Eating Disorder Treatment Made More Accessible With Erin Parks of Equip

Startups get the party. Startups get the party started. Startups get the party. Startups get the party started. You want tech and tacos? Tacos and tech you know we got tacos and tech is on smash border green guacamole keeper captains counting beans Contador quentan frijoles found us trying to raise some queso la vida San Diego school of rappy rapping fire tortillas round jalapenos in these modern times a crappy and coffee my coding yoga posse fold the body origami we be surfing coronado eating tacos el gordo the tacos standing puesto lucha libre and sombrero Got a shout out to cost angels by the ocean watch the sunset la Jolla shores Entrepreneurs trying to get funded When San Diego Startup Week is popping in the summer Oceanside, the Tijuana esti be full of hustlers from couch surfing to penthouses right on the beach Tech leaders believe stars are within reach we interview and founders who be shooting for the moon SD Tecos with your host, Neil Bloom. Startups get the party Startups get the party started.

Welcome to the Tacos and Tech Podcast. I'm your host, Neil Bloom, and I'm thrilled to have you here on the Tacos and Tech Podcast. We interview builders of technologies, of companies, of communities, and we do it weekly, so thanks for tuning in. Every Tuesday, a new interview, and on Fridays, we talk about what's new in the San Diego tech ecosystem from a news perspective. So make sure you join us there as well too. We also have a tech newsletter that comes out every other week@freshbrewedtech.com you can subscribe to listen to it without further ado. Enjoy this episode. I am thrilled to have Aaron Parks, co founder and COO of Equip. Hey, Aaron, thanks for being on the pod.

Thanks for inviting me, Neil. I'm excited to be here.

Yeah, no, I'm thrilled to have you. We've run across each other's paths at Spencer's Digital Health Founders happy hour that he puts on at times, which I'm so glad Spencer does that.

I believe he has time to be so social while also having a startup like, I would have no friends if it weren't for Spencer.

Right, I know. Big shout out to Spencer, big fan of the. Big fan of him, and an early investor in concert health as well. But we're here to talk about Equip. So you want to give us a quick overview of what Equip is?

Yes. So Equip was founded in late 2019 and we are a fully virtual eating disorder clinic and we partner with payers. We're in network with 12, 13 payers now including some Medicaid contracts and we provide families with a fully virtual team. A therapist, dietitian, a physician, including psychiatrist, a peer mentor, that's someone who's in recovery themselves and a family mentor, that's someone who has already helped their own child through an eating disorder. And this five person treatment team surrounds them and helps them for a year or more, all covered by insurance to help people recover from eating disorders.

Wow. Huge, huge, huge unmet need that you guys are tackling and I'm very excited to kind of talk through the genesis of this as well as the telehealth part which obviously you've got some amazing tailwinds luckily. But how did you venture down this vein? Were you always born to to start a telehealth tech company?

No, definitely not. I am a bit of a risk averse like rule following square and I always knew I wanted to get into healthcare and I had a very meandering path. So I originally studied marketing in undergrad and spent my first year out of school. It was right after the Enron scandal, so very few recruiters were on campus that year and ended up marketing Broadway shows while they toured. So that was my first job out of college and I thought I was going to love it and I quickly learned I did not like it. It's an interesting industry to say the least. Lots of weekends and nights of course, and I made a really crazy pivot that I don't even know how to transition in a story. But I ended up doing neuroimaging research at the nih. So straight from Broadway to nih and I knew that I wanted to do something in healthcare and, and I thought research might be a good fit for me and I was just really fortunate that there was a lab that took a chance on me. So I spent a couple of years researching how the brain reorganizes following seizures or strokes in kids. Absolutely loved the work I was doing and I knew that I wanted to be a parent and I'd read that being an academic researcher was one of the best jobs for a working parent. So yeah, so I followed that path and it brought me from D.C. out to San Diego. So I ended up out here in 2005 and got my PhD at UC San Diego and never imagined though still a startup, I thought I was bound for academia.

Oh, fascinating. But I'm guessing ucsd. So big path and big, big pivots. Through. So even, you know, risk averse, you still took some big risks in the career, right? Zigging and zagging in that regard, both geographically as well, east coast to west coast, though not a hard sell to. To land in San Diego in that regard.

