Anonymous
This story is dedicated to young men and women who were denied the help they deserved. To those who were told they weren’t sick enough. To those who fought and made it out alive. To those still fighting, and the ones who fought until the end – because the system failed them before it ever had a chance to save them.
****
I sigh as I roll out of bed, my first instinct not to stretch or to yawn, but to wrap my fingers around my wrist. My thumb still does not reach my pinky. Frustration sinks in.
Most people wake up and start their day with meditation, a prayer, maybe even a morning run. My day begins by measuring my progress.
Holding my breath, I press my fingers together, willing my wrist to be smaller than it was yesterday. Maybe overnight something changed. Maybe today will be the day.
This is how I keep score. First, thumb to middle finger. Win. A few weeks later, thumb to pointer finger. Win. Then, the ring finger. Win. But the pinky, my last battle, is stubborn. Too much fat still lingers. Too much of me still lingers.
But I’m close. Just a little more, and I’ll get there. Maybe I’ll aim for my knuckles next.
Measuring my wrist is my only proof that I have control. That the decisions I make mean something. The less I eat, the closer my fingers get.
You’d think a mirror would do the trick, but I can’t bear the sight. I steal a glance as I brush my teeth. Disgust.
My fingers find my wrist again. A quick check. A reassurance. The mirror lies, but my hands don’t. I press my thumb against my fingers. Relief.
I can go back to brushing my teeth.
I weirdly like the taste of toothpaste. After hours of nothing in my mouth, it is refreshing, almost tasty. I could brush my teeth for 20 minutes just to keep that feeling there. I soak it in for a second longer.
Finally, I spit it out, wipe my mouth, and move to my closet.
If the mirror lies, my clothes should tell the truth.
Wrong.
They hang a little looser, but I don’t feel different. And isn’t that the point? To feel different?
I reach for the extra-large sweatshirt and sweatpants. My body doesn’t deserve to be shown. Not yet.
I don’t know what the scale would say. Unfortunately, it hides away in my mom’s closet, which would be suspicious for me to constantly go into. There are only so many clothes I can pretend to borrow before my parents start to notice. They might start to ask questions. Questions I don’t have an answer to.
So, I return to my wrist. Relief.
I walk downstairs to find my mom and little brother cooking pancakes. Mom loves to remind us that “breakfast is the most important meal of the day!” Ironic, considering hers consists of black coffee and a banana.
Normally, she is away traveling for work. On those days, it is my dad’s job to get us fed and out the door. I have more control when Dad is home. I like having control.
I try to make myself feel happy that she’s here, but honestly, it’s hard to be excited about anything. I don’t know why.
My eyes scan the kitchen. 100 calories in that banana, 112 in my brother’s glass of orange juice. My mind races with numbers, calculating, measuring, obsessing – none low enough to appease me.
I do the math on the plate my mom put out in front of me.
I force a smile as my mom hands me a fork. I can feel my heart start to race as I panic. However, I see our golden retriever, Annie, waltz over.
Luckily, Annie and I have an understanding. She knows exactly where to sit when mom is home and in the kitchen. I take a bite of the pancakes, chew, then “wipe my mouth,” spitting all of it into my napkin before placing it back in my lap, fingers loosening just enough to let Annie quietly take what’s inside.
When it is time to leave for school, I grab my coat. My dad cracks a joke about it being 65 degrees outside. I lie – being defensive and deceitful per usual, “It’s freezing at school. Everyone wears coats.” He looks puzzled but not concerned enough to push.
It really does feel cold. But I think only for me.
As we head out the door, mom hollers after us. “Don’t forget your lunch!” I freeze. So close.
She tosses me my lunch box. I force a smile.
The ten-minute drive to school stretches on, each minute dragging into the next. I pop in my earphones – a subtle message to my dad and brother that I don’t have the energy for conversation. We used to blast 98.1 the Blaze, laughing at the crazy call ins, hyping up the weekend, or just talking about what we were looking forward to at school. My brother still does. I just sit there, staring out the window, listening but never joining in.
Part of me misses it. Part of me wonders if they miss me.
I used to love school. Top of my class, straight A’s. While my overachieving nature hasn’t changed, my desire to learn surely has.
Sitting in class, I find myself getting irritable. Frustrated. My brain feels sluggish, and it’s harder to comprehend things that once came easily. Any frustration fuels my spiral. The less control I have, the more I want to restrict.
When lunch rolls around, I slip away to the library. No one seems to notice, but even if they did, they would not question it. “You work so hard!” they’d say it like it’s something to celebrate.
My stomach grumbles. While I enjoy the feeling, the noise is irritating. There is nothing more embarrassing than someone hearing it.
I pop a piece of gum. Ah. The minty taste.
I grab my wrist.
My phone vibrates and I see my mom’s name flash on the screen. The message reads, “Hi honey, hope you are having a good day. Don’t forget I will be picking you up from school today to take you to your doctor’s appointment. I will meet you at Entrance 1.”
Panic settles in. The scale.
