Background: Weight Watchers just announced a rebranding plan to target $2 billion in sales by the year 2020. As part of this campaign, Weight Watchers will offer teens ages 13 to 17 free memberships this summer as part of its plan reach the company’s fiscal goals. Let’s look at 3 reasons this campaign is potentially harmful to clients with eating disorders.


Clients with anorexia and bulimia who have pervasive psychological undercurrents motivating their behavior with food are negatively impacted by the billion dollar marketingefforts of the weight loss industry.  When weight, body size and shape are seen as synonymous with love, acceptance, and self-worth, young people are vulnerable to the efforts of the weight loss industry. The same advertisements that target “healthy” behaviors can trigger life threatening “unhealthy” behaviors in others, especially in the teenagers who struggle to fit in with their peers.

Bariatric surgery and eating disorders
The weight loss industry does not take into account individuals who may be struggling with a diagnosable underlying binge eating disorder and for whom weight loss is an endless cycle of yo-yo dieting that deteriorates the individual’s self-esteem over time. There were 216,000 bariatric surgeries in 2016 alone and an estimated 16% of those individuals were struggling with an underlying binge eating disorder.  These individuals will often have detrimental effects from bariatric surgery because the underlying psychological disorder was not dealt with prior and therefore the weight loss after the surgery masks the underlying issue.

Eliminates hope for body positivity campaigns
The fact that Weight Watchers is targeting teens ages 13 to 17 with revenue goals in mind ignores the opportunity for philosophies such as Health At Every Size, HAES, Intuitive Eating, and Body Trust to be introduced as a self-affirming and recovery oriented perspectives. Weight loss sends the message “there is something wrong with me” and promotes a shame based lens for these impressionable teens.

With National Eating Disorder Awareness week just around the corner and our eating disorder treatment centers currently full across the nation, one important word has been on our minds… PREVENTION.  As an eating disorder advocate and treatment provider, this Weight Watchers announcement is harmful to our mission of promoting body acceptance, reducing weight stigma in our society, and promoting lifelong recovery from eating disorders.

If you agree, feel free to join the “Twitter Takeover” campaign in which we will flood @WeightWatchers with our thoughts on this dangerous plan.

Contributed by Dawn Delgado, LMFT, CEDS-S
Certified Eating Disorder Specialist – Supervisor
EMDR Trained Trauma Clinician
National Director of Operations for Center For Discovery


When to Refer Your Eating Disorder Client to a Treatment Program – Psychology Today article

4 ways to tell it is time to refer your eating disorder client to a treatment program.

  • He or she has hit a plateau in therapy

Often eating disorder and disordered eating clients plateau in outpatient therapy alone because there is not a direct food and meal supervision component. The individuals often devote a large amount of energy to convince their therapist that he or she is doing well and progressing. Eating disorder clients are often people pleasers and seek validation for achievement. Without direct meal supervision, support with meal preparation, and working closely with a dietitian to identify consistent food recalls, it is often an insurmountable challenge for clients with eating disorders to make consistent gains in outpatient therapy alone.

  • The client pulls back at mention of a treatment center or

It is not common for the intervention of a higher level of care for eating disorder clients to be a tricky one, demanding both grace and firmness to support the scared client with making an accountable choice. I have supervised therapists who become entangled in countertransference with eating disorder clients. When we hear things like, “He/She trusts me a lot and trust would be broken if I referred to a treatment center” then we know the client is crafti
g a case to avoid the treatment setting. Removing obstacle to treatment is an important part of the therapist-client relationship.

  • The client is terrified to integrate a registered dietitian into

When clients are in the midst of disordered eating or eating disorder struggles, they often avoid dietitians and eating disorder specialists like the plague. My clients in recovery tell me that at the times when they were the most compromised, they sought out non-specialists and avoided dietitians. Therapy is only a piece of the treatment team and collaboration with a multidisciplinary team including medical doctor and registered dietitian are key components for recovery. Avoidance of talking about the food component is avoidance of what is needed to fully recover.

