Together with San Diego-based company Equip, Kristina Saffran has convinced health insurers from UnitedHealthcare to Aetna to cover research-backed treatment for thousands of patients with eating disorders.
From Katie JenningsForbes Employee
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ristina saffron was first diagnosed with anorexia at age 10. She went through various hospital programs, only to return home and fall back into the same destructive behaviors. “I didn’t know how to take care of myself, and my family didn’t know either,” Saffran said. ForbesDoctors told her parents that there was little hope of her recovery, but that they could send her to an inpatient treatment center on the other side of the country. “It’s pretty horrible to tell a 13-year-old that you’re going to have to live with this forever,” she said.
Instead of giving up, Saffran’s parents discovered an alternative called family-based therapy, which allowed Saffran to stay at home. But that meant her parents had to be heavily involved in her treatment, guiding her at every meal, weighing her regularly and meeting with a therapist weekly. “(It) was the hardest year of my life,” said Saffran, now 32, “but it was definitely the year that made me better.”
Ten years after recovering from anorexia, Saffran founded a company to make this form of therapy more accessible. It created a single online portal for families to treat and manage a child’s eating disorder. Equip also offers comprehensive services that are not always offered with in-person therapy. The full care team includes a therapist, doctor, nutritionist, and peer and parent mentors.
Anorexia is one of the deadliest mental disorders, second only to opioid addiction. Before founding Equip, Saffran had tackled the problem from a different angle, co-founding an eating disorder nonprofit called Project HEAL, which earned her a spot on the 2017 list of top mental health issues. Forbes She was named to the 30 Under 30 list for her work to increase access to treatment for more children, but she soon realized that grants would do little to address the estimated 28.8 million Americans will develop an eating disorder in their lifetime, costing $64.7 billion annually in lost productivity and health care costs.
Equip’s virtual therapy is so effective because of a shortage of specialized therapists and in-person office hours, says Saffran’s co-founder Erin Parks, 44, a clinical psychologist who previously worked at the UC San Diego Eating Disorder Center. Before founding Equip, Parks treated families who flew in from across the country seeking help.
Knowing how difficult it was for families to find and pay for treatment, Saffran and Parks also insisted that Equip be covered by insurance. While Optum Ventures, the venture capital arm of the country’s largest insurer, UnitedHealth Group, participated in Equip’s seed round, it took two years to build the platform before Equip launched with its first insurance deal in 2021. Since then, Equip has negotiated deals with more than 25 health insurers across the country, including Optum, UnitedHealthcare, Aetna and Cigna, and treated more than 5,000 patients. Saffran and Parks have raised $110 million from investors, including VC firms General Catalyst, The Chernin Group and F-Prime.
Insurers pay Equip flat monthly fees for caring for each patient, meaning the San Diego-based startup can use the funds to offer services beyond traditional care codes, such as peer and parent mentoring. In 2024, revenue is expected to double from $35 million last year. That growth helped Equip earn a spot on this year’s Next Billion-Dollar Startups list, one of the 25 companies we believe are most likely to reach a $1 billion valuation.
Equip is now trying to expand access to people who don’t typically get treatment, including people over 24 and low-income patients on Medicaid. There has long been a harmful stereotype of anorexia as a disease that affects rich, white teenage girls, meaning they are the ones most likely to be studied. “People of all sizes get eating disorders,” said Equip co-founder and chief clinical officer Parks Forbes“We want fat people to feel safe getting treatment. We want men to feel safe getting treatment. We want people in their 30s, 40s, 50s and 60s to feel safe getting treatment.”
Since Equip began treating all age groups in 2023, it has treated patients ranging in age from 4 to 70, according to Parks. Equip screens all patients upon admission to ensure they are medically stable enough for virtual treatment. Patients whose weight or heart rate is too low may need to be hospitalized.
The most common conditions Equip treats are anorexia, binge eating disorder and avoidant-restrictive food intake disorder (ARFID), which is characterized by anxiety or fear about eating, such as choking or eating only very specific foods. Family-based treatment is considered the gold standard for teens with anorexia, and research suggests there is no difference “in clinical outcomes depending on how treatment is delivered, whether in person or through a computer screen,” said Brittany Matheson, a clinical associate professor at Stanford, Forbes. (Matheson revealed that she had previously consulted for Equip when she was independently contacted by Forbes.)
However, there is no treatment that is guaranteed to work for all patients. Equip has begun treating adults, more types of eating disorders, and comorbidities such as PTSD and depression. The company now also offers other forms of therapy, such as cognitive behavioral therapy, dialectical behavior therapy, and exposure and response prevention therapy.
Sue Chambers first heard about Equip in a local Facebook group where another mother was describing her child’s struggle with anorexia during the Covid-19 pandemic. Chambers’ daughter Eleanor, whose name has been changed for privacy, had just been diagnosed with anorexia at 13, and Chambers and her husband were exploring the various treatment options. “We were really terrified of admitting her,” Chambers said. Forbesand said she could not imagine not being able to be with her child and help him during treatment.
Family-based therapy is said to be effective for 30 to 50 percent of anorexia patients and is recommended as long as the parent or guardian is willing to participate and there is no history of abuse in the family. But it is not easy. The therapist guides the parents through what is known as the refeeding process, which requires the child, who is terrified of food, to eat six meals a day, Chambers said. She compared it to the child having to “eat a plate full of spiders and snakes.” Her daughter, who normally had a pleasant disposition, became a different person. “The suffering they go through is like nothing else,” Chambers said. “It’s just horrific.” She said it was “essential” to have a parent mentor from Equip whose child had been through eating disorder treatment and could help them.
Chambers thanks Equip for “saving” her daughter’s life. After 18 months of treatment, Eleanor is “physically fine,” she said, but she still has a long mental road ahead of her. “We’re probably talking a couple more years before we see a full recovery, and that’s perfectly normal,” she said.
Researchers in the field disagree on what exactly recovery means: in anorexia, it is usually defined by a reduction in behaviors such as calorie restriction and negative thoughts, combined with reaching a certain weight for a certain period of time. Different studies have used different measurements to calculate target weight, including BMI or a percentage weight gain goal. Equip claims that 75% of its patients “reached or maintained” their target weight within a year of treatment.
“They are a relatively young company and are still learning, but they have the infrastructure to adapt, change and get better.”
Tracy Richmond, a pediatrician who directs the eating disorder program at Boston Children’s Hospital, said Forbes She offers in-person visits to some patients who use Equip to supplement the rest of the care team. Richmond calls Equip’s peer and parent mentoring the company’s “secret gem,” since these types of services are rarely covered by insurance. But she also stresses that family-based therapy is difficult and doesn’t work for everyone. “A lot of it depends on the dynamic and the willingness of the parents,” Richmond said. “There are a lot of parents who just tell me, ‘That’s just not feasible for my family.'”
And Equip isn’t the right fit for every therapist, either. A half-dozen anonymous employee reviews on Glassdoor say caseloads are too high for some complex patient needs. Parks said Equip’s providers spend 26 hours a week in sessions with patients, while the other 14 hours are spent on training and administrative tasks. “A therapist who says it’s too much isn’t making it up. It was too much for them,” Parks said. That’s why Equip is working to set clearer expectations in the hiring process.
Chambers, whose daughter was in treatment at Equip, said her therapist went on maternity leave in the middle of treatment. While that can happen in any organization, it was a relief that Equip provided a replacement and she didn’t have to go through the process from the beginning. “They’re a relatively young company and they’re learning, but they have the infrastructure to adapt, change and get better,” Chambers said. “While we had challenges, we also had the support we needed at the end.”
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