Eating Disorder Treatment is a Sinister Joke, Right?
Inside the multi-billion dollar industry profiting off relapse, compliance, and a therapy model built on punishment.
Despite decades of research, eating disorder (ED) therapy and treatment in America are failing to deliver lasting recovery for most people struggling with these illnesses. This isn’t just a personal observation, it’s born out in the statistics, clinical studies, and the stories behind the headlines.
An estimated 28.8 million Americans (about 9% of the U.S. population) will have an eating disorder at some point in their lifetime. Hospitalization rates, especially among teens and young adults, continue to climb. Yet, for all this suffering, meaningful advances in outcomes are basically stagnant, particularly for anorexia nervosa, which remains the most deadly psychiatric disorder and the most resistant to modern intervention. Even among well-resourced, early-diagnosed cases, relapse is the rule, not the exception.
The "gold standard" treatments haven’t fundamentally changed: CBT (Cognitive Behavioral Therapy), some forms of family therapy, and a sprinkle of newer buzzwords (DBT, IPT, MBT) are repackaged every few years and hailed as breakthroughs, usually backed by minor effect-size improvements in weight or short-term reduction in symptoms. Studies routinely find that while CBT and similar therapies can sometimes reduce bingeing or purging temporarily, maybe a 45% reduction in binge episodes during a 12-week trial, most people do not achieve sustained remission. Medications have shown even less promise: there are no proven drugs for anorexia, and the best pharmaceuticals for binge eating deliver, at best, small to medium temporary effects. The research quietly admits: treatment does not "cure" eating disorders for the majority. Instead, many cycle between levels of care, outpatient, inpatient, residential, in a pattern that enriches the industry but leaves patients and families exhausted and in debt.
So what do the so-called "experts" blame? Doctors and clinicians consistently attribute lack of progress to “treatment resistance,” poor patient compliance, severe comorbidities, or the supposedly overwhelming influence of social media and peer pressure. The latest round of “awareness” campaigns focuses on the dangers of TikTok trends and #bodygoals influencers, but that finger-pointing has been around for decades, shifting blame from failed models and toward patients or amorphous social ills. It’s an easy answer, satisfying to grantmakers and the media alike, but it misses the real story.
The business of eating disorder treatment is booming and there’s no real need, financially speaking, for success to look any different. The system profits from repeat admissions, endless cycles of partial recovery and relapse, and the promise of “new” therapies that all center the same assumptions and deliver the same lackluster results. This is exactly why the story matters: if the industry suddenly started curing eating disorders, patient volume and revenue would plummet. For executives, shareholders, and the investment firms that own treatment centers coast-to-coast, that would be a disaster.
This exposé will look past the easy scapegoats, expose the real statistics, and dig into the deeper reasons why “treatment” for eating disorders is set up to fail, because that keeps the business alive.
The eating disorder treatment industry isn’t run like medicine, it runs like a high-yield investment vehicle, with every facet designed to maximize profits first, patient recovery last. Almost no large-scale ED rehab center is truly independent anymore. Most have fallen under the control of private equity firms and their financial power brokers, who buy, consolidate, and flip these providers just like any other asset class, leaving “care” as a buzzword for shareholders while outcomes flatline or worsen.
What does this look like in practice? Giants like Eating Recovery Center (ERC) have changed hands repeatedly between massive funds: from Lee Equity Partners to CCMP Capital for $580 million, then to a joint venture between Apax Partners and Oak HC/FT for $1.4 billion, all in under a decade. Each flip means new waves of capital, cost-cutting, and expansion. During these cycles, the focus is clear: boost margins, scale up volume, and seek new lucrative patient streams through expanded insurance coverage and virtual “access”.
How the profit machine works:
Growth at all costs: Firms back national roll-ups, buying up smaller centers or simply crushing them. The result? Fewer real local options, more “brands” under one financial umbrella, and standardized, streamlined treatments that keep overhead low and billables high.
Cherry-picking: PE-owned centers systematically prefer patients with “good” insurance (private, commercial) and lower clinical complexity, reliable payers, fewer headaches, faster turnaround. Medicaid, the uninsured, or those with complex trauma histories? Sidelined, or excluded entirely.
Relapsing revenue streams: Because short-term stabilization, not long-term recovery, is incentivized, the same patients cycle in and out, each turn a new payday. Sustained healing would mean fewer billable beds and lower returns, so little innovation is aimed at true root-cause treatment.
Staff cuts and churn: After buying a network, PE groups often replace experienced clinicians with cheaper, less qualified staff, cut corners on patient-to-staff ratios, and favor lower-paid, less specialized therapists.
Shareholder structure: Funding for these expansions comes largely from huge pools managed by institutional investors, pension funds, endowments, and yes, the likes of BlackRock and Vanguard, whose stake isn’t in health but in raw quarterly returns.