Thoughts begin to race through my head. My weight. Will they question me? Judge me? Will I be punished? What will happen when they see me?
The rest of the day vanishes. It is time to face my fate.
My mom can tell I am off as we sit in the car. “Honey, are you okay?” she asks. “Yeah. I had a really hard test today in math,” I murmur, staring out the window, unwilling to meet her eyes.
We pull into the parking lot. Here we go.
“Lucy Taylor.” The nurse announces. I drag myself to my feet, hoping my mom stays in her seat. She doesn’t.
“First, I will take your height. Then, I will have you step on the scale.”
5’8”, she announces.
I move to the scale, holding my breath.
148.
She says it so casually. Like it’s just a number.
I wait for the reaction. My mom. The nurse. Someone.
Nothing. Just a smile as she leads us back to the exam room.
We go through the usual checklist: “How are you feeling?” “When was your last period?” “Any new allergies?”
I wait for it. The question about my weight. The concern. Still nothing.
The twenty-minute wait for the doctor feels like hours. When the knock finally comes, I brace myself, waiting for impact.
She moves through her usual tests. I stand on one foot, then the other. I raise my right hand, then the left. I walk a straight line.
Her hands are clinical, precise, and for some reason, extra cold. She checks my pulse – first at my wrist, then at my neck, then gently against my back.
She presses into my stomach. I wince as the fat shifts beneath her touch, nauseating and undeniable.
“Well Lucy, you have grown two inches and lost a few pounds since the last time I saw you…”
I wait.
“Which is perfectly normal for young girls your age going through puberty. Everything else looks great!”
My mom winks at me, pleased. I force a smile back, pretending this moment doesn’t feel like a test I’ve just failed.
The Doctor continues to talk, but I have tuned her out. I nod at the right times and let my mom answer the usual questions, but a range of emotions crashes over me – relieved, defeated, anxious, disappointed.
I grab my wrist.
The numbers were supposed to mean something. They were supposed to confirm what I already knew, to validate the work I had done. Instead, they sit there, meaningless, leaving me more confused than before.
On the car ride home, I pull out my phone and search BMI chart. Turns out, the Doctor was right. According to the CDC, I am a “healthy weight.”6 Apparently, when I was there over a year ago, I was “slightly overweight.”
I start to spiral into a hole of comparison. Overweight. It feels like the word was stamped across my forehead in big, bold letters, visible to everyone except me. Had they all seen it? Had I been walking around oblivious while everyone else just… knew?
I quickly tap my camera roll, zooming in on pictures with my friends. Suddenly, I see it. The way my calves are the size of their thighs. The way my arms stand out. The way I stand out.
The funny thing is, none of this started because I was worried about how I looked. It wasn’t about my body. It was always about control.
The kind of control I feel like I lost once I got to high school.
When I complain that high school is hard, my mom laughs. “Just wait for the real world, these are the best years of your life!” she says.
But high school has never felt that way to me. High school feels like one long identity crisis – trying to figure out who you are. Who you are as a friend. Who you are as a student. Who you are supposed to be. Even before my obsession with my body, I was obsessed with what people thought of me.
When you’re younger, it’s easy. People are easy. Everyone pretty much likes each other, or at least tolerates each other. But then, high school happens, and suddenly, nothing is in your control.
I couldn’t control whether I was invited to things, what people thought of me, or who I was supposed to be.
So, I looked for something I could control.
First, it was school. I had decent grades in elementary and middle school, but by high school, I decided I would be perfect. And I was. I excelled in every class I took. But after a while, school became predictable, routine. I knew exactly what to do to get an A. There was no challenge anymore. No thrill.
I thought about sports, even though I’d never played in my life, but every coach told me it was too late. They didn’t take beginners.
“Why now?”
“You should have started in middle school.”
“Try Intramurals!”
I heard the same lines over and over. The tryouts weren’t even tryouts. They were just formalities for kids who had been playing since they could walk.
Normally, that kind of rejection would have fueled me. If I wasn’t good enough, I’d make myself good enough. But this was different. No amount of practice, studying, or effort would change the fact that I wasn’t what they wanted.
And that was the problem.
School had rules. If I studied hard enough, followed the formulas, and wrote my papers exactly how the teacher wanted, I would succeed. I could be perfect. But in sports, effort didn’t guarantee success this late in the game. This was out of my hands.
So, I turned to food.
I never once thought about what I was eating before. And even now I can’t quite rationalize why this was where my mind went, but there was something gratifying about controlling what went into my body. It felt like a game.
First, it was healthy swaps. My mom would pack me a bag of chips and I would trade it for someone’s banana.
It felt good for a while, but only in fleeting moments. A quick rush. A passing sense of accomplishment. But it never lasted. I wanted something that would stay.
Naturally, I found it in restriction.
How much could I refrain? How little could I get by on?
The less I ate the better I felt. Never feeling full felt good.
So, I kept going.
Strangely, this made me feel like I had control in other areas of my life too.
The thing I feared most – not feeling wanted – started to disappear with the weight. Suddenly, I was invited to things. Boys noticed me. People gave me compliments. “You look SO good.”
