Anorexia Nervosa
Nearly 10% of people living in the United States will develop an eating disorder at some point in their lives, according to the National Association of Anorexia Nervosa and Associated Disorders. Yet, millions of people living with conditions like anorexia nervosa and bulimia often struggle to find the support they need.
Within Health is a digital health startup on a mission to change the way people engage with eating disorder treatment, and the ways clinicians approach treatment. The company’s app and remote patient monitoring devices provides patients with a remote clinical team, allowing for treatment and recovery from the comfort of one’s own home.
I spoke with Within Health co-founder Abhilash Patel about what drew him to this work, his personal experience with disordered eating, and how Within is creating a new model for recovery-based treatments.
Rhett Power: Within Health is a fascinating company. Can you talk about what you do?
Abhilash Patel: Within Health is a fully-remote solution for people struggling with eating disorders. Essentially you can think of it like a complete and comprehensive treatment center…that meets you where you are. . We treat all forms of eating disorders in all types of people in all types of bodies. Our mission is to bring treatment to people where they are: Everybody, and every body.
RP: Love that. Why eating disorders?
AP: My co-founder, Wendy Oliver-Pyatt, has been healing people in the field of eating disorders for 25 years. She’s extraordinary and accomplished. For me personally, I felt like this was next — I still do. Within Health needed to happen.
I didn’t like investing. I wanted to operate. My three rules—the three questions I ask—are: Are these the right people to do this business? Is there a real legitimate business here with a sustainable model? Is this business going to matter? When I met Wendy, it was a resounding yes to all three of those things. So we hit the “go” button.
I like to build companies that address my personal problems. I spent a long time in the addiction treatment space. I’m over 18 years in recovery, and I spent a lot of time trying to help other people recover and get the lives that they’re meant to have. My eating disorder goes back to when I was 19 or 20—
RP: Did you recognize it back then?
AP: Yeah, it was impossible to miss. But, it was an intensely personal and private coping mechanism for the shame I had, and I didn’t get well for a long time. There was no one I could ask for help. In my case I was a successful professional male, I had plenty going for me. The idea that I would stop to raise my hand and say “hang on a sec, I need help because I can’t eat in a healthy way?” There was so much shame around it.
When I was younger and ready to ask for help in my early 20s, I looked online and saw that most advertisements and resources for treatment were presented and represented by primarily thin white women, who weren’t talking to me. I’m sorry to say it so plainly, but it’s just what happened. I carried on getting sick privately thinking: “Well, I guess it’ll just happen some other way.” The fact was the professionals that I worked with over the years weren’t always equipped or capable or practiced at treating this illness. What I’ve found is that sometimes it takes a village of people. Ultimately I got better.
RP: Give me a scale of how big eating disorders are. How big a problem is it?
AP: There are just under 30 million Americans that have some form of disordered eating, and about a third of the people that are affected are men. The Harvard School of Public Health estimates the economic cost of eating disorders to be $64 billion per year.
RP: What is “the treatment gap?”
AP: There are a tremendous number of people that need care that either can’t or don’t get treatment . Either they’re undiagnosed, they’re misdiagnosed, or they’re not seeking help. And there are a number of reasons for why a person would not seek treatment even if they were aware they needed it.
RP: Is it a lack of therapists? Why does the gap exist?
AP: There are several reasons. The ones that jump off the page for me are stigma, access, and costs. Ninety-seven to 98% of counties in the United States don’t have brick and mortar options for treatment, despite the millions of Americans who need it. This is part of why virtual care is so crucial. It’s incumbent on us to continue working with insurance providers and payers to create those relationships and secure those contracts so we can provide access to their members, where they didn’t have it before.
There’s a lot of shame. Eating disorders are someone’s safe spot—when they’re sick, it’s what makes them feel better. It’s their attempt to self-medicate or to treat themselves.
RP: Walk us through the effectiveness of using a platform like this versus going into an office for therapy, and how you think this is ultimately going to change this treatment gap.
AP: Imagine a group of moms or dads who can’t leave their lives because they have young children. What are they supposed to do? That’s a busy, difficult job, being a parent. How are they supposed to get well? They can’t go to some place for 90 days.
The way we think about treatment at Within Health is that we can actually interrupt the progression of the illness for people who aren’t yet acutely affected. We’re trying to help as many of these people as we can who otherwise wouldn’t have gotten care.
It begins with bio-psychosocial assessments. We’ve got psychiatrists, therapists, clinical leaders, dieticians, and nurses making sure that your orthostatic vitals are right and they’re tracking a person’s vitals remotely. You step on the scale and the numbers don’t show up for you. It goes to your clinicians and you just focus on being okay, and giving yourself permission to eat, because it’s going to be okay.
Additionally, [remote offerings] can help people normalize a level of care in their home. We deliver the food, so we help them understand what a healthy relationship with food looks like. We’ll sit there and eat the food with them, together, because it’s not always that instinctive and natural.
Most of the [residential treatment] places around the country are full. They’ve got waiting lists. Our mission is to increase access however we can.
RP: And I see how that applies to these other subgroups this could help, whether it’s men—
AP: LGBTQ+, and trans people specifically, have an extremely high occurrence of eating disorders. Because of stigmas and medical bias, it can be difficult for trans patients to find inclusive care offerings — especially in states where trans-affirming healthcare is under attack. On a virtual platform, we can bring this sort of inclusive care to users, regardless of their location — allowing trans patients to connect with one another, as well as with trusted providers.
What existed before was Zoom plus a meal-logging app that we didn’t necessarily agree with clinically. That’s not enough—we can do better. We said, let’s build an app with avatars, connectivity, engagement, and support – then we did that and so much more.
RP: How is the growth? Are you seeing real progress?
AP: It’s happened pretty fast. Thankfully I’ve got an extraordinary co-founder with Wendy. She’s built treatment programs for many years. We have a pretty cohesive team, so that’s helped our velocity.
But eating disorder cases are complicated. It’s not like we’re just giving someone a tele-psychiatric prescription and sending them on their way. These are intense cases, each and every one.
We’ve been really happy with the velocity and the growth, and we’re excited for what’s to come. We’ve treated people as young as 13 and as old as 70—and it works. Over 90% of people had a significantly better quality of life eight weeks after beginning treatment. We’re in about 25-30 states today, and hopefully we’ll be in 50 in the near future.
RP: It sounds like you’re going to solve a lot of problems and help a lot of people.
AP: I hope so. Make no mistake: People with eating disorders can still be high performers and many of us are. But when you restore someone’s sense of self-love and dignity, and that connection to themselves and others, incredible things will happen. I have no doubt about that.
RP: The bottom line is that this has the potential to save lives. And what I really appreciate about this is that we don’t all live in NYC or Miami or LA. How many people across the world live in a small town, who have the same problem, but have nowhere to go?
AP: More than half of the country lives in an area where there are no eating disorder treatment professionals, let alone a facility. That’s not okay. Within Health has to exist for them, and we have to be able to deliver.