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Surge in eating disorders spurs state legislative action

Lawmakers in states including Colorado, California, Texas, and New York are taking big, legislative swings at the eating disorder crisis

The Colorado state Capitol in Denver.David Zalubowski/Associated Press

DENVER — Stranded at home amid pandemic lockdowns in spring 2020, Emma Warford stumbled down a social media rabbit hole in her quest to get in shape. Viral 28-day fitness challenges. YouTubers promising “hourglass abs.” Diet videos where slim-stomached influencers peddled calorie-tracking apps.

Warford, then a 15-year-old starting volleyball player, bought a food scale and began replacing meals with energy drinks hawked by social media stars.

Soon, her calorie-cutting became a compulsion. By season’s end, she began volleyball games benched, too feeble to start. A year into the pandemic, her heart rate slowed and she was rushed to the hospital.

Stories like Warford’s are why lawmakers in Colorado, California, Texas, New York, and elsewhere are taking big, legislative swings at the eating disorder crisis. Warford, who’s now in recovery after two years of treatment, is among nearly 30 million Americans — about the population of Texas — who will struggle with an eating disorder in their lifetime. Every year over 10,000 die from an eating disorder, according to data cited by the National Association of Anorexia Nervosa and Associated Disorders.

Anorexia, one of the more common eating disorders, typically involves restrictive eating habits and extreme thinness. It can cause abnormally low blood pressure and organ damage. Bulimia, another eating disorder, includes eating large amounts of food followed by self-induced vomiting. Still, an eating disorder diagnosis does not necessarily mean someone is overweight or underweight.

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Proposals across the United States include restricting social media algorithms from promoting potentially harmful content; prohibiting the sale of weight loss pills to minors; and adding eating disorder prevention into middle and high school curriculums.

The slew of legislation follows a spike in eating disorder cases as pandemic lockdowns pushed youth into long bouts of isolation. Hospital beds filled and waiting lists swelled as many struggled to find treatment for an illness that already had few care options. In Colorado, only one hospital was equipped to offer inpatient care for Warford.

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Colorado’s bill creates the new state office that is broadly charged with, in part, closing gaps in treatments, offering research grants to further research, and working to educate students, teachers, and parents. Bills in New York and Texas similarly seek to educate students on mental illnesses including eating disorders.

Katrina Velasquez, chief policy officer of the Eating Disorder Coalition, said these policies will give students the tools to catch signs of disordered eating habits in themselves or their peers early — potentially giving them a critical head start in treatment.

Colorado is also taking a swing at axing the use of body mass index, or BMI, even though it remains the industry standard. The measurement is used often to determine the level of care required for those with eating disorders, but mental illness is not invariably linked to body weight or BMI, said Claire Engels, program coordinator for the Eating Disorder Foundation.

“Eating disorders are not necessarily about food. It’s about mental illness, anxiety, depression, trauma,” and control, Engels said.

When Riley Judd was around 12, she saw a photo of herself on vacation in a bathing suit. Turning to her mom she said, “I look like a whale.” It was the first time she remembered a voice in her head ruthlessly comparing her with the beaming, thin celebrities on the cover of Seventeen Magazine and Girls’ Life. “If I lose all this weight, people will like me,” the voice muttered to her. She attempted suicide at age 13.

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“It was an all consuming voice,” said Judd, now a legislative intern and student at the University of Denver.

California lawmakers are targeting social media with a bill prohibiting social media platforms from having algorithms or features that expose children to diet products or lead them to develop an eating disorder. Platforms that violate the legislation could be fined $250,000.

Another California bill would expand the list of approved facilities that can provide inpatient treatment to people with eating disorders — similar to a Texas proposal that would expand Medicaid coverage for mental health services, including eating disorders.

Texas state Representative Shelby Slawson, a Republican, also introduced a bill to protect minors who use digital platforms.

Cathy Johnson, a school counselor of 24 years who testified on the Texas proposal, said “one of the biggest issues” she has seen from social media is an increase in eating disorders.

“We have kids having panic attacks in school because their anxiety is so high, they are comparing themselves, they think they are going to be like one of the influencers on TikTok,” Johnson said.