The nature and culture of military life increase the risk.
Most VA medical centers do not regularly screen patients for eating disorders, even though increased access to care for individuals with EDs is particularly relevant to veterans, according to J.C. Huston and colleagues at the National Center for PTSD at the VA Boston Healthcare System in Boston (Int J Eat Disord. 2018;doi: 10.1002/eat.22885). However, this recent paper examining health care use among veterans with EDs is one sign that EDs are receiving more attention in the VA setting.
The authors call attention to aspects of military life, which includes strict weight and fitness requirements, exposure to combat, and military sexual trauma, may increase the risk of developing eating disorders among men and women veterans. The authors hypothesized that female veterans with eating disorders would report greater health care utilization and worse quality of life than would female veterans without eating disorders.
A sample pool of 700 randomly selected female veterans was recruited from a larger sample of randomly selected female veterans 18 years of age or older in New England (10,840 women in fiscal year 2011). Study participants were drawn from the Veterans Healthcare Administration (VHA) Corporate Date Warehouse, which has names and addresses taken from VHA electronic files. From this group, 581 veterans could be located and received a survey and 198 (28.2%) completed the study.
Surveys were mailed to all potential participants between February and April 2013. The participants completed a number of questionnaires, including the Eating Disorder Diagnostic Scale, a 21-item scale used to measure a range of ED symptoms. The study looked at participants’ use of healthcare services during the past 12 months, using data from the National Survey of Veterans, 2010. Other instruments included the CES-D for depression and the Post-Traumatic Stress Disorder Checklist-Civilian, which measures the frequency of DSM-IV PTSD events during the past 30 days.
About 10% had ED symptoms
Many participants in the study—10.6%–met criteria for probable AN, BN, or BED. The authors found that the average frequency of VA medical care visits was higher in those with EDs. Use of substance use disorder services was also higher in those with EDs.
The frequent use of VA mental health and substance abuse services observed among women with probable ED underscores the need for ED screening in the VA setting. While the VA healthcare system provides extensive mental health services and treats obesity, effective ED treatment is also clearly needed.