I was kind of an east coast snob when I arrived, though. I kept saying, like, ugh, everybody wears pastels and no one gets to work until 9. And I was kind of grumpy about it for a year. And if I could go back and smack that younger version of myself, I probably would. I was probably pretty annoying, but I, yeah, I quickly fell in love with it. They just built the new Petco park and we were living downtown by Petco park and did research for 5 years while getting my PhD still really focused on how the brain reorganizes due to events happening. And one of the fun things about doing brain imaging research is part of it is really lots of interacting with people and getting to talk to little kids and teach them how to go on the scanner. Then the other half of it is coding and analyzing the data. And I think that kind of sums me up. Like, I like the people interaction and then I just like, hit a wall and I cannot socialize anymore. And I just want to take refuge in a good Excel sheet or like putting together a PowerPoint. So I really enjoyed that. And then it was time to go to my residency year and I went up to San Francisco. UC San Francisco and the San Francisco VA have a consortium there. And it was when the recession was hitting and I decided I should probably diversify a bit and learn some clinical skills instead of just planning on being a researcher. I ended up also having a baby. And so I was off cycle for fellowship when I finished my doctorate degree. So I called all my grad school friends and I asked who is hiring people off cycle for fellows? Because the academic calendar can be very tight. Like, you have to hit so many rungs on the academic ladder within a certain number of years to get, you know, to where you want to. And they're like, well, the eating disorder clinic is hiring off cycle. I said, I don't know why I would want to work in an eating disorder clinic. Sounds awful. And that's the truth of the matter that most people get zero hours of training in how to treat eating disorders. So even though I was now a clinic clinical psychologist who'd spent, I think, six years in school and then another couple years of a fellowship, most people are never told anything about how to treat eating disorders. They're kind of like the lung cancer of mental health illnesses. Remember when we used to blame people for having lung cancer, thinking, oh, they brought it on themselves. So we didn't research it. There wasn't as much philanthropy towards it. Same thing happens with eating disorders since people perceive them to be a disorder of vanity and choice. But my friend said, no, I think you're really going to like it. The guy who runs it is just really business minded and cares about the business of mental health and I think he'd be a great mentor for you. And he was. I had a wonderful decade, both my fellowship and then I stayed on as faculty. Just really the privilege of a lifetime getting to work there. And you might be like, you still haven't mentioned equip. And we're a million minutes into this podcast. So my co founder, Christina had started a nonprofit when she was 15 years old. She was recovering from her eating disorder and she started raising money for people who couldn't afford treatment. So this was the mid 2000s and a time period when a lot of people were having insurance deny them treatment and then people died and then their parents sued the companies and a lot of laws were created, but there was still just really spotty access to getting treatment. And so she started this nonprofit, was trying to solve the financial access issue and she was really smart and attended a lot of academic eating disorder conferences to get to know, like, what treatment should we be paying to send people to because there's no shortage of bad treatment. So like, how do we define what is good treatment? What are the outcomes we should look at for. And her and I met at one of these conferences and hit it off and I like to talk about the physical access issue while she wanted to talk about the financial access issue. So UC San Diego has truly the best eating disorder treatment center in the entire world. People come from Dubai and Shanghai and Sydney and at any given time probably 10 countries have patients that are there in all 50 states. And I loved working there. But it also made me wonder, why do people have to travel from all 50 states to get treatment here? Why don't they have evidence based treatment in their backyard? So I like to joke that I must have, I don't know, had my Zoloft dose at just the right amount or been exceptionally breezy. Because Christina called me and she's like, you want to improve physical access, I want to improve financial access. Let's raise some venture capital and do a startup. And I'm like, well, let me Google venture capital first. And yeah, that's how Equip started. So that's kind of our origin story.

Wow. I mean, incredible. Obviously the path that you, the two of you coming together in that it's quite serendipitous. Take us through a little bit more, like set the landscape even more for eating disorders. Like, and why. How did San Diego come to be kind of the center of it?

