MISSOULA - Generally, someone dies from an eating disorder about every 52 minutes.
Eating disorders have the second highest mortality rate of all mental health disorders, second only to the opioid crisis, according to the National Association of Anorexia Nervosa and Associated Disorders.
Yet, until the opening of the Eating Disorder Center of Montana Missoula office this month, most Montanans would have had to travel to Bozeman for in-person care.
There is a lack of eating disorder awareness and care in the US, but this lack of care is particularly felt amongst rural states and communities, like Montana.
The Missoula office — which is located off Higgins Avenue — will offer outpatient care and intensive outpatient care.
Intensive care will include three monitored meals per week, group therapy and meetings with a specialized therapist and dietician.
The center is the first of its kind in Missoula and is now the closest option for most of Western Montana.
Clinical Director Hannah McKinney is excited to offer this care and work with the community to overcome stigmas.
"I think just by bringing care here is going to help improve," she says. "We'd love to partner with schools, medical providers, with other clinicians in town, just to increase the education around eating disorders, the advocacy, just increasing everyone's knowledge."
Dr. Caitlin Martin-Wagar, assistant professor of psychology at the University of Montana, has been conducting research on the care for eating disorders in Montana and the health providers in rural communities.
She has noticed that many providers in the state have little knowledge of how to deal with eating disorders.
"I'm still in the process of data collection, but I have found some pretty interesting and alarming things thus far," she says. "One thing that I found that only about 20% of health care providers are correctly identifying the mortality rate of eating disorders."
Health providers in rural communities are under-resourced, and it is harder to spread awareness about eating disorders to these areas, Dr. Martin-Wagar says.
Generally, there are not a lot of eating disorder specialists in the country, so it is easy to understand why so few of them move to less-urban states.
"We don’t have any internships or post-docs in Montana that focus on eating disorder specialty," she says. "It’s really common that people end up staying where they do internship or post doc, so just the fact that we don't have those type of training opportunities here means that it is going to be less likely that people with that specialized training are going to be residing long term in Montana."
Another barrier stopping rural Montanans from getting the care they need is the stigma around mental health and therapy.
Overall, eating disorders have some of the biggest misconceptions of mental health disorders, according to Ashlee Knight, senior program director for Project Heal, a non-profit organization that aims to make eating disorder care more accessible for all demographics.
Knight says that there is a stereotype for how someone with an eating disorder should look, so those who don't fit that stereotype are less likely to receive a diagnosis.
She highlighted the effect of fat bias in the medical field.
"There's a lot of fat phobia that lives in the medical community, and it's almost like in part of their training with physicians is to be fat phobic, essentially, and to always make things about weight loss, and knowing that that inadvertently is perpetuating eating disorder symptoms," she says.
Dr. Martin-Wagar agrees and says that out of the 30 million people diagnosed with an eating disorder in the US, only about 6% of people diagnosed with an eating disorder are actually underweight.
"There are a lot of misconceptions about what an eating disorder looks like. So one barrier is folks think that folks with eating disorders are going to be emaciated," Dr. Martin-Wagar says.
Other than the already established societal stigmas, Montana has its own culture that can discourage reaching out for mental health help, Mckinney says.
"A pick yourself up by your own bootstraps sort of mentality which can really prevent someone from reaching out for help when they need it, or believing that they deserve to have help, which absolutely everyone does," Mckinney says.
While there isn't much research on the rates of eating disorders in rural areas compared to urban cities, Dr. Martin-Wagar says rural communities can have a higher amount of risk factors.
Things like food insecurity and rates of high weight can lead to disordered eating.
"There's several things that are happening that might indicate that we need to look more at rural youth," she says.
Knight says the most important step to care is receiving a diagnosis.
Project Heal has a free, online phone assessment that anyone can use if they think they may suffer from an eating disorder.
They also have resources for understanding insurance coverage and overcoming financial barriers and other obstacles to care.
Information on how to sign up for care at the Missoula or Bozeman Eating Disorder Center of Montana can be found on their website.
People can also call the National Eating Disorder Helpline.
"If you are someone who you think you might have an eating disorder, or you feel like your relationship with food, eating and your body is disruptive to you and impairing your ability to just thrive and enjoy your life, just reach out and start that conversation with us, or with someone trusted, because you do not have to suffer alone, and there is help on the other side of this," Knight concluded.