Rising levels of obesity grab most of the headlines these days, overshadowing eating disorders as a threat to the nation's health.

But more than 10 million Americans are so obsessed with being thin that they starve themselves, vomit after eating or exercise compulsively to burn calories. It's those patients who will be treated by a private clinic opening this week in Durham.

Carolina House will offer a treatment approach that's new to North Carolina, providing long-term residential care. Patients treated at Carolina House will live in a farmhouse-style facility complete with a wraparound porch and rocking chairs.

For stays lasting six weeks or longer, they'll be scheduled from morning until night with activities designed to break damaging eating patterns and establish healthy ones. Families will be invited in for periodic therapy sessions. Patients will take part in individual and group counseling, art therapy, yoga, movement therapy and even work with horses on the wooded 10-acre grounds.

That's sharply different from existing treatment options in the area.

Eating disorder programs at Duke University Medical Center and at UNC Hospitals in Chapel Hill primarily treat people on an outpatient basis, with patients coming in for regular individual and group therapy, as well as family sessions that teach strategies for maintaining healthy eating over the long haul.

Eating disorders are considered a mental health diagnosis, with food becoming the means of expressing emotional pain or coping with stress. Advocates of the outpatient approach say that many patients treated in intensive, residential settings relapse once they return to life's daily trials.

"We want to keep people in their lives," said Nancy L. Zucker, director of Duke's program.

However, not everyone gets better with outpatient care, Zucker said, and Duke ends up referring between 5 percent and 10 percent of its patients to more intensive treatment. The only inpatient hospitalization option is at UNC, where patients with eating disorders are admitted for stays of about two weeks. Before Carolina House, patients in North Carolina had to go out of state for other types of residential care.

Duke will launch a new program this month that offers yet another level of care. Patients will come to Duke three times a week for evening sessions of four hours each.

"We felt there was a middle step that was missing," Zucker said. "There were lots of occasions where we felt we needed to do more for patients."

There is little scientific evidence to show which approach is more effective. Clinicians who specialize in such disorders agree, however, that more treatment of all kinds is needed.

An estimated 10 million women and 1 million men have either anorexia, a disease marked by self-starvation and extreme weight loss, or bulimia, which is characterized by binges on large quantities of food, followed by vomiting or using laxatives to purge. An additional 25 million people -- about two-thirds of them women -- engage in binge eating but don't purge the food from their systems.

Barry Karlin, chief executive of CRC Health Group, the national behavioral health care provider that operates Carolina House, said less than 10 percent of patients with eating disorders get treatment, despite the often devastating effects of their disease. The mortality rate among young women with anorexia nervosa is about 12 times higher than the annual death rate for all females age 15 to 24, according to the National Institute of Mental Health.

"It's unconscionable in our society that such a tiny percentage of people who need help get help," Karlin said at a grand opening celebration at Carolina House last week.

The cost of treatment and the lack of insurance coverage to pay for it remain important barriers to care for many patients. Patients with anorexia, for example, are often treated for up to 90 days in residential programs similar to Carolina House at a cost of about $1,000 a day, or $90,000. Less than half of patients treated at CRC Health Group's four other eating disorder facilities in other states have insurance that will pay for it, Karlin said.

Still, Carolina House, which will accept referrals nationally, does not expect to have difficulty filling the six beds at its new facility. Two young women, one from North Carolina and one from Texas, were scheduled to begin treatment Monday, said Stacie McEntyre, the treatment center's executive director. By next year, Carolina House hopes to expand to 12 beds, including some space for men and boys.