And for a little while, it made me feel good.
Until it didn’t.
What was a fun little game with myself has taken over my life. I know it’s bad for me. I know I should stop. But I can’t.
It’s addicting. And no one knows how deep I am.
I grab my wrist.
Mom pulls into the driveway and looks over at me. “I am so proud of you, honey. You are doing so well in school, you’re happy, and you look healthy.”
Doing well in school. Yes.
Happy? Well… I guess.
Healthy though – that one sticks. It feels like a stab. You look healthy.
I want to ask, “Well, what did I look like before?” but I know that would sound weird.
So instead, I force a smile. “Thanks, Mom.”
I grab my wrist.
One month later.
I wake up feeling awful. Fever. Chills. Headache. Something gnarly.
None of the over-the-counter medication my mom has spooned into me seems to help, so she announces that we’re taking a trip to the doctor.
I don’t think much of it and nod in agreement. I take a quick shower and throw on my sweatshirt and sweatpants and tie the drawstring extra tight.
When we get there, the wait is short.
“Lucy Taylor,” the nurse calls. My mom follows me.
When we stop at the scale, I casually mention we don’t need to do my height or weight because I was just here.
The nurse smiles, unfazed. “It’s just routine.”
Ugh.
5’8″, she announces.
I move to the scale, holding my breath.
130.
I wait.
The nurse doesn’t react. My mom is buried in her phone, answering work emails. I let out my breath. I got away with it.
The Doctor comes in shortly after, running through my symptoms. She takes a flu test, and sure enough, I am infected. She gives directions on what to do, how long it will last – blah, blah, blah.
Then, she stops.
“Lucy, there is something else I would like to talk about.”
My stomach drops.
“You have lost a significant amount of weight since the last time you were here.”
My vision blurs – tears? No. Sheer panic. I force myself to pull it together but stay silent.
She continues, “How is everything at school? At home?”
My mom chimes in, “Lucy is a straight-A student. She is excelling in her studies. Why are you asking about home? Lucy is a happy kid.”
The Doctor adjusts, shifting her attention to my mom, “I am just trying to understand if there have been any major changes in Lucy’s life recently.”
My mom frowns. “No.”
The Doctor smiles politely. “Okay” Then, turning back to me, “Lucy, how is your relationship with food?”
Again, my mom answers for me, “This girl has a hollow leg. She clears her plate every single breakfast and dinner and comes home with an empty lunch box.”
My mom smiles at me.
I don’t know whether to feel embarrassed that she doesn’t think I can answer for myself or relieved that she’s answering for me.
Part of me is confused. Why is she being so defensive? But mostly, I’m grateful for the deflection.
My mom pipes up one last time, “It must be this flu. Lucy’s been complaining about all sorts of symptoms. It’s probably taken a toll on her body.”
I start to disassociate.
The Doctor smiles, but it feels so forced. “Mrs. Taylor, can I speak to you in the hallway?”
My mom follows her out.
I can only catch bits and pieces through the thin walls.
Concerned about her health. Low pulse. Brittle hair. Baggy Clothes. Drained. Treatment.
My mom comes back in. Alone.
“Let’s get home.” She smiles.
The car ride was silent.
When we get home, my mom asks if I want to sit outside. “You’ve been stuck inside the past few days!”
“I don’t feel like it.” I snuff.
Mom sighs. “It’s a beautiful night. I promise it will make you feel better.” I stomp upstairs, throw my backpack in my room, and trudge back down.
“Honey,” my mom says, voice firm, “It is 75 degrees outside. You cannot seriously be wearing sweats and a sweatshirt.”
I just stare.
“Go change into shorts.” Her tone isn’t a suggestion.
I stomp back up. Louder this time
I keep my oversized sweatshirt on but swap the sweats for shorts, then make a quick detour to the bathroom. Black and blue. Bruises scatter up my legs, blooming like ink stains. I cannot stop bruising.
I waltz back downstairs, and I see it immediately – the shift. My mom takes one look, then readjusts. Puts back on her smile. Slips back into character.
“Much better!”
We don’t talk much. She fills the silence with small talk about her latest work trip, complaining about the terrible plane ride, the annoying seatmate, the delay at baggage claim. I nod, pretending to listen.
Then, she finally asks.
“Why do you have so many bruises on your legs?”
I don’t hesitate. “PE’s been rough. I’ve been really getting into dodgeball.”
She laughs. I know it’s fake.
Dinner is silent that night. My brother keeps looking at me, then at our parents, who spend the whole meal staring down at their plates.
I assume my mom has filled my dad in quickly.
At least they are not paying attention. This way, Annie and I can keep up our bit. Annie has been gaining weight. They haven’t noticed.
Later, in bed, I hear whispers from the kitchen. Slipping out, I tiptoe to the top of the stairs.
“Have you noticed her acting differently when I am gone for work?” My mom’s voice is quiet but sharp.
Silence. I picture my dad shrugging.
More whispers. Fragments drift up the stairs.
