I spent years watching people get turned away from ED treatment because a chart said they weren't "sick enough" — despite bloodwork, bingeing, purging, or restriction that would alarm any clinician looking past a number on a scale.

Here's the pattern I kept seeing in traditional care:

• Insurance and intake criteria are often built around weight thresholds, not symptom severity

• Diet culture gets baked into "nutrition education" — patients leave recovery programs with a meal plan that reads like a diet

• Higher-weight patients get told to "just eat less" while restricting; thinner patients get fast-tracked into care they don't want because they "look sick"

• Virtual care rarely fixes this — it just makes the same broken triage faster

What actually works, from what I've seen build trust with patients who've been failed before:

1. Symptom-first intake. Behaviors and labs decide urgency, not a weight number.

2. Weight-inclusive nutrition counseling. No meal plans dressed up as "clean eating." Food is food.

3. Continuity between sessions. Recovery happens in the 166 hours a week you're not in a session — async check-ins matter as much as the session itself.

4. Medical oversight that doesn't moralize. Labs and vitals tracked clinically, not used as a scare tactic.

If you're building anything in telehealth or mental health care, this is the gap worth closing. Happy to talk shop with anyone else working in this space.