The hidden risks: Telehealth and AI in eating disorders care
A physician-led interdisciplinary team with a broad range of expertise is a cornerstone of Homewood Health’s comprehensive and individualized inpatient program to treat eating disorders. sDI productions via getty images
Digital innovation is transforming all aspects of our society including provision of mental health care services. Telehealth and support systems based on artificial intelligence (AI) have emerged as promising new tools to expand access to mental health care and make it more affordable.
However, experts are urging caution about applying digital tools to treatment of eating disorders, which are complex, deeply personal and often life-threatening conditions. Not only are some of these new technologies not helpful, but they could pose significant risks.
Specialists in eating disorders care have a number of concerns about the use of virtual resources for individuals with these disorders, and they call for careful consideration of how these new resources might fit into broader treatment approaches.
“We need to understand that AI systems are trained on vast datasets from the internet, which often contain biased, stigmatizing or even dangerous content. These biases can be reflected in chatbot responses that perpetuate fatphobia, body shaming or misinformation. ”
The human factor critical to eating disorders treatment
“Eating disorders require nuanced, individualized care. Unlike trained clinicians, tools such as AI chatbots and telehealth platforms can’t adapt to emotional cues or complex interpersonal dynamics,” says Dr. JD Vanderkooy, medical director of Homewood Health Centre’s Eating Disorders Program.
“And these technologies have limited capacity to consider the full context of a patient’s lived experience, including cultural background, trauma history and co-occurring conditions.”
Homewood Health Centre, based in Guelph, Ontario, offers Canada’s largest inpatient program for eating disorders. The complexities of treating these disorders are reflected in the comprehensive nature of the 16-week program, which is available to individuals aged 16 and older.
A team approach is often required for treatment, and Homewood’s physician-led program is delivered by an expert interdisciplinary team that includes psychology, nursing, social work, psychotherapy, personal support, occupational therapy, dietitians, recreation therapy and pharmacy.
Homewood’s program focuses on full weight restoration, symptom interruption, exercise normalization and nutrition rehabilitation. Adding to the complexities of treatment is that individuals with eating disorders frequently have co-occurring disorders that must also be treated, such as substance use disorder, anxiety and depression.
Research shows that the rate of substance use disorders among those with eating disorders is high, with approximately half of all women with eating disorders also struggling with addiction. Additionally, up to 35 per cent of individuals dependent on alcohol or other drugs have also had eating disorders, a rate 11 times greater than the general population.
Risk of harmful or inappropriate advice
Experts say one risk with AI chatbots is their potential to promote harmful or inappropriate advice. A striking example occurred in 2023 when the National Eating Disorders Association in the U.S. piloted an AI chatbot intended to support individuals with eating disorders. The pilot quickly ended due to failure – instead of offering coping strategies, the bot promoted weight loss advice, reinforcing harmful diet culture and triggering vulnerable users.
“We need to understand that AI systems are trained on vast datasets from the internet, which often contain biased, stigmatizing or even dangerous content,” Dr. Vanderkooy says.
“These biases can be reflected in chatbot responses that perpetuate fatphobia, body shaming or misinformation,” he adds. “And we are seeing more potentially harmful messages about weight in all forms of media, with progress in body-positivity at risk of being reversed by the momentum of the weight-loss drugs industry. We are seeing eating disorders become more complex and severe in our society.”
Need for rigorous ethical and safety standards
New technologies can become add-on tools to help individuals with mental health challenges, but sometimes they evolve faster than the ethical safeguards required to protect users. Safeguards for matters such as privacy, accountability and transparency are still in the early stages for some of these tools, and further development is needed to reduce the risk of potential harm.
Experts point out other weaknesses with virtual resources. One example: Unlike human therapists, AI tools and telehealth platforms may not be equipped to handle crises such as suicidal ideation, self-harm or medical emergencies. Telehealth can inadvertently reinforce isolation, especially for individuals who struggle with social anxiety or avoidance behaviours, and although remote care offers convenience, it may reduce opportunities for in-person therapeutic relationships, group therapy or community support, which are key components in recovery.
Telehealth and AI-based tools offer exciting possibilities; however, when applied to eating disorders care, these technologies must be held to the highest standards of safety, ethics and clinical rigour.
“Multidisciplinary teams, including individuals with lived experience, must be involved in design and deployment,” Dr.Vanderkooy says. “Most importantly, these tools should complement – not replace – human connection, empathy and expertise.”
Are you or someone you care about living with an eating disorder? Reach out today to learn more: 1-866-264-3244 HomewoodHealthCentre.com/EDP
To view this report on The Globe's website, visit globeandmail.com
To view the full report as it appeared in The Globe's print edition Mental Illness Awareness Week