“What should we do?”
“How do we help?”
I don’t want to hear the rest. I already know how this ends.
One week later.
A few days ago, my parents took me to meet with a “nutritionist and counselor.” While I should have at least pretended to care, I didn’t.
Instead, I threw a tantrum. Told the lady that if she tried to make me eat, I’d kill myself.
I heard her talking to my parents after the appointment. “Lucy needs a different type of help.”
I laughed to myself. Help.
At school today, I feel on edge. Like there are eyes on me. Everywhere.
The librarian, who has never once looked up from her book, suddenly notices me when I walk in for lunch. Her gaze follows me as I weave through the tables, searching for a place to sit.
The entire duration of lunch, I can feel her watching. I get up. Her eyes follow.
I don’t know what possesses me to do it, but right before the bell rings, I gather my things and glance up.
She’s still staring.
I don’t know if I want to prove a point or if I’m just testing something, but I move toward the massive trash can by the entrance. I lock eyes with her as I dump my untouched lunch inside.
Then, I smile.
She immediately looks down at her book.
It feels good.
Does she even know? Have my parents told the school? Have they told anyone? Regardless, I don’t like being watched. It makes me feel out of control. I grab my wrist.
When the final bell rings, I walk outside and spot my mom’s car. Except this time, my dad is in the passenger seat too. Nothing is said when I get inside.
I glance into the back. Suitcase. I ask them where my little brother Ethan is.
They exchange a look.
My mom clears her throat. “He is with your grandmother for the rest of the week.” This is so weird.
“Okay… What is going on?” I speak.
She exhales. “We’re going on a trip.”
“Where?” I push.
My dad turns in his seat, his voice and face soft. “Honey, you are so strong. We are so proud of you. But we had no idea what you were going through. You do not need to fight this alone.”
My stomach tightens. “What are you talking about?”
My mom barely whispers, “Honey, you are unwell.”
“No, I am not.”
She looks at me, eyes glassy. “We’re taking you to get the help you need.” What does that mean?
Hours pass in silence. The drive feels endless, my fingers gripping the fabric of my sleeves so tightly my knuckles ache.
Then, we pull in.
A long driveway. A brick building that looks eerily like a retirement home. A place they send people to die. Am I going to die?
My eyes dart to the sign.
Carolina Eating Recovery.
Panic crashes over me.
I start screaming. Thrashing. Clawing at the seat. I hold on so tightly my fingernails dig into the leather.
“I am NOT going in there!”
“Yes. YOU ARE.” My mom’s voice is sharp. Unwavering.
“This place was highly recommended by both your doctor and other professionals. You need help, Lucy.”
“STOP saying I need help?” I spit. “I need new parents! I hate you all!” Tears spill down my mom’s face. Her voice shakes. “We love you so much honey.”
Two security guards and a nurse pry me from the car. My body fights them. I scream, kick, and even feel strands of my own hair tear from my scalp in the struggle. But they don’t let go.
I am left there. Alone.
Just me and my suitcase.
I collapse onto the lobby floor and weep.
The staff let me cry. It is evident that this is not their first time seeing this type of reaction.
When I finally pull myself together – just enough to form words – one of them gently suggests I might be more comfortable lying down in bed. I nod, too exhausted to argue.
My room looks like what I’d imagine a college dorm to. Two twin beds against opposite walls. One already claimed. The other, mine.
I set my bag down and lie there. For hours.
When I open my eyes, my roommate is sitting cross-legged on her bed, threading string through her fingers, tying knots – making the kind of bracelets I used to make at summer camp.
“Hi,” I whisper. “I’m Lucy.”
She looks up. Sunken eyes, hollow cheeks, a tube taped to her face.10 “Hey.” she says. “I’m Ana.”
I hesitate before asking, “Do you know where the bathroom is?” She doesn’t look up this time. “Down the hall, to the right.”
“Thanks.”
When I get there, a woman is sitting outside reading her book. “Hello,” I say, “are you waiting?”
She laughs. “No honey. Go ahead.”
Then, she stands up and follows me in.
I stop. “Excuse me?”
She gives me a sympathetic smile. “Sorry, sweetie. It’s protocol. We have to keep you all safe. We don’t want anyone to hurt themselves.”11
I roll my eyes.
In the mirror – what should be my reflection – is a collage of sticky notes. You are enough. You are strong. You are beautiful.
Could this place get any cheesier?
I grab my wrist.
The nurse takes out a clipboard and writes it down.
When I return to the room, Ana is still twisting knots into her bracelet, eyes fixed to the thread like it holds an answer.
“How long have you been here?” I ask.
“4 weeks.” Her gaze doesn’t lift.
My mind starts spinning. 4 weeks? That’s a month of events, plans, school. What’s going to happen to my grades? My chest tightens. I grab my wrist.
Ana notices. She looks up at me “Do what they say. The faster you play along, the faster you will get out of here.”
I nod. Play along. I repeat it in my head like a mantra.
A nurse passes the door. “Time for dinner.”
