What's Eating Our Veterans?

Research suggests high rates of eating disorders and dysmorphia in both genders.

Posted Nov 20, 2018

As we enter into the time in our calendar year associated with gathering together, it’s important to acknowledge that the majority of these gatherings take place in the presence of copious amounts of food.  And, food can be an unknown stressor in many service members’ lives—both male and female. 

Military members have an institutionalized, bizarre relationship with food. From being required to consume copious amounts of food in short periods of time at basic training to extreme caloric deficits in some types of military training and austere environments, food is both reviled and revered. A Vietnam veteran once told me a story of how after many weeks on patrol in the dense jungle, he can still recall the taste and emotion associated with a frozen can of peaches—a rare delicacy for infantrymen. Food deprivation, even for a short period of time, can have a lasting impact on how we relate to eating. 

Moreover, there are very few professions outside of the military that emphasize body image and physical ability. Military members are governed by weight regulations and physical fitness requirements. Interestingly, the most stringent of which are relegated to special operations and combat arms units where the percentage of women is still extremely small. Furthermore, it is within that subset that there is an increased possibility of being exposed to or witnessing violence; death, dying, and harm to self or others during combat; and killing during combat. All of which might be associated with an increased risk of developing an eating disorder (ED).

Eating disorders can look like many things and societally we are most familiar with its presentation in women. The most common eating disorders are anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. The most common in military members is bulimia nervosa. This ED involves a cycle of binge eating and inappropriate compensatory behaviors. These behaviors include fasting or excessive exercise, and supplement use for the non-purging type, and self-induced vomiting, use of diet pills, laxatives, or diuretics for the purging type.    

Yet, while women veterans are consistently underrepresented in studies associated with many factors of military service, there is a somewhat robust body of literature on the prevalence of EDs and eating disorder symptoms (EDS) in this population. Likely, because it is unnervingly common.  A self-report survey of 3,000 women in the military found that the majority of respondents had a probable ED or exhibited EDS. Another study found high rates (37.9 percent) of body dissatisfaction and previous disordered eating behaviors (77 percent) in a sample of young, female Marine Corps recruits.

Conversely, eating disorders are understudied among male veterans, who may be at increased risk due to all the reasons listed above. In a study that sought to examine the associations between specific types of trauma (i.e., childhood physical abuse, adult physical assault, childhood sexual abuse, adult sexual assault, and military-related trauma) and eating disorder symptoms in a large, nationally-representative sample of trauma-exposed male veterans, it found that military-related trauma was the sole factor associated with eating disorder symptoms (EDS). This suggests that military-related traumatic experiences other than combat (e.g., an accident, traumatic loss, or moral injury) may be most strongly associated with EDS.

Moreover, while nearly 35 percent of Americans are obese, 78 percent of veterans are overweight or obese, and nearly one out of four is diabetic, according to the Department of Veterans Affairs.  To that point, weight gain rates in veterans increase prior to and around the time of discharge from military service.  This weight gain translates to approximately five pounds of additional weight gain per year over the course of 6 years, and a near tripling of obesity, from 12 percent to 31 percent.

Eating disorders are not the only culprits impacting how some male and female veterans relate to food and their bodies. Body dysmorphic disorder, characterized by obsessive thinking about a flaw that is usually imagined or if present, hardly noticeable to others, affects approximately 1.7 percent to 2.4 percent of the normal population, with roughly equal distribution among men and women. However, in a study conducted with service members the prevalence rate skyrocketed to 13 percent in males and 21.7 percent in females.  Additionally, the same study found that muscular dysmorphia, marked by a negative body image and an obsessive desire to have a muscular physique, appeared in nearly 13 percent of male service members and roughly four percent of female service members. 

There is a lot we do not talk about in the veteran community.  Eating disorders and body image remain two highly stigmatized issues, among both men and women.  Many suffer in silence or do not understand how the manifestation of the eating disorder or dysmorphia is related to military trauma.  Most worry it’s a sign of weakness or not a big deal and for men, this is even more prevalent and insidious.    

All of this isn’t to say, do not indulge and enjoy Thanksgiving or the holidays.  Everyone deserves the opportunity to treat themselves from time to time.  However, some military members and veterans may have trouble doing just that.  Where the intake and regulation of food and exercise may help some feel like they are exerting control over their environment, in some cases, it is actually controlling them. 

If you notice your service member or veteran, or any family member, struggling to enjoy the meals laid out in front of them, do not call attention to it by telling them to eat more or eat less. Strike when the iron is cold. Try to have a conversation when food isn’t present and as always, approach the issue from a place of compassion, non-judgement, and love

References

Arditte Hall, K. A., Bartlett, B. A., Iverson, K. M., & Mitchell, K. S. (2017). Military‐related trauma is associated with eating disorder symptoms in male veterans. International journal of eating disorders, 50(11), 1328-1331.

Bartlett, B. A., & Mitchell, K. S. (2015). Eating disorders in military and veteran men and women: A systematic review. International Journal of Eating Disorders, 48(8), 1057-1069.

Campagna, J. D., & Bowsher, B. (2016). Prevalence of body dysmorphic disorder and muscle dysmorphia among entry-level military personnel. Military medicine, 181(5), 494-501.

Forman-Hoffman, V. L., Mengeling, M., Booth, B. M., Torner, J., & Sadler, A. G. (2012). Eating disorders, post-traumatic stress, and sexual trauma in women veterans. Military Medicine, 177(10), 1161-1168.

Littman, A. J., Jacobson, I. G., Boyko, E. J., Powell, T. M., & Smith, T. C. (2013). Weight change following US military service. International Journal of Obesity, 37(2), 244.