  • If you do not have current lbs or a weight on the client

One of the benefits of working with a multidisciplinary team is the ability to collaborate weekly and receive updates on the client’s weight and labs. Even the most adept clinician cannot tell visually if a client is doing damage to their body with purging, bingeing, or restricting behaviors. Potassium and other electrolyte imbalances are one of the most dangerous health consequences of an eating disorder, which are not visible upon physical assessment. Weekly, biweekly, or monthly “blind” weights are a good way to monitor behavioral trends that may be reflected in weight trends.

As a Certified Eating Disorder Specialist and designated CEDS -Supervisor through the International Association of Eating Disorder Specialists, I have worked with hundreds of outpatient therapists to understand the importance of understanding how to establish a multidisciplinary team in the outpatient setting, as well as how to initiate and hold a firm boundary with referring clients to an outpatient treatment program. Most treatment centers will offer a free phone or face to face eating disorder assessment and some organizations have online assessments available as well. Benefits of day treatment include, meal supervision, inclusive weekly counseling with a registered dietitian, support in monitoring labwork and collaborating with medical doctors, group therapy, support from peer community, family therapy and family support, and weekly collaboration with eating disorder specialists.

Dawn Delgado, LMFT, CEDS-S

Certified Eating Disorder Specialist – Supervisor

EMDR Trained Trauma Clinician

National Director of Operations for Center For Discovery



Bridging a gap in eating disorders services 

Marriage and Family Therapist, Dawn Delgado, Founder of Inspire Evolve Counseling

Marriage and Family Therapist, Dawn Delgado, Founder of Inspire Evolve Counseling

September 10, 2013 by Dawn Delgado, MS, LMFT

Roughly 10% of men and 30% of women entering treatment for drug or alcohol addiction also suffer from anorexia nervosa, bulimia nervosa, or binge eating disorder. In order to treat the whole person and improve long-term outcomes, addiction professionals must not only recognize the signs of these eating disorders, but also have a firm understanding of eating disorder treatment options and trends.

In this article we explore a new innovation in eating disorder treatment: the 11-hour extended day treatment (EDT) program. Through the lens of “Lisa,” a psychologically vulnerable, opiate-addicted client whose weight is in the double digits, we will see how the EDT program can help bridge a critical gap between inpatient treatment and a partial day program.

Imagine Lisa is your client. As you look at her, you realize that her protruding ribs and emaciated structure are visible indicators of life-threatening malnourishment. You know that both the physiological destruction caused by her addiction and her starvation mirror the neurological and psychological trauma that underlies her multiple diagnoses: anorexia nervosa, post-traumatic stress disorder (PTSD), debilitating anxiety, opiate addiction and clinical depression.

Immediate action is taken to help Lisa get the medical care she needs. She is sent to an inpatient facility such as Rosewood Centers for Eating Disorders where she can medically detox, address her anorexic condition and receive treatment for her underlying disorders.

Lisa becomes medically stabilized, and her treatment team keeps you informed of her progress. Within 30 days her weight normalizes into the triple digits, she begins to feel more energized, she no longer experiences fainting spells or seizures, and her lab reports indicate that her health is improving. Within this time, Lisa’s multidisciplinary treatment team helps her to begin identifying and addressing underlying trauma through psychodrama, one-on-one counseling, group therapy, and equine therapy and other experiential modalities.

Now imagine that after a decade of illness and only 30 days of inpatient treatment, Lisa (who was literally dying of starvation prior to treatment) is suddenly removed from the safety and familiarity of around-the-clock care. She travels by airplane to another city to enter a new program with a new treatment team. She is in a new transitional housing environment with new peers, and now instead of 24-hour supervision she is reduced to 6.5 hours of structured programming, six days a week. She must adjust to 40 hours of weekly care, vs. the 168 hours of weekly care she had received as an inpatient client.

So, what happens? Lisa leaves the hospital and soon begins losing weight, withdrawing from others, using unhealthy substances in order to numb, and slipping back into destructive eating disorder behavior patterns. In short, Lisa relapses.

What is the solution? What happens when she is finally discharged? How does she make the leap from inpatient care to being unsupervised 50% of the time in a partial day program?