The dining hall looks nothing like I expected. It almost resembles a restaurant, with round tables seating four to six. Napkins and silverware are carefully placed on each plate, everything arranged just so—like they’re trying to make this feel normal.
I sit, waiting for a menu, already scheming. I’ll pick the lowest-calorie option. I can make this work.
But there is no menu.
Just me, Ana, and two nurses.
Different meals are set out in front of Ana and me.
The nurse catches me overanalyzing, my eyes darting between the plates, calculating.
“We have customized nutrition plans to help you meet your goals,” she says with a smile.
Goals? I think. Play along.
I nod.
My meal is chicken, rice, and vegetables. I start doing the math. The numbers don’t feel right.
Sensing the tension, the nurses try to distract me with small talk. “What’s your favorite subject in school?” one asks.
“English,” I say, barely paying attention.
“We have reading time tonight! You will love the library. It has every book you could ever want.”
That gives me the smallest relief.
I take a bite of the vegetables. Why does this feel so hard? My hands feel shaky, my stomach tight. I have no control.
A sting of tears presses behind my eyes. Play along, Lucy.
I take a second bite. A third. Before I know it, I’ve nearly cleaned my plate.
The nurses look pleased. Across the table, I feel Ana squeeze my hand under the table and smile.
This is confusing. Her plate is still half full. Why won’t she just play along too?
Guilt punches me in the stomach. Why did I do that? Why did I eat that much? Disgust crawls up my throat.
Reading time is nice, but I cannot stop thinking about dinner. My thoughts are spinning, spiraling, out of control.
Before bed, a nurse follows me into the bathroom. I start to cry as I brush my teeth. “What’s wrong Lucy?” she asks.
“I just want a moment to myself.”
She apologizes but doesn’t move. “I can’t leave you in here alone.” That night, I bury my face into my pillow and let myself cry.
“Pssst. Lucy.”
“Yeah?”
“You did great tonight. If you keep this up, you will be out in no time.”
I don’t respond. I want to ask her why she didn’t try harder. But I bite my tongue. Maybe soon I’ll know.
But her words settle in my chest. A small reassurance.
Play along. I remind myself.
Three weeks later.
I’ve been playing along so well, I’m even starting to believe I want this for myself.
I participate in therapy sessions, eat my meals without protest (at least not in front of anyone), and join every group activity with a smile.
And, oddly enough, I feel safe here. Even though I have zero control, there is something freeing about not even having the option to control.
I’m in my room, helping Ana pick out colors for her next bracelet – she’s made over ten since I’ve been here – when a nurse pops her head in.
“Lucy, you have visitors.”
I jump up, my heart catching in my throat. My parents stand just outside the door. Part of me is happy. Part of me is still resentful.
Play along.
I wrap them in big hugs.
My mom, already crying, whispers, “We are so proud of you, Luc.” I smile.
“Let’s go chat somewhere private.”
I lead them to the library. My favorite spot.
My mom clears her throat. “Honey, our insurance called yesterday. They’ve decided to stop paying for treatment because it’s no longer medically necessary.”
“What does that mean?”
She sighs, “It means they believe you’re stable enough to be discharged. You’ve been meeting all your weight targets, and the center says they believe you’re committed to recovery. That this is something we can work on at home. But if you feel you need more time, Dad and I will pay out of pocket. We’re looking into better-paying positions at work – we’ll do whatever it takes. You come first.”
A wave of guilt crashes over me. I need to make a decision.
For three weeks, I’ve been faking this dedication to healing. I have been doing what I needed to do to get out of here.
But now… I wonder.
Maybe if I stay, I really could fix my thoughts about myself. Maybe I want to. I grab my wrist.
My fingers don’t reach my thumb like they used to.
“I am ready to go home with you.”
Relief floods their faces as they squeeze me tight.
They follow me back to my room. Ana is still sitting on her bed, sifting through her box of string, deciding what color to use next.
She doesn’t look much different than the day I got here. And she still has the tube taped to her face. I never asked her why she didn’t try harder. But I didn’t need to. I think I understand.
Ana might not want to recover. But Ana also doesn’t have anywhere else to go. I gathered this when no one ever called. No letters were ever sent. No family ever mentioned.
My parents tell me they’ll wait in the lobby while I pack.
I turn to Ana. “Hey I’m leaving. Thank you for being such a great roommate and friend the past couple of weeks.”
A nurse still sits outside our door.
Ana gets up, walks over, and presses something into my hand.
It’s the bracelet she was making the night we met.
I squeeze her hard and tie it onto my wrist.
I mouth thank you as I walk out. She winks.
My parents are waiting for me by the lobby door. And just like that, we drive home. At dinner, my parents watch me like a hawk.
Play along.
I clear my plate, every last bite. They look relieved.
I tell them I’m exhausted, that I just want to take a shower and go to bed. They excuse me.
Upstairs, I step into the bathroom and close the door.
This is the first time I’ve seen myself – fully – in almost a month. I stare at the mirror. Then, I start to cry.
The girl looking back at me is not the girl who left this house.
I don’t recognize her.
