New Westchester Program to Combat Eating Disorders Holistically

By Adam Stone

There’s a primal instinct as parents to feed our children. 

So when Pleasantville’s Dr. Emily Bly – clinical director of the Psychology Partners Group – treats adult patients whose children are suffering with eating disorders, she sees them grappling with a unique type of parental pain.

The problem became especially acute during the pandemic, when cases of eating disorders spiked to frightening degrees. 

“So much so that we really dreaded having someone come to the office needing an eating disorder referral because we couldn’t even find hospital space for people that needed inpatient treatment,” said Bly, whose group now operates offices in both Chappaqua and White Plains.  

But even with all of this, she was not specifically looking to start a comprehensive eating disorders program here in Westchester County. 

That was before an expert in the field, Dr. Heather Rosen, came calling, contacting Bly’s group unsolicited late last year.

At their first meeting, Bly knew the opportunity to do immense good for the area had knocked loudly at her door.

“She sought us out because she was looking to branch out on her own, having worked at Mount Sinai,” the Pleasantville resident explained in a phone interview yesterday. “And I ended up having such a great conversation with her here in my office. And I was like, ‘Okay, you’re hired, we’re starting this new specialty.’ It’s been great having her because she’s just brought so much energy.”

 

One Stop Shop

A clinical psychologist specializing in treatment of eating disorders in young people, Rosen had been working as a director of an intensive adolescent program at Mount Sinai, with the Eating and Weight Disorders initiative at the Icahn School of Medicine. 

“I just was ready to do something different after 10 years of being in academic medicine,” said Rosen, who has also worked at Seattle Children’s Hospital and Stanford University, before moving to Bronxville in 2023. 

Experts say the best way to help people with eating disorders is to provide a multidisciplinary group where all necessary specialists – psychiatrists, psychologists, dietitians, medical doctors, therapists, and social workers – can all collaborate for patients, ensuring holistic, coordinated care that addresses all needs.

But, incredibly, it turns out that such a place doesn’t currently exist when it comes to a certain approach to outpatient care through a private practice – at least not in our communities, not in our county, and, not in our state, Rosen explained.

“Which is shocking to me,” the 39-year-old Maryland native stressed, noting how similar initiatives are more common on the west coast. “And so I really am hoping to bring such a program to the community here.”

While there are established programs that provide intensive outpatient or partial hospitalization services for severe eating disorders, Psychology Partners Group is developing something different: a truly coordinated outpatient care model in a private practice setting for those still within the safer range of the disorder.

Without such a program, families need to piece together various treatments from a variety of disconnected experts. 

“And that’s really challenging and stressful for families when they’re often overwhelmed with the diagnosis itself,” Rosen said. 

Maintaining a central hub for care is particularly important because weekly, outpatient support is “where the treatments are most robust and have a strong evidence-base,” Rosen also noted. 

“We just don’t have any research that suggests these higher levels of care programs are superior to weekly outpatient care for eating disorders,” she added. “That’s not to say that some patients need more intensive care and would benefit from it. Eventually, these patients step down to weekly, outpatient care as they ultimately need to learn to manage the eating disorder in their real life environment.”

For instance, at Stanford’s Division of Child & Adolescent Psychiatry and Child Development, where Rosen served as a clinical assistant professor through 2021, experts like her assessed young people for possible eating disorders in an outpatient clinic. They then collaborate with a multidisciplinary team, refer patients to providers, connect families with treatment teams, and generally help coordinate care.

But the aspect of this work that really fuels Rosen’s passion is the fact that best practices for treatment of adolescent eating disorders often involve engaging with the family. 

“I was really drawn to the idea that parents are the best resources to help their kids get better,” she reflected. “And so I think what drew me to it was yes, the complexity of it, but also the treatment modality, the fact that you get to work with the whole treatment and there’s an understanding that everyone is impacted.”

‘Younger and Younger’

If you’re a parent eager to keep a watchful eye for red flags, Rosen said how unfortunately the risk age can come as early as nine-years-old, even if more common a few years later.

