We built Equip because we saw firsthand how hard it is for people with eating disorders to get treatment that leads to lasting recovery. This is a serious issue: An estimated 9% of the U.S. population (almost 30 million people) will have an eating disorder in their lifetime, but only 20% of them will get treatment, and an even smaller fraction will access care that actually works. 

There are a lot of factors perpetuating this unacceptable situation, but a major one is the fragmented nature of traditional eating disorder treatment. At Equip, a pillar of our treatment is continuous care that eliminates this fragmentation and instead supports patients through every step of the recovery journey. Here, I’ll unpack exactly why continuous care is so important in the treatment of eating disorders, and how the Equip treatment model allows for continuity at every stage of recovery. 

The problem: a fractured treatment landscape that lets patients slip through the cracks

When someone has a physical health issue—say, they need a knee replacement—they usually see the same provider or set of providers from the point of diagnosis through full recovery. If they see multiple providers, like an orthopedic surgeon and a physical therapist, for instance, those providers are communicating with one another and ensuring that the patient continues to make progress. But with mental health problems, and eating disorders in particular, patients are often passed from program to program or provider to provider, creating a fragmented environment in which vital information gets lost, patients are tasked with being their own case managers, and it’s easy to lose motivation and drop out of treatment. 

In the traditional eating disorder treatment framework, patients usually begin at a higher level of care and then “step down” to lower levels as they move toward recovery. This may mean starting with inpatient or residential care, then progressing to a partial hospitalization program, then an intensive outpatient program, and then individual outpatient providers. Each of these transitions requires the patient to establish relationships with new providers, wrangle new insurance approvals, adjust to a new routine, and tell their story again. Each of these transitions offers another opportunity for the eating disorder to gain ground, for patients to disengage, for recovery to take a back seat. Given all this, it shouldn’t be a surprise that relapse rates are staggeringly high: a report from Deloitte showed that roughly half of all patients discharged from residential eating disorder treatment relapse within one year.

The solution: continuous care that follows patients through every stage of recovery

If half of the people receiving treatment don’t recover, it’s clear that something is broken in the current system—and indeed, the root of the problem is (at least in part) that eating disorder treatment itself is broken into different steps rather than integrated into a continuum of care. For true parity to be achieved, we need to provide mental health patients with the same seamless, end-to-end treatment approach that we provide for physical health problems.

The need for this shift becomes even clearer when you begin to consider the benefits of continuous care:

• Patients see the same set of providers throughout the recovery process. Research shows that the relationship between a patient and their therapist is an important factor in eating disorder treatment, and this is likely also true of other providers, like dietitians and medical doctors. Additionally, clinical evidence shows that once folks get to a place of full symptom remission and nutritional rehabilitation, staying with their same treatment team for at least 6 months to work on relapse prevention and comorbidities gives them the best chance at lasting recovery.
• Patients are protected against setbacks and relapse. It’s during these times of transition, when patients step down from one level of care to the next, that the eating disorder has an opportunity to regain control. As the chain of custody shifts and new providers get up to speed, patients may find themselves without the support and structure they need. It’s a vulnerable moment, one in which it’s all too easy to lose motivation, or even fail to enroll with the next step of treatment. In a continuous care setting, these transitions are eliminated.
• Important information doesn’t get lost. When a patient steps down from residential treatment to a PHP, or from PHP to IOP, for instance, there’s a lot of information that needs to be relayed from one set of providers to the next. It’s one thing to send over medical records, but there’s also all the information that isn’t documented in these records: emotional and psychological observations, historical context, family dynamics, sensitivities to consider, unique goals and challenges, and more. With continuous care, all of this information lives with the same team throughout treatment. 
• Patients and families have less admin work. There are a lot of non-treatment tasks related to treatment—finding and coordinating care, dealing with the logistics of scheduling, figuring out insurance coverage, and more—all of which can contribute to burnout before the real work of fighting the eating disorder even begins. Staying with one care team for the duration of treatment greatly reduces all of this overhead. 

Unfortunately, not many traditional eating disorder treatment providers are set up to provide this type of continuous care. It’s difficult for brick-and-mortar treatment centers to house all levels of care in one physical setting, and even if they could, this wouldn’t be helpful for the people who travel far from home for residential treatment. 

Luckily, virtual treatment makes it easy for patients to access continuous care as they work toward recovery—and, even better, it works. In fact, early research indicates that virtual treatment may actually be more effective than traditional, in-person treatment. A 2021 study found that virtual treatment was approximately 115% more effective than in-person treatment in reducing eating disorder symptoms, and 73% more effective in reducing dietary restraint.

How Equip fits into the care continuum

A question we get asked a lot is, “What level of care is Equip?” Our answer reflects the fact that, as outlined above, the entire “level of care” framework makes it harder for people to achieve lasting recovery. Instead of providing care for patients at certain stages of recovery, Equip completely reimagines the eating disorder treatment landscape, providing continuous care for medically stable patients of all acuity levels. Our dynamic, integrated treatment model allows us to support patients from the time they admit to Equip until they achieve full recovery, and along the way, we use measurement-based care to assess patient symptoms and inform how often we see them. Throughout all the ups and downs of the recovery journey, Equip provides one stable anchor.  

Equip treatment is an appropriate choice for patients who might otherwise seek residential, PHP, IOP, or outpatient treatment. In fact, 75% of Equip patients are considered “high acuity,” and 30% come from a higher level of care. But at Equip, instead of “stepping down” to new care teams and environments as they move toward recovery, patients stay with the same providers and in their community through their treatment.

To ensure the health and safety of all patients, some patients must be medically cleared by a physician before they can begin Equip treatment, and all patients are monitored for stability on a regular, ongoing basis. If a patient does become medically unstable during their time at Equip, we help coordinate their hospitalization—and, following stabilization, the vast majority of these patients discharge back into Equip treatment, where they can benefit from our flexible and continuous care model. 

Looking forward: virtual treatment enables us to make continuous care the norm 

We have an ambitious goal at Equip: to help everyone struggling with an eating disorder achieve lasting recovery by accessing treatment that works. The only way to achieve that goal is by providing patients with continuous care through a virtual, evidence-based treatment model. The research backs up this approach, showing us that though our mission is big, it’s achievable.

I’m hopeful that we can all work toward a future where continuous care is the norm, and patients receive the dedicated, wraparound support they need as they work toward recovery—and the full, free life awaiting them on the other side.