Why 30–50% Don’t Respond: What We’re Missing in Eating Disorder Treatment

Dr. Kim Dennis brings a deeply integrative and courageous voice to the conversation on eating disorders, food addiction, trauma, and recovery. As a board-certified psychiatrist and the Co-Founder, CEO, and Chief Medical Officer of SunCloud Health (https://suncloudhealth.com/) she has spent more than two decades treating complex, co-occurring conditions—while also drawing from her own lived experience in long-term recovery from alcohol use disorder, bulimia, and food addiction. Dr. Dennis believes recovery must address the whole person: biological, psychological, social, and spiritual—not just symptoms or weight. A central theme of this episode is what happens when treatment doesn’t work. Dr. Dennis points to a sobering reality: 30–50% of people with eating disorders do not respond to gold-standard treatments, often leaving patients believing they are broken. She challenges that narrative and argues that food addiction—particularly addiction to sugar and ultra-processed foods—is a critical and often dismissed missing piece. Drawing parallels to Big Tobacco, she explains how corporate influence, stigma, and lack of diagnostic legitimacy have delayed research funding, insurance coverage, and effective treatment, despite growing neurobiological evidence involving dopamine reward pathways, craving, withdrawal, and continued use despite harm. Dr. Dennis approaches every patient through a trauma-informed lens, emphasizing that all eating disorders and food addiction exist on a continuum shaped by disrupted safety, neglect, or adversity—what she describes as both “big T” and “little t” trauma. Rather than separating behavior from biology, she explains how trauma alters reward systems and coping mechanisms, making food a powerful regulator of emotion and survival. Her model centers on patient-led collaboration, clinical humility, and a strong therapeutic alliance—meeting people exactly where they are, without leaving them there. The conversation also explores some of the most debated issues in the field, including harm reduction versus abstinence, the eating-disorder community’s resistance to food addiction, and the expanding use of GLP-1 medications. Dr. Dennis stresses that abstinence is a “tricky word” that must be defined clinically and individually—not ideologically—and that medications may have a place when used thoughtfully, transparently, and alongside comprehensive care. She closes with a message of hope: recovery is not about weight or perfection, lives do get bigger, and no one should stop seeking answers simply because one approach failed. #eatingdisorderrecovery #healthyliving #obesity #MAHA Dr. Nicole Avena (https://www.instagram.com/drnicoleavena/?hl=en) #ashleygearhardt #foodaddiction #ultraprocessed #addictionscience #foodfreedom