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Eating Disorders and Disordered Eating Among Veterans

The blinking digital numbers on the scales seem to be taking forever. I can’t believe I agreed to have dinner with my friends last night.  Now I have to get up an hour earlier so I can get in extra time working out before work.  

The next morning after my workout at the gym, I grab my stuff and head to the shower. I keep replaying seeing the fat rolls on my sides doing the side plank, I knew I shouldn’t have gone out to eat last night. Pinching by sides to confirm what I saw; I know today is going to be a horrible day. 

Walking out of the gym one of the women from my class stops me, “Wow! How do you stay so thin?” she asks me.  

I mumble something, put my head down and pull my oversize sweater down a little further. 

I don’t know why people lie to me. I can see the fat rolls on my sides. Do they think the fake compliments make me feel better? 

Eating Disorders Vs. Disordered Eating 

Eating disorders are psychiatric illnesses that cause severe, frequent, and persistent unhealthy eating habits to develop (Petre, 2017; “Disordered Eating,” 2019).  Eating disorders are typically characterized by an obsession with food, body weight, and/or body shape leading to behaviors such as severe restriction of food intake, uncontrollable food binges, or purging behaviors like vomiting or over-exercising (Petre, 2017).  

Disordered eating refers to a wide range of abnormal eating behaviors that do not meet the criteria for an eating disorder diagnosis (Richman, 2017a). Such behaviors can include an inability to control eating habits; skipping meals to either fast or to eat other foods in excess; obsessive calorie counting; using laxatives to help release food from the body; having an excessive exercise routine; using food to cope with stress; or engaging in “healthier” eating to a harmful extent (Richman, 2017b; “Disordered Eating,” 2019). Like eating disorders, disordered eating is typically associated with higher stress and decreased self-esteem based on body shape or weight (Disordered Eating, 2019). Although disordered eating is far more common than eating disorders, disordered eating behaviors can develop into an eating disorder (Richman, 2018). 

Common Types of Eating Disorders and Disordered Eating Behaviors 

Anorexia Nervosa 

Anorexia nervosa is an eating disorder that is characterized by very restricted eating patterns that lead sufferers to be considerably underweight compared with people of similar age and height. People with anorexia nervosa generally have an intense fear of gaining weight, a distorted body image, preoccupation with constant thoughts about food, and difficulty eating in public (Petre, 2017).  

There are two subtypes of anorexia nervosa:  

Subtype 1 – The Restricting Type 

Those who suffer from subtype 1 lose weight exclusively through dieting, fasting, or excessive exercise (Petre, 2017). 

Subtype 2 – The Binge and Purge Type 

Those who suffer from subtype 2 may restrict food intake for a period of time and then eat large amounts of food, or they may just eat very little. In either case, however, eating is followed by behaviors such as vomiting, taking laxatives, or exercising excessively in order to rid the body of calories (Petre, 2017). 

Anorexia nervosa can be very damaging to the body. Over time, individuals with this disorder can experience the thinning of their bones, infertility, as well as heart, brain, or multi-organ failure and death (Petre, 2017). 

Bulimia Nervosa 

Bulimia Nervosa is an eating disorder that is characterized by frequently eating very large amounts of food in a short period of time, usually until the person becomes painfully full; this is called a binge. During a binge, the person may feel like they cannot stop eating or control how much they are eating.  

Following a binge, individuals with bulimia will induce vomiting, take, laxatives or diuretics, or excessively exercise in order to offset the calories consumed in the binge; this is called a purge. While these symptoms appear very similar to those of the binge and purge subtype of anorexia nervosa, individuals with bulimia usually maintain a relatively normal weight, rather than becoming underweight (Petre, 2017).  

Bulimia nervosa can cause swollen salivary glands, tooth decay, acid reflux, severe dehydration, hormonal disturbances, electrolyte imbalances, stroke, or heart attack (Petre, 2017). 

