Eating Disorders High Among Military Women

A combination of environmental and traditional factors place military women at greater-than-normal risk for developing an eating disorder, according to a recent study by Tamara D. Lauder, MD, and her colleagues.

The 1-year study showed a higher-than-normal prevalence of eating disorders among 423 women on active duty in the Army (Med Sci Sports Exer 31:1265, 1999). Thirty-three percent (142) of the women met the screening criteria (Eating Disorders Inventory, or EDI) for being at risk for abnormal eating behavior. Among 108 women interviewed, 33 were diagnosed with eating disorders: 3% had anorexia nervosa, 9% had bulimia nervosa, 15% had binge eating disorder, 33% had an eating disorder not otherwise specified (ED-NOS), and 39% had what the authors termed a “situational eating disorder.” The authors developed this category to describe intermittent behaviors that were consistent with a DSM-IV diagnosis of ED-NOS. Situational eating behaviors occurred in connection with specific events during which the women felt significant pressure about weight and fitness.

The women with eating disorders exercised more, felt more dissatisfied with their weight, and felt more pressure about their weight than the other women in the study. Women with eating disorders also had a greater drive for thinness, used more bulimic behaviors, were more dissatisfied with their bodies, and had higher overall scores on the EDI Symptom Checklist. Army women face regular weigh-ins and army physical fitness testing (APFT) on a regular basis; the women reported that these were particularly high-stress times, and they engaged in abnormal dietary behaviors and exercise before the weigh-ins. Other studies have shown similar patterns (Mil Med 1999; 164:630; Mil Med 1997; 162:753).

Pressures similar to those in civilian athletes

Military women face many of the same pressures to be thin and fit as do civilian women athletes in organized sports. For example, women entering military academies are expected to perform at the same high physical and academic levels as their male counterparts. Women who become full-time active duty soldiers in the U.S. Army hold physically demanding jobs and also must participate in daily physical fitness programs. They also have to pass tests of fitness and meet weight standards every 6 months. In addition, they face the same societal pressures to acquire a “model-like physique.”

The military lifestyle also challenges the soldiers’ attempts to maintain weight and fitness standards For example, soldiers may only have access to high-calorie, high-fat foods. Frequent moves, field deployments, and field time may also make meal planning difficult.

The authors raise some interesting questions about whether eating disorders are being produced by the types of pressures put upon women and men in the military and whether this is the best approach to prepare soldiers for military duty. They suggest that women in the military could benefit from development of educational and preventive measures similar to those from the 1993 Eating Disorders Information and Education Act, which provided information and education about preventing and treating eating disorders.