The shower drowns out the sound as I move to the toilet.
My fingers slide down my throat easier than I expect.
I stay there until every last bite of dinner is gone.
Quickly, I rinse off, wrap myself in a towel, and crawl into bed.
I should feel relief.
Instead, I feel trapped.
The next morning, I wake up to Annie licking my face, her tail thumping against the bed.
“I missed you too.” I murmur, scratching behind her ears. She wiggles closer, warm and familiar.
I put on an outfit for school. My clothes fit. They fit the body they were bought for a year ago – the body that, according to a BMI chart, was slightly overweight.
I grab my wrist.
As I walk downstairs, my mom greets me with a forced smile. “Oh, honey, you don’t need to go to school this morning. Your dad and I thought it might be fun to take you shopping or do something special!”
The thought of trying on clothes makes my stomach twist.
“Can we just forget this happened? Please? You all are making me feel way worse by babying me.”
Her face falls, stunned by my answer.
“Yeah… okay.” she says softly. Then, after a moment, “Let me get you some breakfast. Is oatmeal okay?”
“Fine.”
She sets the bowl in front of me. I stare at it, remembering too late that Annie hates oatmeal.
Even though we still have our routine – our secret exchange – I know she won’t take this one from me.
I force a few bites down quickly. The texture sticks in my throat. “I need to grab something from my room,” I call out, already halfway up the stairs. In the bathroom, I turn on the sink.
Then, I head to the toilet.
Here we go again.
Two months later.
I am miserable. The past few months have been a cycle of binging and purging.
I binge because I worry that if I don’t eat enough, my parents will notice. I purge because I hate myself after.
One of the practices I learned in residential was journaling. Most of my entries were fake – I wrote what they wanted to hear so I could get out – but when I got home, I kept writing.
While I put on a show for the world, my journal is the place where I can be honest. It’s freeing.
I still go to therapy. Technically, everything I say is confidential, but I know if I say too much, my therapist will be forced to tell my parents I need a higher level of care. So, I keep my lips tight. Still, it’s nice to talk to someone outside of my bubble, especially since my friends at school think I was on a long trip with my grandparents. I wonder if they actually believe that or if they’re too scared to ask more.
Through all of this, my weight isn’t changing. There have been a few fluctuations, but I still hate my body. If anything, I hate it more than before treatment. I spend every second thinking about food.
But something in me lately is shifting.
I think I am finally ready to recover. I want freedom.
This morning, before anyone woke up, I walked downstairs and left my journal by the coffee machine. Then, I grabbed my headphones and went for a walk, soaking in the world one last time before they send me back.
This time, I am ready. Ready to change. Ready to get better. Ready to do the work.
When I get home, my mom is at the kitchen counter, reading my words. Tears stream down her face.
She looks up as I walk in the door.
I start crying too.
She pulls me into her arms. “Honey, I am so sorry.”
I feel guilty, like I have failed her. “It’s not your fault.” I whisper. “This time, I am ready to get help.”
That day, we went to the doctor.
My weight is healthy. My vitals are perfect.
But my doctor sees my parents’ concern. She reads my journal. She listens. “Based on what’s written here, I recommend returning to treatment.”
My mom contacts our insurance. Usually, these things take time. But this time, their response is fast.
Denied.
“Not medically necessary.”
Apparently, my BMI, vitals, and therapy attendance all indicate that residential care is not medically necessary for me to get better.
My parents call the treatment center. My mom repeats the number back slowly, as if she’s making sure, she heard it right.
“Two thousand dollars a day?” she whispers. “Okay, thank you.” I can tell she’s stressed. Even with new jobs, my parents could never afford this. We settle on a more affordable option. Another type of therapy.
Internally, I groan. I feel defeated. Like I’m not sick enough. Like I’m not good enough.
But still, I go. I sit in therapy. I nod at the right times. I pretend like I care, but I don’t.
Two months later.
Every week, my therapist asks me if I’m eating. I lie. She doesn’t press.
The worst part is – no one notices. My parents are so relieved that I am “trying.” They don’t look too closely anymore.
They don’t see how I leave the dinner table and head straight to the shower. They don’t see how much I shake when I stand up.
They don’t see how much I don’t care.
One night, as I lay in bed, I think about the last thing I ate. I can’t remember.
My hunger used to be a victory. Now, it’s just a sound. Just a feeling. Something I ignore.
At some point, my mom starts knocking on my door. “Lucy?”
I don’t respond.
The knocking gets louder. “Lucy?”
My body is so heavy. I try to lift my head, but I can’t. I want to say something, but my throat is dry. My heart pounds in my ears – loud, uneven, struggling.
I close my eyes.
I wake up to beeping. A slow, steady rhythm. A sound I’ve heard in TV shows but never in real life.
Bright lights. Scratchy blankets. The weight of something clipped to my finger. I blink. My head is pounding.
My mom is sitting next to me, holding my hand so tight it hurts. Her eyes are red and swollen. My dad looks like he might break.
“What happened?” My voice is barely a whisper. My mouth feels like sandpaper.