Binge Eating Disorder and Binge Eating Behavior 

Binge eating disorder is believed to be one of the most common eating disorders in the United States. People with this disorder eat large amounts of food until they are uncomfortably full, often feel a lack of control when binge eating, and do not use any purging behaviors to compensate for the binging (Petre, 2017).  

Binge eating behaviors are a pattern of disordered eating that is less severe than binge eating disorder and does not meet the criteria for an eating disorder. 

People with binge eating disorder and binge eating behaviors are often overweight or obese which increases their risk of heart disease, stroke, and type 2 diabetes (Petre, 2017). 

Avoidant/Restrictive Food Intake Disorder (ARFID) 

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that is characterized by a lack of interest in eating or distaste for certain smells, tastes, colors, textures, or temperatures. This disorder often leads to restricted food intake, weight loss, nutrient deficiencies, and even requires tube feeding in severe cases (Petre, 2017). 

Purging Behaviors 

Purging behaviors can be a pattern of disordered eating but, if severe enough, can also be diagnosed as an eating disorder classified under the category of Other Specified Feeding and Eating Disorder (OSFED). Individuals with purging disorder engage in purging behaviors, such as vomiting, laxatives, diuretics, or excessive exercising. However, they do not restrict their food intake or binge eat (Petre, 2017). 

Orthorexia Nervosa 

Orthorexia Nervosa is a pattern of disordered eating in which a person has an obsessive focus on “healthy eating,” often eliminating entire food groups from their diet that are viewed as unhealthy. This can lead to malnutrition and severe weight loss (Petre, 2017). 

Diagram

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[Graphic compiled and created by Natalie Schroeder] 

Eating Disorders and Disordered Eating in Veterans with Trauma Experiences 

Studies have found that rates of eating disorders, including anorexia, bulimia, and binge eating disorder, as well as disordered eating behaviors, are potentially higher among veterans than among the civilian population (Buchholz et al., 2018; Cuthbert et al., 2020; Slane et al., 2016). 

Several military-associated traumas have been associated with higher prevalence of severe eating disorder symptoms and patterns of disordered eating among both male and female veterans (Cuthbert et al., 2020; Richman, 2017a; Richman, 2017b; Richman, 2018; Blais et al., 2017; Forman-Hoffman et al., 2012; Striegel‐Moore et al., 1999a; Brewerton et al., 2018). 

 These military-associated traumas include: 

Interpersonal violence (IPV) has also been associated with higher risks for developing an eating disorder among both male and female veterans (Huston et al., 2019).  

People who suffer from eating disorders and disordered eating are likely to have experienced multiple traumas in their lifetime.  

Research has found that disordered eating may provide short-term relief from negative feelings or emotions related to trauma, although long-term engagement in these behaviors can lead to severely negative health outcomes (Richman, 2017b).  

Women, in particular, reported disordered eating as a way to change their shape and weight to avoid the attention that may lead to more traumatic experiences (Richman, 2017a; Richman, 2017b; Cuthbert et al., 2020; Forman-Hoffman et al., 2012). 

The Role of the Military Environment on Eating Behaviors 

Studies have found that the military environment may play a significant role in the development of eating disorders and disordered eating patterns in active military personnel.  

Strict military weight and fitness requirements, for example, can lead to the use of disordered eating behaviors to meet these requirements. In addition, needing to eat quickly during basic training, having erratic meal schedules during deployment, and having less appetizing or healthy meal options on military bases can also encourage disordered eating behaviors among military personnel (Richman, 2018; Ashby, 2017; Cuthbert et al., 2020). 

Eating disorders and disordered eating patterns that develop during military service are likely to persist long after leaving.

Eating disorders and disordered eating patterns that develop during military service are likely to persist long after leaving the military (Cuthbert et al., 2020; Richman, 2017).  

The transition from military to civilian life is a very sensitive period, often generating a lot of stress and anxiety. As such, many eating disorders and disordered eating behaviors can also emerge during this transition period (Cuthbert et al., 2020; Richman, 2017; “Eating,” 2016). 

the military (Cuthbert et al., 2020; Richman, 2017).  

