Part 3: The Intersection of the US Military and Eating Disorders

ByLauren Harrison

Part 3: Evolving Frameworks in the Field

In Part 2, we connected the body standards to eating disorders and reviewed the alarming rates of disordered behaviors in military service members in an attempt to meet the set standards. Early on, the research has given us many clues as to why the standards in place might not be working. In 1992, Jones and colleagues examined the relationship between percent body fat and performance and injury rates amongst soldiers. It was found that increased fitness (as defined by meeting standards for 1-2 mile runs, sit-ups, and push ups) was associated with higher BMIs. In 1994, Sharp and colleagues found that women who failed the body composition standards performed significantly better in physical strength tests, and the highest rates of injuries occured in the leaner groups of women.

As early as 1989, Blair and colleagues found that the least physically fit individuals fell in the leanest and lowest BMI categories. Lee and colleagues found in 1999 that the leanest individuals in their study had the highest mortality rates, whereas those who fell into the ‘obese’ category of the BMI standard had lower mortality rates.

What is the response?

The effects of these sometimes impossible standards on service members have been noticed, and have sparked reevaluation. Effective in January 2023, the Marines will raise the allowed body fat percentage by 1% for female Marines. While this is a start in the administration acknowledging the impracticalities of their policies, there is still work to be done across all branches of the military.

In 2021, the SERVE Act (Supporting Eating Disorders Recovery Through Vital Expansion) was passed into law in order to expand treatment option availability to military personnel and dependents. Some highlights of this act include expanding the age limit to allow active-duty military spouses and children to receive higher levels of treatment for eating disorders and a new requirement for the Department of Defense to issue guidance and policies to aid in identifying and treating military service members with eating disorders. Read more about the act here.

TRICARE, the U.S. military’s healthcare program, is difficult for eating disorder treatment centers and providers to contract with due to obscure requirements and low reimbursement rates. This leads to a lack of options for eating disorder treatment for military members and dependents. A 2020 report by the Government Accountability Office (GAO) highlights the difficult process of accessing care for eating disorder treatment within military families and provides a list of the known treatment facilities that are authorized by TRICARE, which only includes 166 facilities located in 32 states across the country. The Eating Disorders Coalition (EDC) reviewed this report and found errors within the list of facilities–stating that TRICARE only authorizes about 35% of the 365 eating disorder treatment facilities in the United States, and only 21% are in-network. Nonetheless, with the already minimal amount of resources available for eating disorder help for military families with TRICARE, this resource can serve as a helpful starting point.

The Department of Veterans Affairs recognizes the prevalence of eating disorders within the military and offers disability benefits for those affected. To read more about the process of receiving reimbursement, click here.

What can we do?

End the stigma. We can all do the internal work to notice the harm that occurs when we relate body size and weight to health and well being, and acknowledge our own biases that occur about these topics.

Know the resources. Check out the embedded hyperlinks to access more information for treatment options and reimbursement if you or a loved one has or has recovered from an eating disorder in the military. Click here for more help finding treatment professionals according to insurance and location. There are also media resources intended to provide support, like @militaryeatingrecovery and @marinewit1775 on Instagram.

Ask for help. Know you are not alone. This series has aimed to highlight the unfortunate and very high number of eating disorders that occur within the military, as well as the movements in place and professionals that are equipped to assist those who serve our country. The more we talk about this issue, the better we can identify, prevent, and treat eating disorders amongst military members and beyond.3.

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References

  1. Artz, N. (2021, June 8). Diet culture: Definition, examples, & impacts. Choosing Therapy. Retrieved October 22, 2022, from https://www.choosingtherapy.com/diet-culture/
  2. Bartlett, B. A., & Mitchell, K. S. (2015, December). Eating disorders in military and veteran men and women: A systematic review. The International journal of eating disorders. Retrieved September 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/26310193/
  3. Bodell, L., Forney, K. J., Keel, P., Gutierrez, P., & Joiner, T. E. (2014, December). Consequences of making weight: A review of eating disorder symptoms and diagnoses in the United States military. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association. Retrieved September 26, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309979/
  4. Disabled Vets. (2021, March 24). Eating disorders veterans benefits. Disabled Vets. Retrieved October 23, 2022, from https://www.disabledvets.com/claim-types/mental-impairments/eating-disorders/
  5. Elisa. (2022, March 13). 8 reasons why BMI doesn’t Reflect Health. Follow the Intuition. Retrieved September 10, 2022, from https://followtheintuition.com/8-reasons-why-bmi-doesnt-reflect-health/
  6. Huck, E. (2020, December 22). Military families experience eating disorders, too. National Military Family Association. Retrieved October 26, 2022, from https://www.militaryfamily.org/military-families-experience-eating-disorders-too/#:~:text=However%2C%20TRICARE’s%20low%20reimbursement%20rates,offering%20treatment%20for%20eating%20disorders.
  7. Institute of Medicine (US) Subcommittee on Military Weight Management. (2004). Weight management: State of the science and opportunities for military programs. National Academies Press.
  8. McNulty, P. A. (2001, January). Prevalence and contributing factors of eating disorder behaviors in active duty service women in the Army, Navy, Air Force, and Marines. Military medicine. Retrieved September 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/11197099/
  9. National Alliance for Eating Disorders. (2022). The National Alliance for Eating Disorders. Retrieved October 24, 2022, from https://findedhelp.com/
  10. National Eating Disorders Association. (2019, August 22). Eating disorder statistics. National Eating Disorders Association. Retrieved September 10, 2022, from https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/statistics
  11. REDC. (2020). Serve Act (S. 2673/H.R. 2767). REDC . SASC/HASC. Retrieved September 2022, from http://redcconsortium.org/wp-content/uploads/2020/09/serve-infographic_house-senate-final.pdf.
  12. Touma, D. A., Quinn, M. E., Freeman, V. E., & Meyer, E. G. (2022, July 5). Eating disorders in U.S. active duty military members and Veterans: A Systematic Review. Military medicine. Retrieved September 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/35788384/
  13. United States Government Accountability Office, Congressional Requesters: Department of Defense: Eating Disorders in the Military1–28 (2020). Washington, DC; GAO.

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