The Dollars and Cents of Eating Disorders

I must admit that I cringe slightly every time I try to think about healthcare from an economics perspective. To me, this comes a little close to putting a dollar value on human beings, which feels uncomfortably post-humanistic to me. Nonetheless, there is no ignoring the ways in which economic concerns factor into policy decisions that drive our human services, including health care.

There are also a number of pragmatic reasons for thinking about the costs associated with illnesses; talking in dollars and cents can make for a convincing argument when seeking funding to do research on a particular illness, for example. The ability to reduce healthcare costs is incredibly compelling in a time of fiscal restraint.

Crow (2014) published a short article about the economic costs of eating disorder treatment. In this article, he highlights some recent studies that have examined factors related to “the economics of eating disorders” and suggests avenues for future research in this area.

I will preface my analysis by noting that healthcare economics are not my area of expertise, and I doubt that my university introductory micro- and macro-economics courses prepared me to present an in-depth deconstruction of healthcare costs for individuals vs. systems. I can, however, logic out some of the basics of “eating disorder economics” in a way that I hope will be thought-provoking, and I am open to discussion in the comments.

The conclusion that eating disorders cost a lot seems perhaps an obvious one. Ignoring, for now, the non-financial costs of eating disorders, anyone who has sought private treatment for eating disorders can tell you that it is not cheap.

Costs for individuals vs. costs for systems vary widely based on where you live and what kind of health care and insurance you have available. One example that comes to mind when I think about the costs of treatment is a recent (and ongoing) Indiegogo campaign, where a mother sought to raise $60 000 to enable her daughter to seek intensive treatment for chronic anorexia. Keep in mind that this is a Canadian example; some who has joked about “moving to Canada” for the “free health care” might be surprised to learn that “universal healthcare” does not mean that all services are covered, 100% of the time.

I was asked, when this campaign came out, whether this amount of money seemed standard for four months of treatment. Sadly, the only answer I could give was yes. Though my own treatment was covered by the Ontario Health Insurance Plan, I was always aware that this treatment was not “free”; somebody is always paying, be it the government, the individual, or a third party insurance company. Psychiatric care, dietician consultations, meal services, and other therapy all cost; often, they cost quite a bit.

This huge digression is all to say: it’s complicated. When you talk about money and health, you’re bound to stumble upon irreconcilable differences about who should be footing the bill. I will try to refrain from injecting too much opinion about this particularity, and move now to Crow’s article.


How much does eating disorder treatment really cost? As I alluded to above, I’ve found some to be a bit incredulous that 4 months of treatment could possibly cost $60 000. Crow introduces studies that have looked at this, primarily from a cost-effectiveness standpoint.

Cost-effectiveness Analysis

Cost-effectiveness analysis in some ways avoids the kind of “ick” factor I feel about monetizing people; instead, analysts compare different methods of delivering healthcare and look for a ratio of the costs to produce a gain in health over the health gains (e.g. years of life).

Ultimately, however, the studies Crow introduces look to determine what direct and indirect costs are involved in care for eating disorders. These studies might be helpful, for example, in determining whether one form of treatment is more cost-effective than another, resulting both in financial savings and more effective treatment.

In the context of a larger randomized controlled trial of individuals being treated for anorexia nervosa, Stuhldreher et al. (2012):

  • Looked at direct (e.g. cost of hospitalization, etc.) and indirect (e.g. being absent from work, etc.) costs linked to eating disorders
  • Found that costs totaled 5866 per patient per 3 months, and were mostly direct and related to hospitalization (approximately 3374 Euros)

Looking specifically at a randomized controlled trial of bulimia nervosa treatment, Crow et al. (2013):

  • Compared cognitive behavioral therapy treatment (with or without Fluoxetine) and stepped care (from guided self-help, to Fluoxetine, to CBT) over 62 weeks
  • Found that the cost for stepped care cost $12 146 (US dollars) per patient and CBT cost $20 317 per patient

Examining cost in a German health care setting, Haas et al. (2012) explored costs associated with hospitalization for AN and:

  • Noted a mean cost of 4647 euros per patient
  • Of this, 40% was allocated to nursing costs, 20% to overhead, 16% to therapist costs and 12% to physician costs

Cost-effectiveness: Prevention

Wang et al. (2011) looked at a prevention program aiming to simultaneously reduce the incidence of disordered eating and obesity (Planet Health). They were interested in projecting the costs saved by preventing cases of bulimia. To be honest, I am not sure how much I buy into a projection analysis of the impact of prevention programs- to me there are far too many other factors that could impact the long term impact of these programs, especially a program targeted toward girls 10-14.

