Residential treatment centers for eating disorders like anorexia and bulimia are big business, particularly now that changes in health insurance legislation have made coverage easier to come by for struggling families. That’s the good news. But are these programs, which are touting cushy facilities, beaches and horseback riding, actually working for people with eating disorders?

That’s the question posed in an article in the New York Times about the growing industry. Given the general scarcity of mental health services and the severity of many eating disorders, it’s hard to criticize more programs dedicated to helping people. Douglas Bunnell, the chief clinical officer at Monte Nido, a program with facilities nationwide, tells the Times: “Only 15 to 30 percent of people have access to specialized care for eating disorders, which means there are a lot of people out there who have zippo.”

The Times takes a skeptical look at the money to be made in the industry, and the aggressive marketing campaign these centers are waging, offering doctors and therapists free trips and putting them up in expensive hotels to encourage referrals..

Reading the article I found myself reminded of the classic conundrum in mental health care, which is that health insurance pays for “procedures,” and woe betide the clinician who can’t bill for tests and scans. In this case, the procedure is a stay at a residential facility, which can be critical to get a patient to a safe, healthy weight. But experts agree that the hard emotional work has to happen after that, when the patient has to rebuild her life in the context of the real world. In conversations with us several years ago, Dr. Bunnell eloquently explains this process, and the importance of the family in treatment.

This is the point Tina Klaus, who has had a decades-long struggle with bulimia, makes to the Times. “Residential treatment is vital when you are at your ultimate rock bottom” she says. But you still need help on the outside, when “you’re going back into your life, you’re going back into all the emotions you used your eating disorder to hide from.” As Klaus says, “This is when you need the most support, and it simply isn’t available due to insurance.” She adds, “as a result the treatment plan is dismantled before you walk out the door.”

These intensive treatment centers are necessary, and we’re glad that insurance is covering more of what can be life-saving treatment. But we also need to think about the reality of eating disorders. If the real work of treatment and recovery often happens in the real world, then insurance and investment should be focusing there as well.