The transition from military to civilian life is a very sensitive period, often generating a lot of stress and anxiety. As such, many eating disorders and disordered eating behaviors can also emerge during this transition period (Cuthbert et al., 2020; Richman, 2017; “Eating,” 2016). 

Comorbid Mental Health Conditions 

Multiple studies that have focused on individuals with eating disorders found that sufferers often have additional mental health challenges (Striegel‐Moore et al., 1999a; Striegel‐Moore et al., 1999b; Maguen et al., 2012; Cuthbert et al., 2020; Brewerton, 2007; Higgins et al., 2012; Masheb et al., 2014).  

Such challenges include: 

In addition to the experiential, sociocultural, and psychological factors that contribute to eating disorders and disordered eating behavior, veterans are also faced with a lack of resources.  

As with much of the civilian population, veterans lack access to adequate mental health services (Hester, 2017).  

Research has also found that many veterans live in areas that have fewer supermarkets, fitness facilities, and parks (Zenk et al.,2017).  

These factors are likely to amplify unhealthy habits. 

Resources 

Mental Health Professionals 

Finding a health professional to help treat mental health problems is very important for eating disorder recovery. 

The VA provides mental health services for veterans. To learn more, click here.  

You can also contact your local Veteran’s Service Office. 

To find a psychiatrist near you, click here.  

To find a psychologist near you, click here

To find a counselor near you, click here

For more mental health resources, click here

Treatment Centers 

Treatment Centers 

A professional team that specializes in eating disorders can be one of the most effective resources for eating disorder recovery.  Some treatment centers for eating disorders have specialized programs for military members, such as Eye Movement Desensitization and Reprocessing (EMDR), which can help address the unique needs that servicemen and women may be facing in addition to an eating disorder. Be sure to choose a provider that is a Certified Eating Disorder Specialist (CEDS). 

Click here to find an eating disorder treatment center near you. 

Unfortunately, if insurance companies do not contract for specific services or do not honor treatment recommendations, the cost of eating disorder treatment cost up to $30,000 a month. It is important to understand your benefits. To learn more, click here

There are also scholarships available for clients who are seeking higher levels of care such as Inpatient, Residential and/or Partial Hospitalization Programs. Project Heal is an organization that partners with treatment centers across the United States to sponsor individuals for treatment at their facilities. In addition, many for-profit companies also provide scholarships through their non-profit branches. To learn more about scholarship options, click here

 Support Groups 

Support groups, though not a replacement for treatment, are a free or low-cost way to gain support from others. Click here to find an in-person support group near you. There are also virtual support groups available. Click here to find a virtual support group through the National Eating Disorder Association. 

For more free and low-cost support resources, click here

Eating Disorder Hotline Listings 

National Eating Disorders Association Helpline: 1-800-931-2237 

This helpline offers support Monday–Thursday from 9 a.m.–9 p.m. EST, and Friday from 9 a.m.–5 p.m. EST.   

Hopeline Network: 1-800-442-4673 

You can talk to someone day or night and can also call if you need referrals to eating disorder treatment centers. 

National Association of Anorexia Nervosa and Associated Disorders: 1-630-577-1330 

The hotline operates Monday–Friday from 9 a.m.–5 p.m. CST. Trained hotline volunteers offer encouragement and support to those having problems around eating or binging, as well as assistance to family members who have concerns that their loved one might have an eating disorder. 

Overeaters Anonymous: 1-505-891-2664 

This hotline is available to people worldwide who need a referral to an Overeaters Anonymous support meeting in their area and provides help for people who suffer from anorexia, bulimia, food addiction, or any other type of eating disorder. 

The United Way’s 211.org: Call 2-1-1 

This hotline is available 24/7 and can offer information and referrals to eating disorder treatment organizations in your area. 

Crisis Textline: Text CONNECT to 741741 

This textline helps people with eating disorders and other mental health issues by connecting callers with trained crisis volunteers who provide confidential advice, support, and referrals. The textline is available 24/7, 365 days a year. 