Eating disorders affect so many more people than people realize. So almost half of people who suffer are men. They rarely talk about it. They rarely have access to treatment. They're very likely to not get correctly diagnosed for many, many years. It also affects people of all ages. So we treat kids as young as six and there's also adults into their 90s who have it. It affects all ethnicities and races, all socioeconomic levels. We know that as food insecurity rise or food deserts, so do eating disorders. We also know that during the pandemic there were reports of 70% increases in eating disorders in patients needing hospitalizations. Truly at kind of a crisis level brought on, I think partially the stress of the pandemic, the increased time on social media. And then we also know that eating disorders are. They're neurobiological illnesses. And so not everybody will get an eating disorder, but a lot of people are susceptible. And we just had a couple years of a perfect storm to kind of pull the trigger on people who were wired to have eating disorders with the increased stressors. So there is a shortage of eating disorder providers. Most people can't find anybody in their communities who takes insurance and has any availability. A lot of places have four to six month wait lists to get treatment for eating disorders disorders as well.

Wow. So the two of you, from what I'm hearing, we didn't hear Christine's background too much, but not hearing a lot of tech. In this tech business that you're building, how'd you get up and running and starting and how to. Besides Google searching, how'd you know to surround yourself with that with tech teams to build and grow and scale this?

Yeah. Well, Christina's superpower is relationship building. I've never met anyone who can relationship build the way she can. And just really ask. Brilliant question. So she got together the heads of three major insurance companies and we all met in New York and she had me present from a research and clinician perspective on the eating disorder landscape. She presented from a patient perspective and there were a few other people around the table who like used to run residentials and then the payers were there as well. And we had about four hours where we talked about all of the problems in the treatment landscape and how to fix it. And they said, if you build it, we will come. And from there she just kept asking people's advice. Who should we talk to next? What should we do next? We raised our seed in 2019 from F Prime, which is Fidelity's venture arm and also Optum Ventures participated in the round. We also had the opportunity to meet some other great firms at the time who either later participated in a or kind of became informal mentors to us. And they were tremendously helpful in introducing us to the right people and helping us understand the tech hires that we needed to make. And we like to say that we are a services enabled by tech company. And recently I had a really interesting discussion about, like, why are we building our own emr? Like why? You know, there's plenty of things on the market that you can just buy. And it really is because our tech product isn't just an emr. So what we want to do is to be able to catch people before they relapse. So we know that 50% of people with eating disorders will relapse within seven months of treatment. So how can we help get people better but also prevent future relapses? We also want our tech to help provide support in the moment when people need it. So if you were struggling with many other illnesses, you might have to do the intervention. Like if you're struggling with trauma once a week you have to go see a therapist and really like face all of those hard emotions. Or maybe with some things you have to take a medication once a day. But in eating disorders, food is the medicine and food is also the thing that you really fear doing. And so you have to do that usually six times a day, three meals and three snacks a day. So you need to have a technology that allows you to be getting support in the moment because you're going to have many, many challenging moments throughout every single day.

Super interesting. I'm very curious about some of the differences, trends you've seen from seeing people in person versus remotely. I gotta imagine like this is a disease that like you said, a lot of people won't talk about. What's. How are people reacting differently when they can hop on a computer and do it? Because sometimes you're around family, you have to like hide in a closet or something like that. Like, you know, so that people, even your own family won't talk about. What are some of the things you've learned of treating people this way?

