House Joint Resolution (HJR) 268 directs the Joint Commission on Health Care to:

"study the adequacy of health care coverage for anorexia nervosa and bulimia. The Joint Commission shall (i) receive information concerning the causes of these eating disorders; (ii) analyze current anorexia nervosa and bulimia treatment options; (iii) assess the current means by which health insurers, HMOs, and others are currently providing health care coverage for such treatment options; and (iv) make recommendations concerning improvements for such coverage and care."

The term "eating disorders" encompasses several disorders related to the ability of a person to maintain a health body weight. According to the American Dietetic Association, "onset of an eating disorder typically follows a period of restrictive dieting; however, only a minority of people who diet develop eating disorders." Eating disorders are found in both men and women, however they are most common in women. It is estimated that as many as 5 percent of young women and one percent of young men may have eating disorders.

The most commonly discussed eating disorders are anorexia nervosa and bulimia. Eating disorders can also encompass binge eating and other nonspecific disorders. At present, both anorexia nervosa and bulimia are classified as mental health disorders for purposes of medical coding and in the current (fourth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). However, eating disorders can result in serious physical health problems, including starvation, dehydration, electrolyte imbalance, and osteoporosis.

Based on our research and analysis during this review, we concluded the following:

• eating disorders are very difficult to treat, can require long periods of time to successfully treat, and involve both mental health and physical health care treatment;

• limits on insurance coverage for eating disorders are related to the broader question of parity for mental health care;

• eating disorders do not lend themselves to mandated benefits legislation, due to the wide variation in time and therapies required for successful treatment of eating disorders;

• agencies of the Commonwealth, particularly the Department of Health and the Department of Education, have not been particularly active in eating disorder prevention and education.

A number of policy options were offered for consideration by the Joint Commission on Health Care regarding the issues discussed in this report. These policy options are listed on pages 16-17.

Our review process on this topic included an initial staff briefing, which comprises the body of this report. This was followed by a public comment period during which time interested parties forwarded written comments to us regarding the report. The public comment received, which is provided in Appendix C, provides additional insight into the various issues covered in this report.