When the Eating Disorders Association of Western New York lost all of its public funding last year, the organization moved to bolster its finances.
The association laid off two of its three staffers. The remaining employee took a pay cut, moved the association to an office with lower rent and began charging fees for services.
Now, officials are warning that the association could be forced to close by year's end if it can't raise more money from the private sector.
"With the recession, it couldn't come at a worse time," said Ann Marie LiCausi, the association's executive director, who stopped taking a salary this month.
Eating disorders are frequently misunderstood and minimized but they can, if left untreated, lead to life-threatening medical problems, experts said.
Shutting the doors would hurt the hundreds of people suffering from bulimia, anorexia and other conditions who are helped by the association, advocates said.
"I would be devastated. I would lose the one truly constant support I've had in my life," said a woman who receives counseling for an eating disorder and who spoke on the condition that her name not be used.
The head of the Erie County Mental Health Department, which slashed $109,000 in association funding after the state cut the department's own budget, said the organization does good work but isn't alone in providing these services.
"There are some other programs in the area that have that capacity," Commissioner Philip R. Endress said.
The association has existed for 25 years and provides group and individual counseling, referrals for specialized treatment and coordination of its clients' care. About 250 people per year receive some form of assistance.
Most of the clients are women in their late 20s and 30s who struggle with anorexia, bulimia and binge eating, LiCausi said. Her oldest client is 72.
Many don't have health insurance that would cover sessions with a private therapist.
Association staffers also speak at high schools, colleges and companies about eating disorders, their symptoms and how people can get help.
Eating disorders are widespread, the National Eating Disorders Association reports, with nearly 10 million women and 1 million men suffering from anorexia or bulimia.
People with anorexia starve themselves in an effort to get as thin as possible.
Bulimics go through cycles of bingeing and purging -- eating large amounts of food and then forcing themselves to vomit the food -- that can hurt the functioning of the digestive system and other major organs.
"They are very difficult to treat, and they are very resistant to treatment," said Catherine Cook-Cottone, a University at Buffalo associate professor of counseling, school and educational psychology who studies eating disorders.
The client who agreed to an interview as long as her name wasn't printed said she has struggled with anorexia and, later, bulimia since she was 15.
Now a teacher in her late 30s, the Buffalo resident said she suffered from low self-esteem and she believed getting thinner would make her feel better.
"You can't control anything else about your life. But you can control whether you eat or you don't eat," she said.
She cut down to 500 or 600 calories per day and, at 5 feet tall, she weighed just 68 pounds.
In college, she became bulimic and her weight over time rose to 117 pounds due to the bingeing, but she remained an emotional wreck.
At 28, her trainer told her she would no longer work with her unless she became healthier.
A few weeks later she saw a note in The Buffalo News about the association's programs.
She started out going to group and individual counseling each week and continues to attend individual sessions every other week. Her physical and mental health have improved -- she weighs 100 pounds now -- but it is an ongoing struggle.
"It's a terrible, devastating disease. I've been to hell and back. I've fought very hard to get healthy," she said.
Last year, the association was set to receive $109,762 through Erie County to serve this woman and its many other clients.
But in July 2008, Endress informed LiCausi that the county had to cut the association's funding because the Mental Health Department had its budget cut by several hundred thousand dollars by the state Office of Mental Health.
Endress said state guidelines limited where the county could make its budget reductions.
"We were not displeased with the services they provided. They just did not fit with the priorities as outlined by the state Office of Mental Health," he said.
Endress said the cuts were unfortunate, but he noted that eating-disorder programs are offered by Women and Children's Hospital, Sisters Hospital and Avalon's treatment center.
The association responded by laying off staff and moving from Buffalo to a cheaper office in Williamsville.
LiCausi, who was earning $36,000 per year as executive director, has taken on the responsibilities of the other staffers and stopped taking a salary.
The association also has started charging a fee for its programs, including community education, counseling and case-management services.
The fee limits the association's ability to reach everyone who needs help because, said board President Bob Kruger, "there are some people who simply don't have enough money."
The association is down to the last $8,000 in its bank account and LiCausi fears it won't be able to keep operating after the first of the year.
The association has applied for grants from area foundations, and recently learned it has received a $10,000 award from the Patrick P. Lee Foundation.
But more private-sector support is needed. "[The $109,000] isn't a ton of money to do what we do," LiCausi said. "We don't need a million dollars to keep this service in Buffalo."