Eating Disorder Prevention Laws

Each year, approximately 10,200 individuals in the United States die from an eating disorder (ED), making it the second deadliest mental health disorder. The prevalence of eating disorders has risen in the past decade, with the most significant increase in diagnoses occurring during the COVID-19 pandemic. In response to an increase in ED diagnoses, several states have introduced or enacted legislation to raise awareness of and prevent EDs and disordered eating patterns from becoming more prevalent.

Classification as a Mental Disorder

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies EDs as a mental disorder due to the “persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” EDs are routinely co-morbid with other psychiatric disorders, including mood and anxiety disorders. Individuals who have an ED often experience anxiety about their weight, personal appearance, and eating in general.

Types. The DSM-V recognizes six types of EDs: anorexia nervosa (anorexia), bulimia nervosa, rumination disorder, avoidant restrictive food intake disorder, binge eating disorder, and pica.

Although there are characteristics unique to each type of ED, common associated behaviors include ritualistic eating, restrictive eating, avoidance of certain foods, binge eating, and purging by vomiting, laxative misuse, or exercise.

Associated Risks. Medical complications can arise as a result of any ED, especially when a co-morbidity is present. The most severe complications are associated with anorexia, which can result in conditions including amenorrhea or infertility, drop in internal body temperature, insomnia, lanugo, lethargy, muscle wasting, organ failure, and death. All EDs can be deadly, though individuals diagnosed with anorexia are more likely to die either by suicide or from a medical condition related to starvation than are other ED patients.

Treatment. Most ED treatment plans focus on recovery and preventing relapses. Individuals with a severe ED are typically admitted to an inpatient program or a hospital for medical stabilization due to malnourishment. Treatment for less severe EDs may include medication and therapy. ED treatments can range from hundreds to thousands of dollars per day.

Increase in Diagnoses

Prior to the COVID-19 pandemic, inpatient admissions for adolescents and young adults with EDs rose at a rate of 0.7 percent per month. By April 2021, the rate of admissions increased to an average of 7.2 percent per month. Between 2018 and mid-2022, the number of ED-related health visits doubled among individuals under 17 years of age.

National ED Prevention Legislation

21st Century Cures Act. In 2016, the U.S. Congress enacted the 21st Century Cures Act (Cures Act), which includes two main provisions of an ED prevention bill known as the Anna Westin Act. The first provision creates grants for health care workers who train in ED prevention, detection, or treatment. The second provision amends the mental health parity law to ensure that insurers cover residential ED treatment services at a comparable rate to their coverage of residential treatment for physical ailments.

Although the Cures Act made it more difficult for insurance companies to deny coverage for ED care, many patients are still required to pay out of pocket for treatment.
Eating Disorders Prevention in Schools Act. In May 2020, the Eating Disorders Prevention in Schools Act was introduced in the U.S. House of Representatives but was not enacted. If enacted, it would have required school districts to develop nutrition programs and physical activity programs to prevent disordered eating.

Anna Westin Legacy Act. The Anna Westin Legacy Act was signed into law in December 2022 to expand and reauthorize funding through federal fiscal year 2027 for the Center of Excellence for Eating Disorders (Center) created by the Cures Act. The Center supports patients in recovery and provides training and technical assistance to health care workers, teachers, and parents on identifying EDs.

State ED Prevention Legislation

After the COVID-19 pandemic, several states introduced legislation to prevent and raise awareness about EDs. The following ED prevention laws have been enacted since 2020.

Prevention in education. In 2022, Louisiana and West Virginia enacted laws requiring public schools to educate students on ED awareness, prevention, and treatment.

Prevention councils. In 2020, the Kentucky Legislature established an Eating Disorder Council to, among other duties, oversee the development and implementation of ED education and prevention programs and to identify strategies for improving access to services.

The 2021 Texas Legislature and the 2022 Vermont Legislature enacted similar legislation that instructs state agencies or working groups to prepare reports on available ED treatment options in the respective states and make recommendations on improving access to services.

ED treatment. In 2023, the Colorado Legislature enacted broad ED prevention laws to close gaps in treatment services. One law established the Disordered Eating Prevention Program, which is charged with many of the same duties as those mentioned in the previous subsection, with the additional duty of dismantling discrimination and bias with regard to weight.

Another Colorado prevention law prohibits health benefit plans from using the body mass index (BMI) or other similar standards when determining the appropriate level of care for individuals diagnosed with certain EDs. However, the BMI may be considered in determining the level of care for patients with anorexia, though it may not be the determining factor. Other factors that must be considered when determining a patient’s level of care include the individual’s need for supervised meals, support interventions, and any co-occurring disorders. In an effort to curb the potential development of disordered eating habits, Colorado ED prevention laws prohibit retail establishments from selling over-the-counter diet pills to persons under the age of 18.