BY: Melissa Munn-Chernoff, PhD

DATE: 12 April 2017

We know that eating disorders affect people of all genders, ages, races, ethnicities, body shapes, weights, sexual orientations, and socioeconomic statuses. Another group of individuals who must be included in these discussions about eating disorders are men and women in the military.

The prevalence of and factors that contribute to eating disorders in military personnel is understudied. Yet, the handful of existing studies have generally reported that the prevalence of eating disorders [anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS, including binge-eating disorder)] and eating disorder symptoms in military men and women are similar to or even higher than in civilian populations. Two review papers^{1, 2} highlight the research findings to date and discuss avenues for future directions. A summary of their findings and conclusions are below.

What do we know?

• According to Bodell and colleagues², the average prevalence of AN is between 0.2% and 1.6% in women in the military, depending on methods of assessment (i.e., interview versus self-report), and 0.008% in men. For BN, the average prevalence is between 0.71% and 9.7% in women and 0.015% in men. In women, the average prevalence of binge eating is 19.3%, whereas the average prevalence of purging behaviors ranges from 3.4% to 14.6%, depending on purging method. By comparison, for college and community-based samples, the average prevalence is as follows: 0% in women and men for AN; 1.1% in women and 0% in men for BN; 11.67% in women for binge eating; and 4.2% in women for purging behaviors.
• Similar to civilian populations, trauma, including post-traumatic stress disorder, is associated with eating disorder risk in service members. However, military personnel are uniquely exposed to combat trauma and trauma associated with sexual assault, which is high in the military. These experiences may present their own risks for the development of eating disorders and associated symptoms.
• The types of food available to military personnel during deployment are different than those when not deployed. Switching from Meals Ready-to-Eat (MREs), which are high calorie ready-to-eat packages of food used in combat when organized food facilities are unavailable³ to “regular food” that is consumed when individuals are at home could contribute to eating disorder symptoms.
• There are unique military requirements, such as fitness checks that require individuals to meet certain fitness and weight standards, which may make individuals more vulnerable to the development of an eating disorder and/or may exacerbate existing eating disorder symptoms.

What research is needed?

• Information on the prevalence of and risk factors for eating disorders in men is sparse. Given that the military is a male-dominated profession, it will be critical to include men in future studies and evaluate whether specific eating disorder symptoms are more prevalent in men versus women. Men and women don’t always express eating disorders in the same way. Eating disorder symptoms that are more common in civilian men than women (e.g., use of muscle-building products) will be important to examine in the future.
• Studies that include diagnostic interviews, self-report assessments, and medical record data are needed to provide a more robust assessment of eating disorders and symptoms in service members since there are clear advantages and disadvantages for each method. For example, while diagnostic interviews can more easily ensure that respondents understand the meaning of certain questions, they may be less likely to provide honest answers to an interviewer for fear of consequences from the military, such as denial of promotion, separation from the military for medical reasons, or disability discharge. Answering self-report questionnaires, though sometimes less precise, can be more anonymous and help the respondent feel more comfortable in answering questions honestly.
• Additional work should follow individuals over time to assess whether the eating disorder is present upon enlistment or whether it develops during the course of their military career, including during and between deployments.
• It is unclear whether certain branches of the military are associated with higher risk for eating disorders (e.g., Army, Air Force, etc.). In addition, more studies are needed that address different components (e.g., Active Duty, Reserves, National Guard).
• Finally, it will be important to assess the prevalence of and risk factors for eating disorders in family members, as the spouses and offspring of individuals who are deployed may be more vulnerable to the development of eating disorders.

Understanding the prevalence of and risk factors for eating disorders and symptoms that may be unique to military men and women is critical in order to determine who is most at risk for the development of eating disorders and provide prevention, intervention, and treatment to improve psychological resiliency and prevent other challenges during service.

References

¹Bartlett BA & Mitchell KS (2015). Eating disorders in military and veteran men and women: A systematic review. International Journal of Eating Disorders, 48, 1057-1069.

²Bodell L, Forney KJ, Keel P, Gutierrez P, & Joiner TE (2014). Consequences of making weight: A review of eating disorder symptoms and diagnoses in the United States Military. Clinical Psychology, 21, 398-409.

³https://en.wikipedia.org/wiki/Meal, Ready-to-Eat