Nonetheless, the authors are fairly conservative in their estimates, arguing that this program would likely prevent 1 case of BN, saving $33 999 and 0.7 years of life, adjusted for quality of life. The Crow article reports on the article’s broader conclusion that a combined eating disorder and obesity prevention program would net $14 238 in savings and 4.8 years of life gained; I imagine that this thus reflects results for “obesity prevention.” Again, I would be very cautious in using these results to support arguments for the long-term effectiveness of prevention initiatives.

Societal Perspective Analysis

Looking beyond dollars and cents, Crow notes that eating disorders may also have indirect costs like lost time. Citing a study by Raenker et al. (2013) that focuses primarily on the parents and partners of individuals with eating disorders. Raenker and colleagues found that, in the month prior to hospital admission:

  • Mothers spent an average of 90.6 hours providing care
  • Fathers spent an average of 72 hours providing care
  • Partners spent an average of 72 hours providing care

Though the Raenker et al. study has implications for indirect costs of eating disorders, the authors also focused on the type of support caregivers providers (primarily emotional) and received, and how this impacted their own feelings of distress.

Beyond the results of this particular study, it takes only a glance at the literature on quality of life and well-being for individuals with eating disorders and their loved ones to reveal compelling arguments for the non-financial costs of eating disorders.


Crow also discusses ongoing steps toward better understanding cost effectiveness and eating disorders. These include:

  • A study by Goddard et al. (2013) about the Experienced Carers Helping Others (ECHO) study, a self-help intervention for day and in-patients with AN
  • A study by Schmidt et al. (2013) about the MOSAIC study, wherein adults with AN are randomized to Maudsley model anorexia nervosa or Specialist Supportive Clinical Management
  • A study by Bulik et al. (2013) comparing online vs. face-to-face CBT for BN

Overall, it would appear that researchers and policy makers are interested in learning more about the costs associated with eating disorders. I am still reticent to assign dollar values to eating disorder cases and treatment; to me, the human costs are much more compelling. I can’t begrudge this kind of work, however, because I do think that a fiscal argument tends to be compelling, especially to those who decide what funding goes where (primarily, the government…).

If these kinds of studies help to demonstrate the toll that eating disorders can take not only on individuals’ lives but on individual and national pocketbooks and thus direct more funding toward finding more effective solutions for eating disorders, I think they are well warranted.

What I would caution against, however, is reducing eating disorder “costs” to the financial. I do not believe that any of the studies Crow refers to, nor the Crow article itself, is doing this; I am worried about how these arguments could be taken up. I would also be cautious in advocating for one form of treatment over another because it is more “cost-effective.” Just because a type of treatment is “cost-effective” for one (or many) people does not mean it will work for all. Because I like to be a broken record, I will reiterate: one size simply does not fit all, in eating disorder treatment.

So, readers, what do you think of taking an economics perspective on eating disorders? Do the figures surprise you, or are they in line with what you would expect?


Crow, S. (2014). The economics of eating disorder treatment. Current psychiatry reports, 16 (7) PMID: 24817201

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Andrea is a PhD candidate focusing on individual, familial, and health care definitions and experiences of eating disorder recovery. She has an MSc in Family Relations and Human Development and a BA in Sociology. In her Masters research, she used qualitative and arts-based approaches (digital storytelling) to explore the experiences of young women in recovery from eating disorders. Andrea has recovered from EDNOS. She can be reached at andrea[at]scienceofeds[dot]org.


  1. I often think costs reflect, in part, institutional bias for the status quo and adherence/alignment with traditional settings and methods of delivery for care … and, especially, institutional and provider comfort, legal considerations and institutional/practice business plans. It’s “safer” to admit patients to inpatient or residential care; to keep patients in highly structured environments that generally separate them from community and family and reduce liability concerns; and to mostly do what they’ve always done (or what any particular provider/group/facility believes in or thinks might work) or what insurance will cover.

    In some ways, the insurance companies increase the cost of care when standards for care-necessity require significant decompensation, medical acuity and/or critical psychiatric factors. That leaves the system caring for very compromised patients, which means longer length-of-stay; increased likelihood for expensive medical problems and interventions (and increased staffing costs). It feeds the cycle of rationing treatment and a racheting-up of acuity triage, especially with limited programs; limited spaces; and limited beds. It also means lower levels of care can’t accept patients who might be served, or better served, in that setting because it skews “the curve” toward sicker patients. And that again feeds the cycle (and normalizes exceptional illness and becomes a set-up for comparisons by patients, parents, providers, etc … “well, she hasn’t lost xx pounds or doesn’t purge x times a day, so it isn’t that bad yet …”

    Then others bypass third-party compensation entirely by non-participation and requiring private payment … no third-party-payer treatment requirements or refusals; no answering to “necessity” …of anything, from therapies to meal plans to costs for setting, facility, Intensive treatment and continuing treatment is often presented as “… invest in this time, place, people now, so you can go on with your life …” As if it just might be one-and-done, or nearly, even though everyone knows there is no way/path/light and relapse, even chronicity to some degree, is common.