Nutrition Resources 

Nutrition and Food Services (NFS) provides nutritional services for veterans and their families across VHA health care facilities. To learn more, click here.  

The VA also provides Registered Dietician Nutritionists. To learn more, click here

TRICARE is a health care program for service members, veterans, and their families that covers a limited set of services from a nutritionist or registered dietitian. To learn more, click here

Home Base Nutrition Services for veterans provides nutrition counseling for patients seeking support for various topics, including weight-management, diabetes, and the management of food allergies/intolerances. To learn more, click here

Premade meal delivery services, such as Personal Chef To Go can be very helpful for veterans who do not have time to cook, or who don’t have access to healthy food options. To find discounts on premade meal delivery services, click here

Meals on Wheels and Food Pantries may also be an option. 

Fitness 

MOVE! is a weight management program offered through the VA that helps veterans develop healthy eating behaviors and increase their physical activity. To learn more and register, click here. Through TELEMOVE!, veterans who have a busy schedule or who live far from a Veterans clinic can meet with a registered dietician from their own home. To learn more, click here

If you do not qualify for these programs, there are also gyms and fitness centers that offer discounts to veterans. For a list of these facilities, click here

Bariatric surgery includes a variety of weight-loss procedures, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric band (AGB), that are an option for veterans with class II and III obesity. However, veterans must meet specific criteria for a surgical evaluation through the VHA. 

To learn more about bariatric surgery offered through the VHA, click here

The VHA’s strict requirements for bariatric surgery, however, may make it inaccessible to some veterans. In addition, these procedures are not widely offered within the VHA. As of 2020, only 23 of 170 VA Medical Centers offered bariatric surgery (Cuthbert et al., 2020). Furthermore, bariatric surgeries are expensive, and costs may represent a barrier to receiving such surgeries (Cuthbert et al., 2020). If you are unable to get bariatric surgery through the VHA, you can contact your local VSO.  

There are free weight-loss surgery grants available through the Weight Loss Surgery Foundation of America (WLFSA) and there may be free weight-loss surgery clinical trials available as well. To learn more, click here.  

In addition, you may also want to look into raising money for surgery using fundraising resources like gofundme

MST Resources  

Veterans and service members can receive MST care, free of charge, even if they do not qualify for other VA benefits. For more disability benefit information visit the VA’s MST fact sheet, click here and the VA’s Health Care Services for MST fact sheet click here, or contact your local Veterans Service Office.  
 
Safe Helpline  is a confidential system that provides live, one-on-one support and information to MST survivors. You can Call the Telephone Helpline at 877.995.5247, visit the Online Helpline by clicking here, or download the free Self-Care App (iOS and Android).  

Strength and Recovery – Men Overcoming Military Sexual Trauma is a brochure from the VA that provides MST resources.  

Safe HelpRoom Sessions for Military Men is an online community of sexual assault survivors in the military that meets on Sundays.  

1in6 provides free and anonymous weekly chat-based support groups for male victims of sexual assault.  
 
For more MST information and resources, click here and here, or visit Know A Vet’s information and resource page.  

PTSD Resources  

Female Veterans with PTSD should call their local VA and speak to a Women Veterans Program Manager, as well as contact their local Veterans Service Office to be connect to resources in their area.   

To find a local support group for women with PTSD, click here.  

For more PTSD information and resources, visit Know A Vet’s information and resource page. 

Interpersonal Violence Resources 

For help finding a domestic violence shelter in your area, click here

To go to the National Domestic Violence Hotline’s website, click here

To locate domestic violence resources in your state, click here

For more IPV information and resources, visit Know A Vet’s information and resource page. 

For more information on eating issues, click here

Visit Know A Vet? for a list of resources for a wide range of issues and resources by zip code. Your local VSO can help connect you to other veteran or civilian organizations. To find your local VSO visit Know A Vet? and put your zip code in the box toward the top of the home page for your local Federal, State and County resources.  

Watch for future articles from Know A Vet? that will discuss VA benefits for Veterans and their families. 

