US lawmakers in several states making legislative moves to combat surge in eating disorders

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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. The thought of eating cake for her 16th birthday induced severe anxiety. 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. On Thursday, Colorado lawmakers advanced a bill that would create a state Office of Disordered Eating Prevention, intended in part to patch holes in care, to fund research and to raise awareness.

The bill passed committee by a 6-3 vote with Republicans demurring, partly concerned with the creation of a new government office and skeptical of its efficacy.

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.

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Proposals across the U.S. include restricting social media algorithms from promoting potentially harmful content; prohibiting the sale of weight loss pills to minors; and adding eating disorder prevention to 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, who was diagnosed with anorexia.

Anorexia typically involves restrictive eating habits and can cause abnormally low blood pressure and organ damage. Binge eating disorder is a compulsion in the other direction. Still, having an eating disorder does not invariably mean someone is overweight or underweight — and that's left many who suffer with the mental illness to go undiagnosed, experts say.

Riley Judd, a student at the University of Denver, gives testimony during a Colorado Senate hearing on measures to address eating disorders on March 23, 2023, in Denver. Lawmakers in states including Colorado, California, Texas, and New York are taking big legislative swings at the eating disorder crisis in America. (AP Photo/David Zalubowski)

Colorado’s bill creates a state office that is broadly charged with, in part, closing gaps in treatments, offering research grants, 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 national 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.

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Colorado is also taking a swing at axing the 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. That means that those who fall outside of the BMI prescription are often denied care, or kicked out of treatment prematurely.

"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 to 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.

"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.

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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 Rep. 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. ___ Associated Press reporters Sophie Austin contributed from California, Acacia Coronado contributed from Texas, and Michael Hill contributed from New York. Jesse Bedayn is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.