    Then, you have patients who have exhausted benefits and loved ones who have already contributed to out-of-pocket costs … and can’t afford another cycle, or cycles, which prompts emergent and urgent care “putting out fires.” That increases the likelihood of problems, cost and chronicity.

    All of the above factors, from institutional to medical and individual, increase the cost of lost work and productivity … on the part of the patient and the patient’s family.

    • Thanks for the insightful comment! I think you make a good point about the reasons behind maintaining the status quo; it seems ironic that maintaining the status quo often feeds into the problems you mention, namely, the cycle of not providing the same level of care to those who “aren’t that bad yet.” I would hope that with the increasing awareness of the danger of “subclinical” eating disorders and eating disorders not otherwise specified that we would have seen movement in a different direction, but I don’t think that is really playing out (yet?).

      This is partly my problem, too, with the lack of insurance coverage for those falling into these categories. Of course there need to be lines somewhere in terms of when and where insurance coverage is provided, but given that we know that DSM diagnoses do not tell the whole story (and do not always capture those who are “sickest” and most need treatment) and that there are many barriers to seeking treatment, it seems flawed to rely on these categories as the dividing line between having your care paid for and not having it paid for. But then, these are the times we live in, and things are driven by categories and by costs.

      It seems bleak, to be honest, which is perhaps why I don’t often think about eating disorders in reference to economics… still, things we need to be thinking about if we hope to make change that would move things in a better direction (namely, the need to provide a more sound continuum of care that corresponds to the needs, financial and otherwise, of individuals with eating disorders and their families).

  2. I think it’s important to study the economic costs of eating disorders, if only because they are so great and so often are one of the very real reasons why people do not get the help they need. I was interested in the discussion of lost time, etc. as a non-direct measure of the financial costs of eating disorders, and while we often think of the loss of caregivers’ time, I think this represents a bias towards the adolescents we so often think of as being the main sufferers of eating disorders. This is certainly not to say that adults with eating disorders do not impose strain on others in their lives and do not often need caregiving, but I think that often highly educated adults end up losing their own careers or are highly under-employed, or wind up on disability leave due to their eating disorders. Or even those who are able to keep their jobs probably have increased sick days and decreased productivity at work. While I certainly would love to believe that I am not hampered at all at work due to my eating disorder, it is hard to argue that I couldn’t perform more efficiently if I were better nourished and less distracted. Add that to time taken off for doctors’ appointments, etc.

    I digressed from what I was originally thinking, which was that in every other disease, we demand the best care for the least amount of money. We don’t just pay for care that we are told works. We (in the US) are moving towards a healthcare system in which we pay for results and effectiveness of treatments as a whole, rather than for more tests, more appointments, more scans. We are trying to rein in costs but also to do more with less. The fact is that we have a limited number of resources, and that shouldn’t be a cruel thing as in “more for me and less for you” but more like “why not spend our money on something that has been proven to work so that we don’t spend precious time and money on interventions that are likely to require tens of thousands of dollars to see any results”

    I guess it seems harsh when you think of putting dollar values on human lives, and I certainly shudder to think about it that way. But when you think that what we’re really trying to do is find out how to maximize the benefits (e.g. number of people who move towards recovery) within a system that has inherently limited resources, then we really need to find out how the numbers play out in terms of making decisions. Any hard and fast rules, like we NEVER pay this much for this treatment, should be avoided because everyone is different, but we can at least approach each situation knowing what we’re looking at.

    Also, I’m sorry if this whole post made no sense, as I’m really exhausted.

    • I think your comment makes total sense… thanks for commenting! I agree, I think that if there is a good reason to study the economic costs it largely centres around the fact that costs can act as very real barriers to treatment seeking. I don’t think there is an awareness that often to seek treatment means to go on disability- I don’t know that eating disorders are seen as debilitating illnesses, even though they clearly cause such suffering.

  3. I am just a person who is being treated for an eating disorder. To base a cost on 4 months of treatment is irrational and naive in my opinion. Eating disorders requires years of follow up of nutritional and therapeutic counseling. Very rarely will insurance costs cover that part of it even if they cover the initial costs of inpatient care.

    Then there are people like myself who have been suffering for a lifetime. I am 50 years old and currently in IOP (intensive outpatient treatment). I am very, very fortunate to be covered, at this time, by the VA, as a military veteran. This has been a recent inclusion since for years, I’ve had to pay out of pocket till the VA caught up with their responsibility to treat what was caused by military service and the harsh restrictions on women (at the time I was in). I am also aware that they can pull their funding at anytime so am saving up. The cost will be around $1000.00 USD per month. I’ve been in treatment for 18 months thus far. For chronic anorexics, statistics are 10 years of treatment for full recovery or at least the ability to maintain on ones own. That will be about $120.000 which does not include any inpatient or residential care and not accounting for yearly increases in rates.