“You wouldn’t wake up,” my mom chokes out. “Your heart rate was so low. You were unresponsive.”
The doctor enters, looking at the monitors. He says something about my pulse. My blood pressure. My weights. All I hear is “bradycardia” “severe malnourishment” and “critical.”
I stare at the ceiling. Part of me wishes they hadn’t brought me here in time.
The doctor turns to my parents, “Your insurance approved treatment. You’ll be transferred soon.”
Ah. So now I am sick enough.
****
Legal Issues Raised by “Not Sick Enough”
If someone has a heart condition, they do not need to have a heart attack before treatment is approved. If someone is battling depression, they do not have to prove they are suicidal before they qualify for help. So why is it different for eating disorders?
In writing “Not Sick Enough,” I set out to explore the disconnect between eating disorder treatment and insurance coverage. While every individual who struggles with an eating disorder has a different experience, this story aims to shed light on one perspective, and to highlight that lack of care is far from unique. Even though eating disorders can look different from person to person, many share the same painful reality: being told they are not “sick enough” for help.
Eating Disorders and Treatment
Nearly one in ten people in the United States will have an eating disorder in their lifetime.1 Yet, despite the severity of these illnesses, only about 20% of individuals affected receive treatment.2 For many, access to proper treatment is not just beneficial, it is lifesaving.
Part of the problem is that eating disorders are complex mental illnesses and do not always present in the way people expect.3 While they are often associated with extreme thinness or calorie restriction, the reality is far more nuanced. These disorders involve compulsive behaviors, obsessive thoughts, and deep struggles with control and self-worth.4 Understanding the root causes of these issues is even more difficult. They can be triggered by a range of factors, including food insecurity, trauma, and even cultural identity.5
This raises important questions about diagnosis: What standards are we using to determine which behaviors qualify as an eating disorder? And what underlying factors are considered when evaluating them? Even widely recognized diagnoses, like anorexia, bulimia, and binge eating disorder, don’t always reflect the complexity of people’s lived experiences.6 This lack of clarity has had real consequences, especially for providers trying to detect these illnesses in their early stages.7 In fact, delays in care are not always the result of inattention.8 More often, they reflect how difficult it is to identify the severity of eating disorders within a traditional medical framework.9
However, even when someone is diagnosed with an eating disorder, they may still struggle to receive the care they need because of insurance coverage restrictions. Many insurance companies rely on a “medically necessary” criteria to determine whether they will pay for treatment.10 In the case of eating disorders, these criteria are often extreme, requiring individuals to have a dangerously low BMI or severe medical complications before treatment is approved.11 Even when a patient is in the midst of recovery, insurance may abruptly cut off coverage once the individual appears physically stable.12 This premature end to care can derail progress and ignores the fact that weight restoration does not always mean someone has mentally healed.
Without insurance, continuing care becomes incredibly expensive.13 For example, residential programs, which are often the most effective for sustained recovery, can cost thousands of dollars each week.14 For many families, that financial burden puts essential treatment out of reach. When insurance companies deny coverage, they are not just denying treatment. They are denying hope.
Legislative Efforts
While recent legislative efforts have made strides in recognizing eating disorders as mental health conditions and improving provider awareness, these efforts have failed to ensure that individuals actually receive care. The Anna Westin Act, passed as part of the 21st Century Cures Act in 2016, was the first federal law to recognize eating disorders as a serious mental illness deserving of insurance coverage under federal mental health parity laws.15 However, it did not impose any obligation on insurers to authorize or fund care.16
More recently, the Anna Westin Legacy Act was introduced to expand provider education and training by permanently authorizing and funding the Center of Excellence for Eating Disorders.17 The Center develops adaptive training models for frontline healthcare and community professionals.18 These models are tailored to support screening, brief intervention, and referral to treatment, with a focus on children and marginalized populations.19 Additionally, the Center coordinates with the Center for Disease Control and Prevention and the Health Resources and Services Administration to disseminate training materials and best practices nationwide.20 Once again, the emphasis is on diagnosis and early detection, but not actual access to care. So, although important legislative strides have been made, without real accountability for insurance providers, many individuals are still denied essential care.
The problem is even more dire for individuals insured by Medicaid. In a report published by researchers at UC San Francisco and UC Berkley, Medicaid insured youth with eating disorders were found to have significantly less access to evidence-based care.21 As a result, many adolescents received fewer effective forms of therapy, often leading to repeated hospitalizations and worsening medical conditions.22
However, Medicaid coverage varies by state, and the report is not a one-size fits-all snapshot.23 Still, no individual should ever be barred from receiving help simply because of where they live or who they are. While the challenges facing Medicaid recipients in certain states are particularly difficult, inadequate coverage extends far beyond public health programs like Medicaid.
