Health
Equip has raised $110 million to treat anorexia and eating disorders online
With San Diego-based Equip, Kristina Saffran has convinced health insurers from UnitedHealthcare to Aetna to pay for research-backed treatments for thousands of patients struggling with eating disorders.
By means of Katie JenningsForbes staff
K
ristina Saffron was first diagnosed with anorexia when he was 10 years old. She went through several hospital programs only to return home and relapse into the same destructive behavior. “I didn’t know how to take care of myself, and neither did my family,” Saffran said Forbes. The doctors told her parents that she didn’t have much hope of recovery, but that they could send her to a residential treatment center across the country. “It’s pretty devastating 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 therapy, which allowed Saffran to stay at home, but it meant her parents had to be closely involved in her treatment, coaching her through every meal, weighing her regularly and weekly consultation with a therapist. “[It] was the hardest year of my life,” says Saffran, now 32, “but definitely the one that made me better.”
Ten years after recovering from anorexia, Saffran started a company to make this type of therapy more accessible by providing a single online portal for families to treat and manage a child’s eating disorder. Equip also offers comprehensive services not always offered alongside in-person therapy, with the full care team consisting of a therapist, physician, dietitian, and peer and parent mentors.
Anorexia is one of the deadliest mental disorders, second only to opioid addiction. Before starting Equip, Saffran had tackled the problem from a different angle, co-founding an eating disorder nonprofit called Project HEAL, which landed her on the 2017 list. Forbes 30 Under 30 list for her work to help more children access treatment. But she quickly realized that providing subsidies could make only a small dent when 28.8 million Americans are expected to develop an eating disorder in their lifetime, with an annual economic toll of $64.7 billion in lost productivity and health care costs.
Equip’s virtual therapy is so powerful because of a shortage of specialized therapists and in-person clinics, says Saffran’s co-founder Erin Parks, 44, a clinical psychologist who previously worked at UC San Diego’s Eating Disorder Center. Before starting Equip, Parks treated families who flew in from across the country seeking care.
Knowing how difficult it was for families to find and afford treatment, Saffran and Parks were also confident that Equip would be covered by insurance. Although Optum Ventures, the venture capital arm of the nation’s largest insurer, UnitedHealth Group, participated in Equip’s seed round, it would take two years to build out the platform before Equip launched its first insurance contract in 2021. Since then, Equip has negotiated contracts 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 venture capital firms General Catalyst, The Chernin Group and F-Prime.
Insurers pay Equip a flat monthly fee to manage each patient’s care, meaning the San Diego-based startup can use the money to offer services beyond traditional treatment codes, such as peer and parent mentors. By 2024, sales are estimated to double from last year’s $35 million. That growth helped earn Equip a spot on this year’s Next Billion-Dollar Startups list, one of 25 companies we think are likely to reach a $1 billion valuation.
Equip is now working to broaden access for people who typically don’t receive treatment, including people over the age of 24 and low-income patients on Medicaid. There has long been a harmful stereotype of anorexia as a condition that affects wealthy, white teenage girls, meaning that they are ultimately the patients most likely to be screened. “People of all body sizes develop eating disorders,” Equip co-founder and Chief Clinical Officer Parks said Forbes. “We want fat people to feel safe in treatment. We want men to feel safe during treatment. We want people in their thirties, forties, fifties and sixties to feel safe in treatment.”
Since Parks began treating all ages in 2023, Equip has seen patients from age 4 to age 70. Equip screens all patients upon admission to ensure they are medically stable enough for virtual treatment. Patients whose weight or heart rate are too low may need to be hospitalized.
The most common conditions Equip treats are anorexia, binge eating disorder and avoidant restrictive food intake disorder, or ARFID, which is characterized by fear or anxiety about eating, such as choking or eating only very specific foods. Family treatment is considered the gold standard for adolescents with anorexia, and research shows there is no difference “in clinical outcomes based on the method of delivery, whether in person or via computer through a screen,” says Brittany Matheson, a clinical employee. professor at Stanford, told Forbes. (Matheson revealed that she had previously consulted for Equip when contacted independently by Forbes.)
But there is no treatment that is guaranteed to work for all patients. As Equip has begun treating adults and more types of eating disorders, while also addressing co-occurring conditions such as PTSD and depression, they now offer other types of therapy such as cognitive behavioral therapy, dialectical behavior therapy, and exposure and response prevention therapy.
Sue Rooms first heard about Equip through a local Facebook group where another mother described her child’s struggle with anorexia during the Covid-19 pandemic. Chambers’ daughter Eleanor, whose name has been changed for privacy reasons, had just been diagnosed with anorexia at age 13, and Chambers and her husband were evaluating different treatment options. “We were absolutely terrified to put her in the hospital,” Chambers said Forbesand said she couldn’t imagine not being able to be with her child and help her through treatment.
Family-centered therapy is thought to be effective in approximately 30 to 50% of patients with anorexia and is recommended as long as parents or guardians are willing to participate and there is no history of abuse in the family. But it’s not easy. The therapist guides the parents through the so-called refeeding process, which requires the child, who is terrified of eating, to eat six meals a day, Chambers said. She compared it to the child who had to “eat a plate of spiders and snakes.” Her daughter, who generally had a pleasant attitude, turned into a different person. “The misery they’re going through is like nothing else,” Chambers said. “It’s just terrible.” She said it was “crucial” to have an Equip parent mentor whose child had undergone eating disorder treatment and could help guide them.
Chambers credits Equip with “saving” her daughter’s life. After 18 months of treatment, she said Eleanor is “physically fine” but has a long psychological journey ahead. “We’re probably talking a few more years before we see a full recovery, and that’s very common,” she said.
Researchers in the field don’t agree on what exactly it means to be in recovery: in anorexia, it is usually defined by a reduction in behaviors, such as restricting calories and negative thoughts, combined with reaching a certain weight for a certain time. Several studies have used different measurements to calculate weight goal, including BMI or a target weight gain percentage. Equip claims that 75% of its patients ‘achieved or maintained’ their target weight within a year of treatment.
“They are a relatively young company and they are learning, but they have the infrastructure to adapt, change and get better.”
Tracy Richmond, a pediatrician who directs the eating disorders program at Boston Children’s Hospital, said Forbes she provides in-person visits for some patients who use Equip to round out the rest of their care team. Richmond describes Equip’s mentors as the company’s “secret sauce” because it is unusual for these types of services to be covered by insurance. But she also emphasized that family-centered therapy is difficult and doesn’t work for everyone. “A lot of it is based on the dynamics and willingness of the parents,” Richmond says. “There are a lot of parents who say to me, ‘This is just not feasible for my family.’”
And Equip is not suitable for every therapist. A half-dozen reviews from anonymous employees on Glassdoor say caseloads are too high for some complex patient needs. According to Parks, Equip’s providers spend 26 hours a week on sessions with patients, while the remaining 14 hours are spent on training and administrative tasks. ‘A therapist who says it is too much is not making it up. It was too much for them,” Parks said. For that reason, Equip is working to create clearer expectations in the recruitment process.
Chambers, whose daughter was receiving treatment at Equip, said their therapist went on maternity leave in the middle of treatment. While this could happen at any organization, she said it was a relief that Equip provided a replacement and that 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 in place to adapt, change and get better,” Chambers said. “We did have challenges, but in the end we also got the support we needed.”
MORE FROM FORBES