It's a great question. When we first started the company we would say if you can find an in person provider of evidence based treatment, go and if you can't, come to us. And I think one of the big keys here is evidence based treatment. A lot of people provide mental health services for a lot of different things, but don't discern from treatment that feels good and treatment that actually works. R treatment doesn't actually feel that great a lot. One of the reasons is you have to bring your family to treatment. You bring your siblings, you bring your spouse, you bring your parents. And understandably, most people don't want to do that. And once they do that, they do see that they're more likely to get better. It is the evidence based treatment. Before we started equipped, there had been one randomized controlled trial that compared the evidence based treatment being delivered in person to via telehealth and found that the outcomes were exactly the same. So now, I don't know, we're a couple of years in now and now our tune has changed. We think virtual is better for eating disorder treatment and there are a couple reasons why. One reason is that it works best if you bring your whole village. If you're having treatment in person, only one parent ends up coming. So I'm the mother of an 8 year old and a 10 year old and I rely very heavily on obviously their father, my partner to help me raise them, but also my mom and my sister and my brother and my sister, sister in law, our nanny. And there's no way that all of those adults could go to an appointment at one o' clock on a Tuesday to drive from their jobs to find parking. When it's virtual, people can call in from all over the world from call in from all over the county. And we see a lot of families bring three or four people to treatment. So it's not uncommon to have the teenager and her bio dad and her stepdad and her mom and her maternal aunt all in a call. And the more people that show up, the more likely you are to fully recover and not have a future relapse. So that's one reason we like virtual. You can bring your village. The second reason we like virtual is because there's just so many stinking appointments. So you gotta see a dietitian and you gotta see a psychiatrist and you gotta see a therapist. I haven't brought my kids to the dentist in almost a year, which I know I'm supposed to do that twice a year. It's impossible to go to all these appointments. I couldn't go to three or four in a week, unless that we're virtual. So the frequency also makes sense. It better. And then the last thing is that I don't know about you, but I always like, bring my best self to appointments. Right. Like, even if I'm in a really grumpy mood, I'm not crabby to the dentist or whatever. Same thing is true in therapy, but when you're actually in someone's home, you're more likely to kind of see and hear what's actually going on. And we also are able to have like, we want to have dinner with you and so we can watch the family having dinner. We want to have your snack with you, we can watch you having your snack and participate in the emotions that come up during it. So we've been really, really pleased. And you're right, the snow has plowed for us with COVID A lot of people who had no familiarity with interacting in this way really quickly learned as they put their kids on Zoom or Google Hangouts for school. So they're much more accepting of this mode now.

Got it. And your team as well. You're a fully remote team. You know, take us through that decision of doing that. I think you did pre Covid as well. Like it's kind of always been.

Yeah. So we started the company in December of 2019, and two things really led to us being a fully distributed company. The first is that I'm very anxious and I moved 13 times as a child for my parents jobs and they were executives and they had great careers and it necessitated moving. I could not imagine that. Like we just raised a $3 million seed and we're a company of two people move to San Diego, which is kind of an expensive place and all of us locals don't really want people moving here. And pull your kids out of school and put them in the new, you know, in a new school. Like, I was the new kid so many times in school. It just felt like I didn't have. I had enough hubris to start a startup, but not enough to make someone pull their kid out of school and move to San Diego. So I had all that anxiety and thankfully the podcast distributed by the WordPress guys came out around that time and it was a playbook on why you should have a distributed company and how to do it. And so we listened to it and we did exactly what they told us to do, and it's been great. So we're now 200, near 200 employees spanning all over the U.S. we even have an employee in North Dakota and an employee in South Dakota, which makes me very excited because I was born in North Dakota. So I'm like woo hoo. There's not very many of us because we all leave. But yeah. So we're a fully distributed company and it's been a lot of fun.

Yeah. Pretty incredible to see the growth as well. Like what is it? What does current day look like versus you know, what do you think a year from now is like? Especially as people, a lot of things are changing. Right. Like the hybrid. People are just accepting that things are never gonna go back. Like what are you seeing now versus in the short term?