One case that illustrates this broader failure in the system is Jamie F. v. UnitedHealthcare.24 In that case, a college-aged plaintiff was diagnosed with anorexia nervosa and hospitalized for medical stabilization.25 Upon discharge, the doctors recommended immediate transfer to a residential treatment facility.26 However, the plaintiff’s private insurance denied coverage, claiming that residential care was not “medically necessary.”27 Instead, they claimed the plaintiff could be treated through lower levels of care.28 Their determination relied on superficial indicators such as the plaintiff’s weight being over 90% of her ideal body weight, the absence of suicidal ideation, and her calm demeanor.29 The reviewers failed to meaningfully consider the recommendations of the treating physicians or the severity of the plaintiff’s symptoms.30 The court ruled in favor of the plaintiff, finding that the insurer had improperly disregarded doctor recommendations and clinical evidence.31
Although this case was decided before the Anna Westin Legacy Act was passed, the insurer’s decision might not have changed. The Act expands education and provider training, but it does not mandate coverage or alter how insurers define medical necessity.32 Thus, this case underscores the urgent need for more robust legal protections and enforceable coverage standards for individuals with eating disorders.
To truly close the gap between diagnosis and treatment, there needs to be more than awareness. There must be enforceable insurance mandates, earlier intervention, and a nationwide commitment to treating eating disorders with the urgency they deserve.
****
END NOTES
- EATING RECOVERY CENTER, Eating Disorders, EATING RECOVERY CENTER,
https://www.eatingrecoverycenter.com/conditions/eating-disorders (last visited Mar. 13, 2025).
↩︎ - Katherine Schaumberg et al., eating disorders in the United States: Burden, Treatment Gaps, and Need for Policy Change, 75 PSYCHIATRIC SERVICES 944, 945 (2024).
↩︎ - CLEVELAND CLINIC, Eating Disorders, CLEVELAND CLINIC, https://my.clevelandclinic.org/health/diseases/4152-eating disorders (Sept. 23, 2024).
↩︎ - Id.
↩︎ - Taylor Hawkins, Food Trauma: What It Means and How to Manage This Potential Sign of Disordered Eating, NOURISH, https://www.usenourish.com/blog/food-trauma (last visited Apr. 5, 2025); Vivienne M. Hazzard et al., Food Insecurity and Eating Disorders: A Review of Emerging Evidence, 22 CURR.PSYCHIATRY REP. 74, 79 (2020); Olly Smith, Causes of Eating Disorders – Cultural Influences, MENTALHEALTH,
https://www.mentalhealth.com/library/causes-of-eating-disorders-cultural-influences (last visited Apr. 5, 2025).
↩︎ - Id.
↩︎ - See David A. Klein et al., eating disorders in Primary Care: Diagnosis and Management, 103 AM.FAM. PHYSICIAN 22, 23 (2021) (explaining that signs of eating disorders can be easily overlooked, as subtle weight changes may be just as dangerous as low weight, and patients often downplay or conceal symptoms, complicating timely diagnosis and treatment).
↩︎ - Id.
↩︎ - Id.
↩︎ - PROJECT HEAL, Insurance as a Barrier, PROJECT HEAL, https://www.theprojectheal.org/insurance-as-a-barrier (last visited Mar. 14, 2025).
↩︎ - Id.
↩︎ - ALLIANCE FOR EATING DISORDERS, Insurance & Eating Disorder Treatment, ALLIANCE FOR EATING DISORDERS (Oct. 11, 2024), https://www.allianceforeatingdisorders.com/insurance-eating-disorder-treatment/.
↩︎ - DELOITTE ACCESS ECONOMICS, The Social and Economic Costs of Eating Disorders in the United States of America 39 (2020), https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
↩︎ - Id.
↩︎ - Anna Westin Act of 2015, H.R. 2515, 114th Cong. (2015); EATING DISORDERS COALITION, The Anna Westin Act, EATING DISORDERS COALITION, https://eatingdisorderscoalition.org/inner_template/our_work/the-anna-westin act.html (last visited Mar. 13, 2025).
↩︎ - Id.
↩︎ - Westin Legacy Act of 2022, Pub. L. No. 117-328, div. FF, tit. I, § 112, 136 Stat. 4459, 5688 (2022).
↩︎ - Id.
↩︎ - Id.
↩︎ - Id.
↩︎ - Erin C. Accurso et al., Youth Insured by Medicaid with Restrictive Eating Disorders – Underrecognized and Underresourced, 175 JAMA PEDIATRICS 999, 1000 (2021).
↩︎ - Id.
↩︎ - Oona Hanson, Understanding Insurance Coverage for Eating Disorder Treatment, NAT’L ALLIANCE FOR EATING DISORDERS (Oct. 11, 2024), https://www.allianceforeatingdisorders.com/insurance-eating-disorder-treatment/.
↩︎ - Jamie F. v. UnitedHealthcare Ins. Co., 474 F. Supp. 3d 1052, 1057 (N.D. Cal. 2020).
↩︎ - Id.
↩︎ - Id. at 1056.
↩︎ - Id. at 1057.
↩︎ - Id. at 1063.
↩︎ - Id. at 1061.
↩︎ - Id.
↩︎ - Id.
↩︎ - See supra note 10. ↩︎
Awaken 