approximately ten weeks of waiting.

The authors emphasized an important limitation: waiting in a research study is not exactly the same as waiting for treatment in everyday healthcare. Still, the findings demonstrate why a waitlist should not automatically be treated as though it were treatment itself. As Wade et al. (2024) explain, the evidence surrounding waitlist interventions remains limited, but some approaches show promise. Their review found that certain waitlist interventions may improve engagement with later treatment, while emphasizing that more research is needed. The larger point is simple: being placed on a list is not the same as receiving care. 

The disparities do not disappear once someone enters the healthcare system.

A 2025 study of more than 9,000 publicly insured youth in California examined treatment disparities across eating disorders, mood and anxiety disorders, and psychotic disorders. Across diagnoses, 50.7% of youth received no outpatient therapy during the first year after diagnosis. Youth with eating disorders were the least likely to receive outpatient therapy, while youth of color received fewer days of outpatient therapy than White youth.

The disparities were especially pronounced among youth with eating disorders, including boys and Latinx youth.

A related 2024 study examining publicly insured youth with eating disorders in California similarly found that Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced among Latinx youth. The researchers found high hospitalization rates alongside limited outpatient therapy.

These findings complicate the idea that hospitalization automatically means someone has received comprehensive care.

A person can reach a hospital and still face major gaps in outpatient treatment afterward. They can receive a diagnosis and still struggle to find a provider. They can have insurance and still be unable to find a center that accepts it. They can live in the same state as treatment programs and still live hours away from the nearest appropriate option. And they can ask for help and still spend weeks waiting for it.

So what does policy have to do with recovery? Almost everything that happens before, during, and after treatment exists within a larger system.

Policy can influence whether schools provide meaningful eating disorder education and whether students know where to seek help. Policy can influence whether healthcare providers receive adequate training to recognize eating disorders across different populations rather than relying on narrow stereotypes. Insurance policy can influence whether evidence-based treatment is financially accessible. Medicaid reimbursement and provider participation can influence whether publicly insured patients can actually use their coverage to receive specialized care. Telehealth policy and professional licensing rules can influence whether someone can access a provider across a state border. Broadband policy can influence whether telehealth is even a realistic option for people in rural or lower-income communities. Food assistance policy can influence whether people have consistent access to the food necessary to maintain their health. And public health communication can influence the environment in which people develop their understanding of food, health, and their own bodies.

None of these policies single-handedly cause or prevent an eating disorder. Eating disorders are complex conditions with biological, psychological, social, and environmental influences. But policy can determine whether someone has a realistic opportunity to receive support.

Individual responsibility should not mean systemic responsibility disappears. People still make choices. People still seek help. Families still advocate for their children. Healthcare providers still make clinical decisions. But individual agency exists within systems.

It is difficult to tell someone to advocate for themselves when they do not know what resources exist. It is difficult to tell a family to find a specialist when the nearest specialist is hours away. It is difficult to tell a young person to use their insurance when most specialized treatment centers do not accept it. And it is difficult to tell someone that recovery is available to everyone when the systems surrounding them determine whether they can actually reach it.

This is why eating disorder advocacy cannot stop at awareness. Awareness matters. Education matters. Early recognition matters. But so do the policies that determine what happens after someone realizes they need help.

We should ask whether schools are equipped to recognize warning signs without reinforcing stereotypes. We should ask whether healthcare providers are trained to identify eating disorders across race, gender, age, and body size. We should ask whether public insurance actually provides meaningful access to evidence-based treatment. We should ask why intensive treatment centers are so much less likely to accept Medicaid. We should ask what happens to people living in rural communities. We should ask what support exists while someone waits for treatment.

Most importantly, we should ask what happens to the people who fall through the gaps. An eating disorder does not become less serious because someone lives in a rural community. It does not become less deserving of treatment because someone has Medicaid. It does not become less urgent because a provider does not immediately recognize the symptoms.

Recovery should not depend on whether someone happens to have the right insurance card, live near the right treatment center, have reliable broadband, or fit the stereotype of who an eating disorder is supposed to affect.

Recovery is personal. Access to recovery is systemic. If we want eating disorder recovery to be genuinely available, then our approach has to extend beyond individual behavior.

We need schools that educate without moralizing food. We need public health messaging that recognizes that population-level recommendations can affect vulnerable people differently. We need food assistance programs that recognize food security as part of health. We need healthcare providers who understand that eating disorders do not have one face, one body, or one demographic. We need insurance systems that make evidence-based treatment realistically accessible rather than technically covered but practically unreachable. We need treatment centers that serve publicly insured communities. We need policies that address geographic and broadband barriers. And we need systems that recognize that waiting for treatment is not the same thing as receiving it.

Eating disorders are often described as individual illnesses, but the opportunity to recover is shaped by much more than an individual's willingness to seek help.

Health is not created by individual choices alone. It is created within families, schools, communities, healthcare systems, and policies.

If we want everyone to have the opportunity to recover, then we have to build systems that make recovery possible in the first place.

The question is not simply, “Did someone get help?”

It is: “Did the systems around them make help possible?”

Sources

Penwell, T. E., Bedard, S. P., Eyre, R., & Levinson, C. A. (2024). Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers. Psychiatric Services, 75(10), 944–952. https://doi.org/10.1176/appi.ps.20230193.

Moreno, R., Buckelew, S. M., Accurso, E. C., & Raymond-Flesch, M. (2023). Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: A retrospective cohort study. Journal of Eating Disorders, 11, 10. https://doi.org/10.1186/s40337-022-00730-7.

Welch, R., Rao, T., Karakus, M., Scott, E., Doreson, A., & Ghose, S. S. (2026). State-Level Analysis of Access to Intensive Eating Disorder Care for Medicaid Beneficiaries. Psychiatric Services, 77(3), 209–216. https://doi.org/10.1176/appi.ps.20250233.

Wade, T. D., Jabs, M., Keegan, E., Long, R., McGregor, A., Pellizzer, M., de Valle, M., & Radunz, M. (2024).Developing Solutions to the Waitlist Problem for Eating Disorder Treatments. International Journal of Eating Disorders, 57(12), 2359–2369. https://doi.org/10.1002/eat.24310.

Keegan, E., Waller, G., Tchanturia, K., & Wade, T. D. (2024). The potential value of brief waitlist interventions in enhancing treatment retention and outcomes: A randomised controlled trial. Cognitive Behaviour Therapy, 53(6), 608–620. https://doi.org/10.1080/16506073.2024.2351867.

Kranes, M., Münchenberg, P. S., Thomas, C., Schulz, R. S., Campione, A., & Kreutzberg, A. (2026). The effects of waiting time for outpatient psychotherapeutic interventions on patient-reported outcomes in adolescents and adults with eating disorders: A systematic review and meta-analysis. Journal of Eating Disorders, 14(1), 129. https://doi.org/10.1186/s40337-026-01660-4.

A transdiagnostic examination of sex- and race and ethnicity-based mental health treatment disparities among publicly insured youth. (2025). PubMed PMID: 40553056.

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders. (2024). International Journal of Eating Disorders.

Spatial and telehealth accessibility to eating disorder treatment in the United States: Evidence from registry and LLM-augmented data. (2026). PubMed PMID: 42219482.