A University of Kansas researcher who developed the first screening tool for eating disorders in veterans has been awarded a four-year, $4.2 million grant by the U.S. Department of Defense (DOD) to address eating disorders in active-duty members of the military.
Kelsie Forbush, senior scientist at the KU Life Span Institute, professor of clinical child psychology and director of the University of Kansas Center for the Advancement of Research on Eating Behaviors, is leading the research -; the only eating-disorders grant the DOD funded this year.
We have an excellent opportunity to help military members with eating disorders through this work."
Kelsie Forbush, senior scientist, KU Life Span Institute
As part of the project, Forbush and her team will test a screening tool that they developed for use in veterans -; called the Brief Assessment of Stress and Eating (BASE) -; among active-duty servicemembers.
The project aims to identify the risk of eating disorders in military members, including factors that contribute to onset and progression, and examine the potential for links between eating disorders and alcohol and harmful substance use and mood, anxiety and trauma symptoms. Forbush said a screening tool designed specifically for use in the military is critical.
"Screening is a critical first step for providing intervention," Forbush said. "If we understand what factors are promoting eating disorders, or what factors help promote resiliency, then we might be able to develop novel prevention and treatment programs that are well-suited to this group."
Eating disorders are one of the deadliest mental disorders and are among the main causes of suicide- related mortality in the U.S., with suicide rates comparable to depression, opioid use disorders or schizophrenia. Veterans have been found to have higher rates of disordered eating compared to civilians, with around 5% of male and around 16% of female veterans with a current eating disorder.
The Eating Disorder Coalition (EDC), a national advocacy group, has helped call attention to the problem of eating disorders within the military and has supported Forbush's research.
"The EDC did important advocacy work that helped promote awareness of eating disorders in military- relevant populations, to the ability to obtain funding in order to better understand and treat eating disorders in this at-risk population," Forbush said.
Despite the seriousness of the disorder, a 2019 study by the Government Accountability Office found that the military's screening does not accurately identify servicemembers with eating disorders. One reason is that the military has a larger male population that may not identify with stereotypical eating disorder screening, which tends to focus on a female perspective.
"Asking about dissatisfaction with hips and thighs or a desire to avoid weight gain may miss people with eating disorders who want high muscularity and low body fat," Forbush said. "If a screening tool is highly gendered, then we might miss someone with an eating disorder who is dissatisfied, but in a different direction."
There is evidence to show that military servicemembers are at risk for developing disordered eating due to increased stress, focus on weight and physical appearance and food restriction while someone is on a mission, leading to binge-eating or other unhealthy eating behaviors.
"Studies show that eating disorders have increased in the military as much as 44% between 2013 and 2016, suggesting an urgent unmet military health care need," Forbush said. " "However, most studies that have looked at the prevalence of eating disorders in the military only included a limited number of eating disorders. As a result, there is almost no information on some of the most common forms of eating disorders, such as 'other specified feeding or eating disorders.'
"Our study is important because not only will it result in improved eating disorder screening tools, it will also contribute to improved information on the full scope and impact of eating disorders in the military."
Other KU researchers participating in the study, titled "Assessment of Eating Disorder and Comorbidity Risk and Resilience in a Nationally Representative Sample of Recent Military Enlistees," include Alesha Doan, professor and associate dean in the College of Liberal Arts & Sciences, CARE lab postdoctoral fellow and statistician Yiyang Chen and Mike Denning, director of KU's Office of Graduate Military Programs.
Other team members include Karen Mitchell (VA Boston), Mary Oehlert (Leavenworth VA), Kara Christensen (University of Nevada, Las Vegas), David Watson (University of Notre Dame), Chelsea Song (Indiana University), Alcia Wendler (Topeka VA) and Joanna Weise (psychologist with the 20th Medical Group).