Applicants with eating disorders in their history could still be a good risk

The Reinsurance Group of America (RGA) has published a new note examining the challenges insurers have when underwriting would-be clients with a history of eating disorders (ED). Notably, they say people with EDs in their health history could still be a good insurance risk if they manage their conditions appropriately with treatment and medication.  

The note, entitled Beyond the Myths: Exploring the Complex Realities and Treatment Challenges of Eating Disorders, examines the impact and treatment of eating disorders, including recent diagnosis changes, frequent comorbidities and the outlook for treatment and recovery.  

Psychiatric comorbidities 

The report’s authors note that psychiatric comorbidities occur in 70 per cent of people with an ED. Access barriers to treatment, they also note, are particularly daunting for men, people of colour, LGBTQ+ individuals and those with larger bodies. They add that panelists at a recent United Nations gathering hosted by the National Alliance for Eating Disorders “recounted instances of discrimination, gaslighting and harm encountered both in seeking access to healthcare, appropriate diagnoses and treatment,” they write. “These challenges extend into the world of insurance. Speakers at the U.N. conference called for changes to the way insurers manage complex mental health conditions like eating disorders. It remains a common practice to carve out blanket exclusions for mental health conditions.” 

Mortality rates 

Insurers’ reasons for this are also detailed in the note. Mortality rates associated with anorexia and bulimia remain “alarmingly high,” with those undergoing treatment for anorexia facing a mortality risk over five times greater than the general population. Bulimia mortality risks are lower but are still roughly double compared to general population rates.  

“Major depressive disorder is the most frequent comorbid psychiatric disorder with EDs. The lifetime prevalence of comorbid depression in EDs is 94 per cent. For a person with anorexia nervosa, mortality is 18 times higher when depression is present.” 

The report also looks at assessment, treatment plans and the use of integrated therapy techniques to improve outcomes for people with eating disorders.  

“Because of the strong prevalence of comorbidities with EDs, insurers should certainly look for evidence of those frequent comorbidities like depression, personality disorders or substance abuse disorders. It’s also important to study where the ED appeared in their life trajectory,” they conclude. “Just like those diagnosed with anxiety or obsessive-compulsive disorder (OCD), adolescents or young adults with these conditions can recover completely. If they manage their conditions and, if recommended, take medication, they could ultimately be a good insurance risk.”