    I have eliminated nearly all activities in my life to save for treatment. At what point does one account for quality of life? This, of course, is not a factor for insurance. They seem to think that normalization of weight is enough. Misinformation is also problematic, just as with many mental illnesses.

    As with all things, this is issue has many complexities.

    • Good point; I think that even this approach to studying costs (i.e. basing costs on 4 months) suggests that this is all the time needed to recover, which is obviously not the case (and we have lots of evidence both study-wise and anecdotal that recovery takes longer than 4 months, as a general rule…). Good to hear that your treatment is covered; I’m sorry that hasn’t always been the case. I think that you also make a great point about the non-financial costs of eating disorders, including a diminished quality of life. I think the study of these is more strongly accounted for in other literature on eating disorders, though not generally framed as “costs” per se, perhaps.

  4. M. has made a much more in-depth comment about this, but this is the study I want done so there is a simple side-by-side comparison that highlights the incredibly high cost TO THE INSURANCE COMPANY of the current status quo of eating disorder treatment.

    Two people: same age of onset, one with immediate diagnosis and access to appropriate level of treatment care with continued follow up as needed. One with the usual denials of coverage, leading to a sicker person with more medical complications and hospitalizations (very expensive) for a longer period of time.

    Aetna has spent about 100,000 dollars on my daughter. She’s had two PHP stints at an excellent facility (UCSD). Save one ER visit right before treatment began and occasional lab work, she has no medical issues. Her total time spent very ill has been about 9 months in 2.5 years, and she is currently in her 15th month of strong recovery and completed a full year at University. One never says out-of-the-woods with this disease, but our experience of this devastating illness has been much different than most because of access to treatment and good insurance coverage.

    Most insurance companies spend more on keeping people sick than they would on getting them well.

    • I agree that when treatment is put off too long, insurance companies end up shelling out far more than they would have otherwise. I have often wondered why there is such a hesitancy to cover prevention and early intervention in health care in general- the best example I can think of is that in Ontario, though we have “universal health coverage,” dental care (ie. regular visits to the dentist) is paid for out of pocket, despite evidence that good oral hygiene can be preventative for heart disease, etc. Obviously not an ED example, but an interesting commentary on how a rearrangement of insurance spending priorities can lead to more expenditures in the end…

  5. Financial Cost….

    4 years outpatient: approximately $8,000
    2 months inpatient: $85,000
    All new clothes: $1,000
    Follow up care: $4,000

    So financially it is expensive….but the emotional cost and those loss of light in my child’s eyes….that is the true cost.

    • Absolutely agree that the emotional costs are the true costs of eating disorders. Dollars and cents matter in terms of the barriers they pose to treatment that may help someone to get to a happy & healthy place, but we can’t put a dollar value on the emotional etc. costs for individuals & families.

  6. I think to calculate the costs of the illness over it’s lifetime with the current state of treatment here in Australia – where people struggle so much to just get help and often are ‘very far gone’ before it happens – and to contrast it with the costs if that person was subject to early intervention or at the very least, support when they first asked for it or someone first raised the alarm, and continued care right up til proper recovery (full weight restoration and nutritional rehabilitation and full treatment of all other factors – plus follow up for at least 5 years after ‘recovery’ is reached. I think that we would find that the second option despite being much more intensive than current treatment regimes, would cost far less per person over a lifetime – and that’s what the powers-that-be who don’t seem to recognise the extreme need for more treatment facilities and funding FAST need to recognise.

    What is impossible to calculate however is loss of life, loss of quality of life, loss of self, loss of income, loss of so much more.

    I also think costing should be done with caution. Many times as an inpatient, someone has used the “Do you know it costs taxpayers over $1000 a day to just have you in this bed in this hospital” line to guilt me, thinking that it would make me do the ‘right thing’ in order to stop burdening the taxpayers. Instead it just added to my self-hatred and deep guilt and shame and feelings of unworthiness, and the struggle to ask for help when needed as I’d already ‘cost so much’ and had more than my ‘fair share’ (which is totally not true either – the truth is, treatment is there for who needs it at the time, end of story.) (Or, SHOULD be.)

    Also, while on TPN, I was at the receptionist’s desk one day, shile she was filling out order forms for all the pieces that made up the line, connectors etc (this was when TPN was still in several separate bags that mixed in the line before going into you). Seeing how much those tiny little bits of plastic COST, knowing that they had to be completely replaced every 24 hours, shocked me so deeply that I begged for days to stop the feeding and go home.

    So economics can be a tool or a weapon, depending whose hands it falls into.

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