If this information would help someone you know, show them you are thinking of them by forwarding this email.  If you received this email from someone and would like to receive your own FREE newsletter click here to sign up. 

Article Sources

Ashby, M. (2017). “How Does Military Experience Influence the Obesity Trend Among Retired Veterans: A Qualitative Grounded Theory Study.” ProQuest. The University of the Rockies. Retrieved from search.proquest.com/openview/bffb1dbbceb783e450cd6791b6d2670a/1?pq 

Blais, R. et al. (2017). “Military Sexual Trauma Is Associated with Post-Deployment Eating Disorders among Afghanistan and Iraq Veterans.” International Journal of Eating Disorders. Vol. 50:7 (808-816). doi:10.1002/eat.22705 

Brewerton, T. (2007). “Eating Disorders, Trauma, and Comorbidity: Focus on PTSD.” Eating Disorders. Vol. 15:4 (285–304). doi:10.1080/10640260701454311 

Brewerton, T. et al. (2018). “Sensation Seeking, Binge-Type Eating Disorders, Victimization, and PTSD in the National Women’s Study.” Eating Behaviors, Vol. 30 (120–124). doi:10.1016/j.eatbeh.2018.07.001 

Buchholz, L. et al. (2018). “Rates and Correlates of Disordered Eating among Women Veterans in Primary Care.” Eating Behaviors. Vol. 30 (28–34). doi:10.1016/j.eatbeh.2018.05.002 

Cuthbert, K. et al. (2010). “Eating Disorders and Overweight/Obesity in Veterans: Prevalence, Risk Factors, and Treatment Considerations.” Current Obesity Reports, Vol. 9:2 (98–108). doi:10.1007/s13679-020-00374-1 

“Disordered Eating.” (2017). Women Veterans Health Care. Veterans Health Administration. US Department of Veterans Affairs. Retrieved from www.womenshealth.va.gov/WOMENSHEALTH/OutreachMaterials/GeneralHealthandWellness/Disordered_Eating.asp 

“Eating.” (2016). Know A Vet?. Friends of the Vet Center Inc. Retrieved from www.knowavet.org/?s=eating&submit= 

Forman-Hoffman, V., et al. (2012). “Eating Disorders, Post-Traumatic Stress, and Sexual Trauma in Women Veterans.” Military Medicine. Vol. 177:10 (1161–1168). doi:10.7205/milmed-d-12-00041 

Hester, R. (2017). “Lack of Access to Mental Health Services Contributing to the High Suicide Rates among Veterans.” International Journal of Mental Health Systems. Vol. 11:1. doi:10.1186/s13033-017-0154-2 

Higgins, D., et al. (2013). “Binge Eating Behavior among a National Sample of Overweight and Obese Veterans.” Obesity. Vol. 21:5 (900–903). doi:10.1002/oby.20160 

Huston, J.C., et al. (2019). “Associations between Disordered Eating and Intimate Partner Violence Mediated by Depression and Posttraumatic Stress Disorder Symptoms in a Female Veteran Sample.” General Hospital Psychiatry. Vol. 58 (7–82). doi:10.1016/j.genhosppsych.2019.03.007 

Maguen, S., et al. (2012). “Eating Disorders and Psychiatric Comorbidity among Iraq and Afghanistan Veterans.” Women’s Health Issues. Vol. 22:4. doi:10.1016/j.whi.2012.04.005 

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Richman, M. (2017a). “Research Links Multiple Forms of Trauma with Eating Disorders in Female Vets.” Research Currents. Office of Research & Development. US Department of Veterans Affairs. Retrieved from www.research.va.gov/currents/0717-Trauma_with_eating_disorders_in_female_Vets.cfm 

Richman, M. (2018). “Study: Demanding, Fast-Paced Military Lifestyle May Cause Women to Adopt Poor Eating Habits.” Research Currents. Office of Research & Development. US Department of Veterans Affairs. Retrieved from www.research.va.gov/currents/0618-Demanding-fast-paced-military-lifestyle-may-cause-women-to-adopt-poor-eating-habits.cfm 

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