When one thinks of the military, images of elite, highly fit soldiers often come to mind. Conversely, talk of eating disorders generally steers toward undernourished individuals, often young women. However, data has shown that the prevalence of eating disorders in the military is roughly the same as in general society, and two University of Kansas researchers have secured a grant from the Department of Defense to develop a screening to detect eating disorders among the nation's soldiers and identify organizational barriers to identifying and treating them.
Kelsie Forbush, associate professor of psychology, and Alesha Doan, associate professor of women, gender & sexuality studies and faculty member in the School of Public Affairs & Administration, have secured a three-year, $1.7 million grant to study eating disorders in the military, adapt a previously successful screening tool and determine organizational challenges to detecting and treating eating disorders in both active-duty soldiers and veterans. The grant is administered by KU's Life Span Institute.
Active military face a wide range of dangers on the battlefield, and the risks of post-traumatic stress are well-documented. However, the constant pressure to meet fitness standards, physical requirements to enlist and expectation for leaders to maintain fitness levels as role models all can lead to eating disorders.
"Many people are not aware that the military has rigorous standards that require military personnel to meet specific body mass and other physical fitness standards," Forbush said. "In addition to physical fitness and body mass standards, in deployment situations, soldiers can experience additional pressures that can lead to disordered eating. The availability of calorie-dense 'meals, ready to eat' and high-calorie cafeteria-style comfort food served in chow halls can cause weight gain. Active-duty service members are also exposed to stress and trauma, which may lead to unhealthy eating behaviors in an attempt to cope with traumatic experiences and temporarily 'escape' from negative emotions."
Recent studies show that eating disorders occur in about 13 to 15 percent of young women and 3 percent of young men in the general population, and those statistics are approximately the same among members of the military. That number could actually underestimate the total in the military as there is not currently a servicewide screening to detect eating disorders, and those most often used in general populations rely on highly gendered questions most applicable to young women, Forbush said.
Failure to maintain body mass index and fitness standards can lead to referral to weight-loss programs and, potentially, discharge from service. Further, eating disorders have the highest mortality rate among all mental health disorders. Yet, despite the severity, no screening is in place for recruits and active-duty military or within the Veterans Health Administration system. Forbush's research group has developed a screening known as the Eating Pathology Symptoms Inventory, shown to comprehensively measure disordered eating in both men and women.
The researchers will work to adapt the screening to identify veterans who may have eating, mood, anxiety or trauma disorder. A nationally representative sample of 1,000 men and women discharged from the military within one year will take the screening at four time points. The reliability and validity will be tested, and a shorter form will be developed and tested with a second sample of 400 veterans to determine if the screening can accurately identify cases of eating, mood, anxiety or trauma disorder.
The screening will be designed to detect disordered eating and other potentially dangerous behaviors such as muscle building, excessive exercise, purging and restricting.
Doan will lead research into organizational barriers by conducting interviews with a subset of 100 veterans on their perceptions of institutional and cultural issues that may prevent identification and treatment of eating disorders.
"We'll be looking at organizational practices and policies that may factor into eating disorders and perhaps impede treatment," Doan said. "We want to better understand how the environment may be creating formal barriers that contribute to the problem. For example, eating disorders are often viewed as a health issue that affects women. Understanding this issue as a gendered problem may heighten stigma for men seeking treatment in the organization."
By developing effective screening, the researchers hope the military can implement measures to detect enlistees at risk of eating disorders when they enter, identify current soldiers also at risk or currently displaying disordered eating behaviors and to serve veterans who suffer from eating disorders. Potential recruits often feel pressure to lose weight rapidly in order to qualify, active-duty military face high levels of stress, and veterans often deal with post-traumatic stress, all of which can contribute to disordered eating. To complicate matters, obesity is a problem throughout society. Early detection and treatment could greatly enhance military readiness, the researchers said, as well as lead to improved health following treatment.
In addition to the Department of Defense funding, Forbush has received $330,000 in Research Excellence Initiative funding from KU's College of Liberal Arts & Sciences. The funding will support two years of research via an Academic Accelerator Award in the College, which will allow Forbush to complete a longitudinal research project designed to improve the ability to predict who will recover or relapse from an eating disorder and to provide treatment to KU students experiencing eating disorders.
The military project is also among the first to examine eating disorders and related mental health conditions among veterans on a national level. Thus, Forbush and Doan said they hope the results will not only contribute to the understanding of the scope and effects of eating disorders in post-9/11 veterans but demonstrate the need for a national VA program to address them.