Online programs say virtual care is just as good as in-person treatment. We see it differently, and we think you deserve to know why before you choose.
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Written by Nick Kahm
Co-Founder, The Kahm Center
Some virtual care is better than no care. But if you are choosing between the two, here is what you give up when treatment moves to a screen.
Eating disorders already isolate people. In person, you recover alongside peers and a team who understand, instead of sitting alone in a room with a screen.
Eating is the hardest part of recovery. In person, staff see your meal, how you are eating, and the moment it gets hard. On a screen, a clinician sees only what the camera shows.
Having a hard time in the middle of group? You can step out and see a mental health technician or your therapist right then. That kind of fast, easy support does not exist through a screen.
So much of what a person is feeling shows in posture, expression and small changes. Those cues are easy to miss on video and easy to read in person.
Recovery means eating around others and talking about hard things face to face. Skills you practice in a room with people carry over into real life far better than skills practiced alone at home.
Trust grows through small moments: the hello in the hallway, the chat before group, the shared laugh. Those moments are part of healing, and they are missing from video calls.
A program with a set schedule, a place to be, and people expecting you is hard to drift away from. There are no other tabs open, no camera turned off, and no quietly logging out.
We use metabolic testing and body composition analysis to see how your body is doing and how well your meal plan is working. Seeing changes sooner means your team can adjust your plan sooner.
Virtual programs require a fully private space for hours at a time. That is hard to find with family, roommates or thin walls, and treatment should not mean whispering. In person, privacy is built in.
Hours on camera, several days a week, is draining, and it is hard to stay focused and take part. In person, you are present, and your day does not end with eye strain.
Remember remote school? Students were home, logged in, and technically attending, and many families were relieved when it ended. During the pandemic, student academic proficiency suffered a historic collapse. The Nation's Report Card (NAEP) recorded the largest math score declines at grades 4 and 8 since the assessment began in 1990, and reading scores fell below every earlier assessment going back to 2005 in grade 4 and 1998 in grade 8. Worldwide, a Nature Human Behaviour meta-analysis found that students lost about 35% of a normal school year's worth of learning.
The Annie E. Casey Foundation reports that the shift to remote learning cut instructional time and left students more isolated and on screens more.
Recovering from an eating disorder asks far more of a person than a school day does. If screens fell short for algebra, we should not assume they are enough here.
Your teen or young adult may already spend much of the day on a screen. Treatment is a chance to give them something different.
Adding hours of video a day, on top of school and social media, is a lot to ask of someone who is already struggling.
On a video call, it is hard to know whether your teen is paying attention. Do they have other tabs open? Is their phone in their lap? In person, they are here and part of the group.
To protect other patients' privacy, many virtual programs keep parents out of meals and groups. We build family involvement into care, including Family Based Therapy.
In our intensive outpatient program, many patients continue with school and daily life, with a care team close by and you nearby.
"Virtual" covers a lot, from weekly video therapy to full-day programs. Programs differ in how much structure they require. At The Kahm Center, intensive outpatient (IOP) and partial hospitalization (PHP) mean being here, on a set schedule, with your team. Before you sign up for a virtual program that calls itself the same level of care, ask:
We are a small, family-owned Vermont practice, run by a mother and son. Groups are small, and every person has a treatment plan built around their own needs.
Therapists, a dietitian and mental health technicians work together in one place, so you are never waiting on a scheduled video call to be heard.
Your plan may include individual, family and group therapy using CBT, DBT, Family Based Therapy and ACT.
Our intensive outpatient (IOP) and partial hospitalization (PHP) programs give you a full level of support while you keep living at home. Many people continue school or work in IOP.
When we opened, we became the state's first intensive outpatient eating disorder center, so families no longer had to leave Vermont for this level of care.
Online programs often say it is. We see it differently. In person, you get meal support in the room, a team down the hall when you are struggling, real relationships with peers, and testing that tracks your progress closely. Some virtual care is better than none, but when your health is at stake, we believe being in the room matters.
Teens already spend a lot of time on screens, and it is hard to know how engaged someone is on a video call. In person, they are present and part of the group. Parents can also stay involved, including through Family Based Therapy, which many virtual programs do not include.
Not necessarily. Our intensive outpatient program is designed so you can keep living at home, attending school or working. Our partial hospitalization program takes up more of the day. Your team will talk through what is realistic for you.
Partial hospitalization (PHP) means full days of treatment, then home in the evening. Intensive outpatient (IOP) means fewer hours with more time for school, work and home life. People start at either level, and many move between them as they recover, including after a hospital stay or residential care. If you need 24-hour care, we will help you find it and plan the transition.
Many people wonder this. You do not have to be certain about what you need before you call. Our team can talk with you and help you work out which level of care makes sense.
We work with Medicare and Blue Cross Blue Shield. Coverage depends on your plan, so call us and we will go through it with you.
Our programs serve Vermont, and treatment happens in person in Burlington. If you live elsewhere, we are glad to talk through your options, and the questions above are worth asking of any program you consider.
You do not need to have it all figured out. Tell us what is going on, and we will help you work out the next step.
The Kahm CenterIf you or someone you love is in immediate danger or having a medical emergency, call 911. If you are thinking about harming yourself, call or text 988, the Suicide and Crisis Lifeline, any time.
For eating disorder support and referrals, visit the National Alliance for Eating Disorders.
This page is general information, not medical advice. Only a qualified clinician can recommend the right level of care for you.
