By Baiyu Qi, MPH

U.S. military veterans may experience an elevated prevalence of eating disorders. However, this population has long been understudied in the field, which may be due to the misconception that eating disorders mainly affect women and are therefore less relevant to this traditionally male group. [1] In fact, eating disorders affect people of all genders and the demographic make-up of the military has become more diverse. [2] Given the high rates of mental health disorders among veterans, it is important to understand the prevalence and risk factors of eating disorders, as well as unique pathways of developing eating disorders in this population to assist in developing targeted prevention and intervention strategies.

The prevalence of eating disorders among veterans reported by previous studies varied, possibly due to different assessment methods used. For example, based on electronic medical records from the Veterans Health Administration (VHA), post-9/11 veterans had a 1-year and 5-year prevalence of any eating disorder of 0.1% and 0.2%, respectively. However, since eating disorders are not routinely screened at the VHA, these prevalence estimates might be underestimated. On the other hand, based on self-report questionnaires, the prevalence of any current eating disorder was 4.1% among male and 14.1% among female veterans. Finally, studies using interview assessments reported a lifetime ED prevalence of 3.7% in male veterans and 4.7% in female veterans. The prevalence also differs across ED types in veterans. Table 1 summarizes the prevalence estimates of different types of EDs reported by previous studies. Taken together, these results indicate that the prevalence of eating disorders is possibly higher among veterans than the general U.S. population. [3]

Table 1. Prevalence estimates of each type of eating disorder reported by previous studies using different assessment methods.

	Self-report questionnaire	Interview (in-person or telephone)
Male	Female	Male	Female
Anorexia nervosa	0.1%	0%	0.1%	1.4%
Bulimia nervosa	2.4%	7.8 – 9.1%	0.1%	0.5%
Binge eating disorder	2.25	6.3 – 7.3%	0.4%	1.3%

Veterans are a group of individuals who not only suffer from common risk factors, but also ones that are unique to military life, including trauma exposure, especially military-specific trauma (MST; e.g., military sexual trauma and combat-related trauma). Previous studies have found an association between MST and disordered eating in both male and female veterans, with the strongest association in men. One possible pathway is that veterans engage in disordered eating to regulate distress associated with comorbid mental health conditions, such as depression or post-traumatic stress disorder (PTSD), that result from trauma exposure. An additional risk factor unique to veterans is the military environment. For example, the strict weight and fitness requirements in the military may lead to situational eating disorders (i.e., extreme measures to induce weight loss or reduce body size to meet fitness standards), which may persist post-separation. Some people may also develop poor eating habits during their enlistment (e.g., eating quickly in basic training, erratic meal schedule on deployment, limited healthy options on post), which may further contribute to eating disorders. [3] Substantial declines in physical activity after discharge from the military may contribute to weight gain and subsequently, the use of maladaptive eating and weight management behaviors. [1]

Despite increasing attention to veterans in eating disorder research during the past decade, more comprehensive and nuanced studies are necessary to provide a better understanding of eating disorders in this population. Robust and consistent routine screening for eating disorders in VHA medical settings would provide a better estimate of prevalence of eating disorders among veterans who use VHA services. Current studies examining trauma exposure and eating disorders focus only on female veterans, failing to attend to the problem in their male peers and thereby missing a critical opportunity to address the problem overall. Longitudinal studies could establish the temporal sequence between aspects of military service and the emergence or exacerbation of eating disorders.

By understanding the prevalence of and risk factors for eating disorders in male and female military veterans, we will be better prepared to improve detection, targeted prevention, and intervention.

References:

1. Bartlett, B. A., & Mitchell, K. S. (2015). Eating disorders in military and veteran men and women: A systematic review. The International journal of eating disorders, 48(8), 1057–1069. https://doi.org/10.1002/eat.22454
2. US Census Bureau. (2021, October 8). Census bureau releases new report on veterans. Census.gov. Retrieved February 4, 2022, from https://www.census.gov/newsroom/press-releases/2020/veterans-report.html#:~:text=The%20number%20of%20veterans%20in,veterans%2C%20were%20women%20in%202018.
3. Cuthbert, K., Hardin, S., Zelkowitz, R., & Mitchell, K. (2020). Eating disorders and overweight/obesity in veterans: Prevalence, risk Factors, and treatment considerations. Current obesity reports, 9(2), 98–108. https://doi.org/10.1007/s13679-020-00374-1