Yeah. So we spent that first year kind of building our clinical model and then we spent last year really building up our operations and serving patients, turning on with payers. We had double the amount of patients we expected last year. We thought we'd sign two or three payers. We signed 10 last year. And so as we go into this year, 2022, we raised our series B as the year began and really using those funds to invest in the growth arm of our organization. I like to joke that I feel like if I were if equip, we're a human being. Like one of our arms is like a Tyrannosaurus rex arm and the other arm is like a Go Gadget arm. Like the departments are growing at different rates. Right. Where as the company grows so fast. So we had very much under invested in our growth arm and our marketing and our enterprise team. So this year is really about that investment as we are taking on even more patients than we did last year. When I think about next year, what gets me really excited is we're going to finally move into adults next year. So one of the things that's unfortunate is that eating disorders start often in childhood. There are seven different types of eating disorders, so it's really an umbrella term. But most of them start before age 18. But if you're not a thin, white, cisgendered woman, you're not going to get diagnosed for at least three to five years. You're going to get misdiagnosed with other things. So oftentimes when we, you know, when I've met, when I've got to treat adults in other treatment settings and we've been treating some adults right now at equip. There are people who've been ill for quite a while and it's affected their life in a lot of different ways. After you turn just looking at the literature for people who are over the age of 18 who have eating disorders, half of them have substance use disorder. And if you go into a substance use clinic and you give all of them an assessment for eating disorders, one out of three of them will have an undiagnosed eating disorder. The two of them really go hand in hand and it's often like whack a mole for people where they get their sobriety but their eating gets worse or they recover from their eating disorder and they lose their sobriety. So we are really excited at equip to be treating the two of those at the same time and just really, really eager to turn that on. So next year I'm excited to add more services like treating adults. I'm also excited because we're going to have a few more like people around the table. We've been running lean and making some really, really invested the first half of this year and some recruiters to help us recruit. Two more chiefs will be joining us and a few more senior level people who I think are really going to elevate the entire company. So I don't know, I kind of think I'm going to be sleeping a little bit better next year though. I said that last year and the year before, so we'll see.

Yeah, well, a lot been going on the last few years both internally and externally. I hope the world calms down for all of us for that sake. That's for sure. Though who knows? With Elon at the helm of Twitter, you never know.

Anything's possible. Yeah. I do often reflect on the fact that our startup was three months old. I barely knew what I was doing. Right. Like we. And then all of a sudden my kindergartner and my third grader were sent home to be homeschooled and we survived that. So now it's my. I often ask my husband like, how's this like going for you, this, me being in a startup? And he's like, you guys are much more calm and than I would have ever imagined. And I think it's because we started with COVID and homeschooling a kindergartner. Like we can do anything now.

That's true. And the growth with talent wise, while yes, we both love San Diego, here you're tapping into a talent pool that's worldwide, which kind of helps a little bit in the funnel as well too. So that is an interesting kind of change. No, it's always been your style. But it's interesting that now everyone is hiring in that way. So you're kind of competing now against everyone, hiring from everyone, everywhere. So always an interesting change. I know you're yeah, go ahead.

No, I say that's very true. And one of the things that I'm liking that I didn't know to expect from it is there's so many unique cultural components to living different places in the US and the people we are treating are living in different places in the US and so to have a dietitian living in the south and have a dietitian living in the Midwest, getting to treat patients in those regions and, you know, suggesting foods that are culturally appropriate that are local to those regions, you can't. I don't know, maybe you can now, but you can't eat locally and fresh, organic foods year round in Minnesota. The ground is frozen. There are not local farms producing things like that year round. So having people who are from those regions has been great.

No, you bring up a great point of, you know, your team should reflect your customers in that regard, and it's a excellent point for that. Okay, north, you're North County, Carlsbadian. Do you have a favorite taco spot?

I do. Carlsbad is rad. And I have two favorite taco spots. The first, and the most honest answer is, is truly my house. I am such a homebody. Probably the worst thing about the COVID and startup is how much I've loved not leaving my house. And that's finally culturally appropriate to be as much of a homebody as I am. So our nanny makes really good tacos and absolutely love those. If we get me to leave the house, we usually go to the La Sola. That's not the Carlsbad location. We prefer the salon of Beach.

Oh, yeah, the car. Yeah. Cardiff Solano One is pretty epic, for sure.

And it's the first place I went back in like 2000, like 4, when I was interviewing for UC San Diego. It was like the first restaurant that I went to. And actually my postdoc, who I worked under out in D.C. who just turned 50. It turns 50 next week. She was a waitress there in high school. Like, so I'm just. It just like, it's so tied to me. I've been hearing about it, you know, for 20 some years before I lived here.

And you never forget your first San Diego taco, so totally understand that. No great spot and endless buckets of chips. So what can go wrong? Aaron, really appreciate you being on the podcast, but even more so appreciate what you guys are building. I mean, it's no easy task, and therefore you're going to change the world because of it. So congrats on everything and keep it up. Thanks for being on the pod.

Thank you so much Neil for inviting me. I really appreciate it and hopefully we see you soon at another one of Spencer's events.

Absolutely. Thanks.

Bye.

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