Put simply, the more patients who relapse or fail to improve long-term, the better for the bottom line. The industry’s profit margin, nearly 10% per facility in 2023, on a market projected at $4.3–$4.5 billion, doesn’t come from curing eating disorders; it comes from their chronicity, their relapse cycles, and systemically fragmented care.
This system isn’t broken. It’s working exactly as designed, for those at the top.
But that opens up the bigger question: Where did all these treatment protocols and philosophies come from? How did this “standard of care” emerge, a standard that serves business first? That’s not an accident, and the rabbit hole starts with the philosophy that underpins everything they do.
If you look at the methods most commonly used to “treat” eating disorders in the U.S., a disturbing pattern emerges: almost every major protocol used today is not actually designed to heal. Not truly. Instead, it’s designed to modify behavior, police thoughts, and enforce compliance, without ever understanding why the disorder exists in the first place. The explanation from clinicians tends to sound the same: “We follow the evidence.” But when you track that evidence to its source, when you actually investigate how these practices came to be, the cracks start to show.
Most modern ED treatment, whether you're in a glittering outpatient clinic or an inpatient facility with round-the-clock surveillance, is based on one core idea: behavior can be corrected, and behavior is the problem. It’s an idea so deeply embedded in the U.S. mental health system that almost no one stops to question where it came from anymore. But question it we must, because the answer is chilling.
The roots of eating disorder treatment go back far beyond the DSM. Centuries ago, starvation was viewed not as illness, but as virtue. Fasting saints and martyr women were glorified for their self-denial; even the term “anorexia” wasn’t coined until the late 1800s by British physician William Gull. With the rise of psychiatry in the 20th century, anorexia and bulimia were pulled into modern medicine, recategorized again as psychiatric conditions. But the treatments remained haphazard, experimental, often violent. Force-feeding. Lockdowns. Even separating patients from their families entirely in the name of “parentectomy,” under the belief that food refusal was merely a plea for maternal attention.
Then came the so-called science: Behaviorism.
John B. Watson, the father of behaviorism, famously claimed he could take any infant at random and shape him into anything, a doctor, a thief, a beggar, purely by manipulating environment and stimulus. He believed free will was a lie. To him, thought itself barely mattered. The human being was a machine, and what mattered was input and output. His experiments reflected this cold logic: in perhaps the most infamous of modern psychology’s foundational studies, Watson conditioned a young child, whom he dubbed “Little Albert”, to develop a phobia of small animals by pairing the animals with loud, terrifying noises. The child screamed and cried, and Watson watched. He concluded that fear, like everything else, could be controlled, taught, weaponized.
If Watson built the foundation, B.F. Skinner erected the machinery. Skinner pioneered operant conditioning, the basic reward/punishment system that’s still the blueprint of much of what gets called “therapy” today. Give a reward when someone does something desirable. Take something away when they don’t. Skinner literally put rats in boxes and taught them to push levers for food pellets. That same model was scaled for schools, prisons, corporate management, and eventually, therapy for eating disorders.
Make no mistake: this framework, unquestioning acceptance of authority, punishment for deviation, and obedience to measurable outcomes, was not elevated by accident. It was historically funded, institutionalized, and strategically promoted by early American industrialists and powerful patrons, who saw human behavior not as something to be understood but as something to be controlled. Historians have outlined how the Rockefeller Foundation and other influential early-20th-century forces aggressively pushed for psychological paradigms that could be standardized, exported, and scaled, models that downplayed the messiness of feelings or trauma in favor of predictable control through institutions. Behaviorism isn’t just a method, it was a weaponized philosophy, built for the age of industry.
Which brings us back to eating disorder treatment.
CBT, or Cognitive Behavioral Therapy, is what passes today as the “gold standard” in ED treatment. It is a direct heir to this behaviorist lineage. While modernized in language, now sprinkled with terms like “maladaptive cognitions” and “core beliefs”, at its heart CBT still sees the mind as a faulty computer that needs reprogramming. In eating disorder facilities, CBT is used to enforce "food compliance,” to reduce or eliminate "distorted thoughts," and to challenge the “false beliefs” a patient holds about food or the body. On paper, it sounds benign. In reality, it often plays out in ways that are mechanical, coercive, and dehumanizing.
Patients are monitored. Their plate sizes are tracked, their bathroom breaks timed and recorded. They're told if they fail to complete a meal, they’ll lose visiting privileges, phone calls, access to outdoor time. The approach is based on the idea that they can be trained out of their “disordered” behavior, if the punishments are real enough and the rewards consistent. Force-feeding is viewed not as traumatic but as necessary compliance. Resistance is pathologized as more sickness. Even emotional resistance, panic around food, self-harm responses to trauma, dissociation, is reframed not through a trauma-informed lens, but as obstinance, deviation, something to correct. This system never stops to ask why. It never asks why someone stops eating, or why someone purges every day, or why the body becomes enemy. It treats these things as chemical glitches or bad habits, rather than signs of pain, trauma, powerlessness. It reduces suffering to a symptom chart. It tells people who are starving, often to exert control in a life where they’ve had none, that the path to recovery is compliance and obedience.