Intermediate step

What seems clear is that there is a need for a solution that would allow Lisa the freedom to explore independent life in recovery while still being supported by structured treatment during the vast majority of her waking hours.

This was the need that eating disorder experts Michelle Klinedinst and Robyn Caruso responded to when they created the 11-hour EDT program at A New Journey (ANJ) in Santa Monica, Calif. Facility executive director Caruso explains, “Transition from the 24-hour structure of inpatient treatment to a partial program where the client spends 65% of their waking hours and 85% of their meals unsupervised can be overwhelming for some people. ANJ’s 11-hour Extended Day Treatment program, coupled with our supervised transitional living environment, is a perfect solution for these clients.”

Caruso says that in the EDT program, clients are in structured programming for 75% of their waking hours, and the rest of the time they are often within the safety of ANJ’s transitional housing environment. This more gradual transition to independent living incorporates more one-on-one care, smaller groups, and more structured meal times.

In ANJ’s program, clients take responsibility for 20% of their weekly meals, including nightly snacks as well as all meals on Sunday. Working with a dietitian, clients plan these independent snacks/meals ahead of time and make commitments to peers regarding their eating behaviors. Held accountable for their commitments, clients discuss the outcomes of their independent snacks/meals in daily therapy sessions.

This structure allows clients to get into a rhythm and slowly internalize healthy eating patterns in an environment where relapse intervention occurs immediately. This early intervention helps clients better prepare for the next step in their recovery journey.

When ANJ clients are ready to step down from the 11-hour EDT to a 6.5-hour partial day program, they stay at the same treatment facility and often remain living in ANJ’s transitional housing units. This allows clients to benefit from maintaining continuity with the peers, location and treatment team they grew to trust in the EDT program.

“Change is difficult, particularly for clients struggling with eating disorders,” Caruso says. “The EDT to [partial day program] solution at ANJ allows clients to focus on recovery, instead of having to adapt to unnecessary changes in their treatment environment.”

Another aspect of the EDT program at ANJ is the low client-to-staff ratio, which runs at about half of the ratio in ANJ’s other programs. A smaller group with more staff means that high-risk clients are able to get the individualized care they need.

Asked about how this program is received in the treatment and recovery community, Caruso says, “Sober livings like it because their clients can get an extended day of structure in conjunction with the support they get in the sober living environment.” She adds, “Counselors appreciate the program because we are open to collaborating with outside therapists to help clients have the individualized treatment team and continuity that they need.”

Remaining hurdle

This new approach to treatment is still not fully understood by insurance professionals. Caruso and her team have been working diligently to advocate for clients by helping these professionals understand that the EDT program truly constitutes a separate level of care.

“They are coming around slowly and beginning to see the potential cost savings in treatment and relapse prevention that a program like this offers,” Caruso says of insurers.

The EDT program has been so well-received by the treatment community that Klinedinst, who is responsible for building eating disorder treatment centers throughout Florida, California and Arizona, plans to introduce the 11-hour program to her newest center, Eating Disorder Recovery at PBI.

“Our goal is to improve client access to treatment, promote long-term recovery, and ensure relapse prevention,” Klinedinst says. “We feel that the 11-hour EDT program helps us reach this goal by effectively bridging the gap between [inpatient treatment] and [a partial day program].”

In the case of Lisa, who is representative of many clients who have gone through ANJ’s EDT program, the 11-hour bridge was just what she needed. After multiple times in treatment, Lisa finally was able to avoid another relapse and step down successfully to a PDP program, this time ready for her newfound independence and confident in her ability to achieve long-term recovery.

Dawn Delgado, MS, LMFT, is a consultant with expertise in eating disorder program development. She has worked with adolescents and adults recovering from eating disorders and comorbid conditions in Southern California since 2002, in inpatient, residential, partial hospitalization and intensive outpatient levels of care. She has served as Membership Chair of the International Association of Eating Disorders Professionals’ Southern California chapter. Her e-mail address is A New Journey’s Robyn Caruso can be reached at


Comments are closed.