Kentucky lacks access to eating disorder treatment, but this professor is changing that

Morgan Watkins
Courier Journal

Growing up, Cheri Levinson watched friends with eating disorders struggle to find the professional help they needed within the Louisville community.

"I had friends who didn't have anywhere to go, or they had to go out of state pretty far away to get treatment," she said. "There just wasn't anything here."

It was — and still is — difficult to find specialized treatment for eating disorders in Kentucky, according to Levinson, who is now a licensed psychologist and assistant professor at the University of Louisville.

Since she moved back to the city a few years ago, Levinson has been trying to change that through her work at U of L's Eating Anxiety Treatment (EAT) Laboratory and Clinic and the Louisville Center for Eating Disorders, a private clinic she launched in late 2017.

"It feels like a lot of work, but I feel like we're just really creating something in Louisville and in the whole state that has just been needed for such a long time," she said.

Cheri Levinson is a licensed psychologist and assistant professor at the University of Louisville.  Her area of expertise is the study and treatment of eating disorders in the Eating Anxiety Treatment lab (EAT) at U of L.  
Feb. 14, 2019

She is focused on increasing local access to the services her childhood friends lacked. And at the EAT Lab, she and a team of graduate students are researching new treatment methods.

It took a long time for eating disorders to be recognized as mental illnesses, and research on those conditions is a growing but still underfunded field, Levinson said. 

Current treatments have only a 50- to 60-percent success rate, but she hopes the research happening at U of L will help improve that.

The center gets five to 10 calls a day from people interested in the services it offers, and callers from other states and countries have asked to be part of the lab's studies.

"A lot of these people ... have tried every single treatment out there," Levinson said. "People are really desperate for something that will work."

The stakes are high. Anorexia nervosa has the highest mortality rate of any mental illness, said Leigh Brosof, a U of L clinical psychology doctoral student who works with Levinson. More than 50 percent of people with eating disorders relapse after a single course of treatment.

Genetics play a huge role in the emergence of eating disorders, but societal pressures also have an impact on at-risk people, Levinson said. Eating disorders are especially common on college campuses because the peak periods of development for these illnesses occur when people are between 13-15 years old and 18-19 years old.

"Society is basically set up so that if someone has a genetic vulnerability for an eating disorder, they're going to get an eating disorder," she said. 

Meredith, a college student and long-term client of Levinson's who asked that her last name be withheld for privacy reasons, said her family was blindsided when she was diagnosed with anorexia as a teenager.

They couldn't find anywhere in the Louisville area to go for specialized treatment or advice back then, Meredith said. She needed inpatient, round-the-clock treatment at that time, but there weren't programs like that available in Kentucky.

"Because there was nothing in Louisville, I ended up going all the way out to Arizona," she said.

She also used to travel to St. Louis for intensive outpatient treatment, which lasts several hours a day, because those services weren't available at home. 

It's been nearly a decade since she was diagnosed with anorexia, and she is still working to treat her illness. She attended several inpatient programs in other states over the years but often had trouble finding the professional support she needed in Louisville to remain stable once she returned home.  

In Levinson, though, Meredith said she has found a professional she can trust. She finished her last inpatient program in May 2018, and this is the longest she has ever gone without returning to that level of treatment.

"I didn't really have hope that things could really get better," she said, but she does now. "You have to be sick and tired of being sick and tired, and even then it's not easy and you do need that really solid care team."

The EAT Lab, as well as the Louisville Center for Eating Disorders, give patients an opportunity to get early intervention for their illness, she said, and offer a team of professionals who can provide the support people like her need.

"It's just kind of a safety net that the community didn't have before," Meredith said. "Her research is trying to figure out ways to make treatment more effective so you don't see people going in and out and struggling with it for decades."

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New services in town

The Louisville Center for Eating Disorders is staffed by a team that includes psychologists, dietitians and a psychiatric nurse practitioner, as well as graduate students who are in training, Levinson said.

In addition to treating eating disorders, they also provide treatment for anxiety and obsessive compulsive disorder, which often go hand in hand with eating disorders, Levinson said. People can schedule weekly meetings with a psychologist and dietitian, and the center offers reduced rates, depending on a client's financial situation.

The center also offers intensive outpatient treatment services during the day and in the evening, where clients participate in group and individual therapy sessions as well as meal therapy, during which they eat with fellow participants or a therapist.

Levinson said they're working to open a partial hospitalization program later this year, during which people would spend up to 12 hours per day in treatment at the center, although clients would be able to develop a schedule that works for them.

Meanwhile, at the EAT Lab, research is ongoing that focuses on developing new approaches to treating eating disorders.

One study centers on imaginal exposure therapy, a method commonly used for anxiety disorders in which people describe and delve into deep fears they can't literally face — such as a concern that they'll start uncontrollably gaining weight — to help them develop strategies for dealing with the associated anxiety, according to Brosof, the doctoral student who works with Levinson. 

Levinson said they're starting a similar study that uses virtual reality as a treatment tool.

In addition to participating in research that allows them to try new treatment methods that are still under development, people can also get individual therapy for eating disorders through U of L's psychological services center, Levinson said. The fees for those services also can be adjusted depending on a person's ability to pay.

Irina Vanzhula, another clinical psychology doctoral student who works at the EAT Lab, said the research and counseling they do at U of L centers on the thoughts and emotions people have around food. 

"Our focus in treatment is never on weight," she said.

Leigh Brosof, right, and Irina Vanzhula prepare for an upcoming statistics presentation in the office for an eating disorder clinic at the University of Louisville.  They are both clinical psychology doctoral students who have been studying and treating eating disorders in the Eating Anxiety Treatment (EAT) lab at U of L.  
Feb. 21, 2019

Virginia Cox Evans, a licensed clinical social worker who treats eating disorder patients in Louisville, said a vital aspect of Levinson's work is how she is teaching graduate students and medical professionals to treat these illnesses effectively.

"People are feeling powerless and treating symptoms rather than resolving the issue," Evans said. "Cheri (Levinson) is really bringing people in and training them, which is wonderful."

Levinson wants to continue expanding access to eating disorder services and research not only in Louisville, but throughout Kentucky.

"I think there's just a huge need for this increased awareness and training throughout the state," she said. "I just really hope that the work we're doing can help decrease the stigma associated with eating disorders and help people understand ... they're biological illnesses, just like cancer or diabetes."

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Morgan Watkins: 502-582-4502; mwatkins@courierjournal.com; Twitter: @morganwatkins26. Support strong local journalism by subscribing today: courier-journal.com/morganw.

Louisville resources for people who have, or are concerned about eating disorders

Louisville Center for Eating Disorders:

Call 502-205-1114 or visit louisvillecenterforeatingdisorders.com.

University of Louisville EAT Lab:

Learn more about the research U of L is doing at louisvilleeatlab.com.

To schedule an appointment at U of L's psychological services center, call 502-852-6782.

The Body Project:

This prevention-focused project, used in many communities, helps girls and women learn about and confront societal standards of beauty and foster healthier perspectives on body image.

A new Body Project chapter at U of L will collaborate with other organizations and focus on connecting with college students on campus, according to doctoral student Caroline Christian. For more information, send an email to bodyprojectlouisville@gmail.com.

Irina Vanzhula, left, and Leigh Brosof walk to an eating disorder clinic at the University of Louisville.  They are both clinical psychology doctoral students who have been studying and treating eating disorders in the Eating Anxiety Treatment (EAT) lab at U of L.  
Feb. 21, 2019