Understanding Eating Disorders in Military Personnel

Close your eyes for a moment and notice the image that comes to mind when you picture a member of the military. Fighter pilots. “GI Joe” figurines, perfectly synchronized marching routines. A scene from Band of Brothers may flick through your imagination. Regardless, what likely comes to mind is an individual who appears strong and ready to defend our nation. Indeed, to most of us it is unsurprising to learn that members of the military are routinely monitored for fitness to serve. This is done in several ways, including a series of physical assessments with physical exercise tests and measurement of height, weight, and body composition. Due to unique service demands, benchmarks differ for each branch of the military. They are individually enforced per branch and occupation.

Body composition standards and fitness requirements may make sense considering the job responsibilities that servicemen and women carry out. Yet, these standards — in tandem with unique job-related stressors — may put servicemen and servicewomen at increased risk of disordered eating and eating disorders. In fact, military populations experience eating disorders at a prevalence equal to or higher than the national average. Naturally, considering this trend, this topic has been of increased interest to researchers.

With sufficient studies completed to warrant collective consideration, a narrative review was recently published in the Journal of Clinical Psychology summarizing emerging themes across military subgroups:

Reserve Officer Training Corps (ROTC)

Similar to the general population, females in the military appear to be at higher risk for eating disorders than males. But, both sexes can be affected. According to results on a commonly used measure of eating disorder risk, the Eating Attitudes Test (EAT-26), the threshold score for “at risk” for developing an eating disorder was met by 19% of females and 2% of males in military study samples. Additionally, 5% of females versus 1% of males appear to meet the criteria for an eating disorder. Using the DSM-IV diagnostic classification system (which varies slightly from the current system), the most prevalent diagnoses were Eating Disorder Not Otherwise Specified (EDNOS) and bulimia nervosa for women, and EDNOS for men. Based on this classification system, individuals meeting the criteria for binge eating disorder would have been classified as having EDNOS.

Active-Duty Servicepeople

Across studies of active-duty military, eating disorders and disordered eating behaviors are well-documented. Interesting themes emerge within particular branches:

• More than one-quarter of active-duty women in the Army may be at risk for an eating disorder.
• The group with the highest prevalence of eating disorders was active duty servicewomen in the Marine Corps (4.9% meeting criteria for anorexia nervosa, 15.6% for bulimia nervosa, and 76.7% for EDNOS).
• Disordered eating behaviors in active-duty Navy men tend to increase during semi-annual weigh-ins, including the use of diuretics, water pills, vomiting, laxatives, and diet pills (It is worth noting, as we have written elsewhere, that these weight control methods can be both dangerous and ineffective.).
• For reservists, those military members who are “in reserve” while still working civilian jobs, the rates of engaging in inappropriate weight control measures listed above were even higher.

Veterans

Studies about eating disorders in veteran populations primarily involve only female samples. By and large, prevalence estimates range widely. In one study using a registry of male and female veterans, the lifetime prevalence of an eating disorder was 1.5%. And, eating disorders were more frequently co-occurring with depression for women than men. Some data suggests that the prevalence of eating disorders among veterans has increased in the last decade. This may in part be due to shifting demographics (i.e., more females in the service).

Potential Risk Factors

Taken together, the themes and findings reported on disordered eating and eating disorders in the military confirm a picture of increased risk. The physical standards associated with military service job performance are a known risk factor in other groups, such as weight class sport athletes and dancers, in which individuals may take drastic measures to meet performance expectations. There are also risk factors more uniquely salient for servicepeople:

• The experience of food insecurity during wartime military service can impact eating behavior and food choices during and after service.
• Post-traumatic stress disorder (PTSD) is known to be both more prevalent in military versus civilian populations. This is a potential predictor for disordered eating behaviors in military populations.
• Military-related trauma for male veterans and sexual trauma (but not combat exposure) for female veterans are specifically associated with eating disorders and related symptoms.

Progress through Policy

The military aims to protect us. And researchers and policymakers have promising ideas of how to use what is now known about disordered eating and eating disorders in the military to protect our servicepeople (past, present, and future) from additional risk.

Experts in this area suggest that the military consider adding a metabolic panel to accompany the semiannual fitness tests. This may assist measuring holistic fitness. Body size is not necessarily the best measure of physical readiness to serve. Multidimensional, comprehensive assessment can decrease the stigma and pressure surrounding body size. Increasing educational efforts on eating disorders amongst military leaders and healthcare providers may allow for increased early detection and intervention. This is critical as it’s associated with improved outcomes.

Bottom line: We must serve our military better on this issue so that they can continue to serve us well.

For a closer look at the review study described above, check out:

Gaviria, D., & Ammerman, A. (2023). Eating disorders and disordered eating in servicemen and women: A narrative review. Journal of Clinical Psychology, 79(2), 316–373. https://doi.org/10.1002/jclp.23424

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