It doesn’t work. We’ve had nearly 50 years of CBT studies, and the hard truth is this: It does not cure eating disorders. At best, it interrupts behaviors short-term. Studies show CBT can reduce incidents of bingeing or purging by small percentages over 12-week courses. For anorexia patients, efficacy is even lower. The relapse rates soar, especially once patients return to real life outside the institution. They come back precisely because the deeper wounds, the ones driving the disorder to begin with, were never addressed. They were punished. Ignored. Repelled by protocols written by men who didn’t believe internal life even mattered.
And here’s where the system perfectly aligns. The financial structure of the ED therapy industry depends on relapse. Patients who get better and stay better are a fiscal liability. But a patient returning for round two, round three, or round ten? That’s a secure revenue stream for investors, PE firms, and shareholders. There’s a reason the business model and the therapeutic model match: they were both designed to treat people like problems to be fixed, not individuals to be understood.
The reality is stark: everyone working in power within the current ED treatment system is playing by a rulebook that originated in labs where children were traumatized, and rats were taught to push buttons for pellets. That rulebook was funded, scaled, and institutionalized by corporate interests who saw people as things to manage, obey, and monetize.
So the protocols aren’t just failing, they were never meant to liberate anyone.
One of the most damning facts about America’s eating disorder treatment crisis is that, even as outcomes lag and relapses soar, almost no doctors or therapists are willing to publicly challenge the status quo. The reasons for this collective silence run deeper than professional caution or even self-preservation, they rest on institutional ignorance, warped incentives, and a fundamental misunderstanding about the nature of these illnesses.
First, the reality is stark: most frontline healthcare professionals simply don’t know how eating disorders work, let alone how to treat them. According to recent surveys, the overwhelming majority of doctors across all specialties (from primary care to specialists) have little or no formal education on EDs, most reporting less than four hours of training over five years. The knowledge gaps are so severe that fewer than half could confidently even recognize effective psychotherapies for anorexia or bulimia. This vacuum of expertise breeds attitudes of helplessness and frustration, many professionals outright admit they do not enjoy working with ED patients, find them “treatment resistant,” or see their illnesses as chronic and untreatable.A significant portion still blames the patient, seeing them as responsible for their illness, or regards EDs as rare “psychological” quirks, ironically compounding the stigma and misinformation that leave patients feeling misunderstood and judged.
Then there’s the persistent, vague mythology that eating disorders are “all about control”. This description, endlessly recycled by clinicians, appears objective but is in fact a seductive red herring, a way to avoid asking deeper, messier questions. Why do so many people, across backgrounds and histories, feel the desperate need to control food, or their bodies, in the first place? What does “control” even mean when someone is starving or destroying themselves in secret? Telling patients their suffering boils down to “just wanting control” doesn't heal, it shames; it caricatures them as manipulative, obsessive, or merely difficult. For years, the dogma of “restoring control” has justified force-feeding and rigid “all-in” compliance-based protocols, reinforcing the fundamental misconception that if you simply break the resistance (with reward, punishment, surveillance), you fix the disease. No surprise: these approaches fail to consider trauma, powerlessness, or alienation, leaving underlying pain entirely unaddressed.
Why aren’t more clinicians standing up to criticize this broken model? A few factors combine to mute dissent:
Lack of expertise and confidence: Many clinicians have only superficial contact with ED patients and feel chronically unprepared and overwhelmed. Even among psychiatrists, only a small minority report comfort or even basic enjoyment working with these patients.
Stigma and negative attitudes: ED patients are still seen as “difficult,” “noncompliant,” or “personally responsible.” This creates a cycle where professionals disengage rather than grapple with the failures of the protocols themselves.
Fragmented and outdated education: Training on EDs is usually outdated, minimal, and fails to provide real understanding or novel approaches. Exposure to CBT and force-feeding models is common, but appreciating the roots, like trauma or social alienation, is rare.
Professional risk and inertia: The clinicians who do question current protocols are often marginalized, dismissed as “radical,” or simply drowned out by the industry’s profits-and-protocols machinery.
To ask “who is calling this out” is, unfortunately, to point to a very small crowd. The majority of critical voices come from former patients, whistleblowers, and a handful of trauma-informed clinicians working outside major institutional settings, people typically ignored by the “mainstream” field. The system remains insulated by its foundational myths, its financial interests, and a pool of professionals who, by training and design, are set up to misunderstand the nature of eating disorders and perpetuate their own failures.
In short: the silence is manufactured, the misunderstanding is systemic, and the price is paid by those who need true help the most. And maybe we don’t need doctors to keep gaslighting us into thinking it is a societal greed, a societal desire for vanity above all else that is causing this horrifying rise in cases and failure in the system. Our ears and eyes and experiences speak louder than the doctors know, and we can inspire change by calling this out for what it is: manipulation.
Bibliography: Bibliography here