“It’s starting younger and younger because of our lovely diet and wellness culture, and social media,” lamented Rosen, while also clarifying that “those aren’t direct causes of eating disorders.”

“They might be contributors,” she added, “but they’re certainly not direct causes.”

The disorder arises from a complex interplay of genetic, psychological, and social factors, including biological predisposition, personality traits like perfectionism, environmental influences such as trauma events, and potentially exacerbated by cultural factors such as absorbing corrosive social media content. 

There are two particularlry risky times for eating disorders, especially anorexia: around the onset of adolescence and then again for young adults who go off to college.

“And so we know that eating and restrictions around food and all of that can actually serve as a way to manage really difficult emotions and fears so those are the two times in someone’s life where they can be particularly at risk for eating disorders and anorexia,” Rosen explained.

If anorexia in particular is treated within the first three years of onset, the prognosis tends to be much better.

“Because it can worsen over time and become more chronic,” Rosen explained. “And once it becomes chronic, like a chronic presentation, it just gets harder and harder to treat.”

Yet once an eating disorder is developed at all, it’s immediately a very serious concern. 

“And so the best treatments that we have, you see remission, you know, recovery in about half,” Rosen replied when asked about success rates.

Experts also point out how patients and their families need coordinated care because eating disorders are especially tricky to treat, often co-occurring with conditions like depression and anxiety. 

“And one of the experiences that I’ve had in working with families who are impacted by eating disorders is that they are often really scrambling to try to find a nutritionist, to try to find the right kind of pediatrician, perhaps, who specializes in working with eating disorders, because that’s not everybody,” Bly remarked. “So they have so many disparate points of care that they end up having this very incohesive experience. And what was inspiring to me about Heather’s impassioned approach was we can make this feel more holistic for people so that we can really offer a sort of one-stop solution.”

Rosen only started two months ago at Psychology Partners Group, and it’ll take time to build the program. But as an independent practice, not weighed down by the bureaucratic hurdles of a large academic institution, she said she is confident the small but mighty team can move relatively quickly and nimbly to assemble the right crew of experts.

“Ideally this time next year it will be a program that is on the map and people know about,” Rosen estimated, while acknowledging that it could take a touch longer to have the full-fledged initiative humming. 

By the Numbers

The statistics are also deeply disturbing. About nine percent of Americans, or 28.8 million people, will experience an eating disorder in their lifetime, according to the National Eating Disorders Association.

Harvard’s Strategic Training Initiative for the Prevention of Eating Disorders, in collaboration with the Academy for Eating Disorders and Deloitte Access Economics, conducted a study that showed that someone dies from the illness every 52 minutes, costing the country an estimated $65 billion.

In fact, the degree to which eating disorders occur in significant numbers across the country helps illustrate the inaccuracy of a common misconception. 

Some of northern Westchester’s demographics invite speculation about whether the issue is especially problematic in the area.

“People do think it’s historically like a rich white girl problem,” Rosen replied when asked about the issue. “And we actually know that that’s not true. And the people who can have the most severe presentation of eating disorders are actually ones from underserved communities for a lot of stigma reasons. And then also people in larger bodies often get misdiagnosed or not diagnosed at all.”

‘Lots of Resources’

As for Bly, she’s excited to continue to build on the small solo private practice she first started in Pleasantville in 2013 at the Marmaduke Forster House.

In 2016, Bly established the Pleasantville Psychology Group, previously located at Manville Road. 

In September of last year, the practice rebranded, with the switch to the Psychology Partners Group coinciding with the opening of a new office location in downtown White Plains at 199 Main Street, to complement the practice’s Chappaqua site, at 400 King St.

And in reflecting on her latest initiative, Bly said that although the spike in eating disorders has decreased somewhat since the pandemic surge, it remains a huge medical problem – one she’s hoping her group can better address under Rosen’s leadership.

“It remains high,” she said of eating disorder statistics, “and because it is so serious and can be life threatening for folks, it requires a lot of resources.”