Disordered Eating in the Military

For just over 4 years, I worked as a dietitian for military members (and their families) on one of the largest Marine bases in the world.  I was and am honored to work with this unique and special population.  Just a few months after I started that job, I realized that disordered eating ran rampant among these men and women in uniform. My eating disorder (ED) patient load became so large that I knew that I had to get additional knowledge and training to ensure these folks were getting the best care possible. You see, not all dietitians specialize in eating disorders.  It is a very specialized field of nutrition that requires additional education to ensure competency in treatment.

Unfortunately, there is only outdated and limited research about eating disorder prevalence and treatment in service members. This may be in part because many wouldn’t want to actively admit disordered eating due to the possible consequences.  In my experience, many of those who came forward to seek help were also administratively separated (honorably discharged)- if these service members wanted to continue to serve their country this would be a good reason to keep their mouths shut.  That being said, we do know that military members are six times more likely to have an eating disorder than their civilian counterparts. We also know that Marines are affected more than other branches but likely because they have the most stringent physical fitness tests (PFTs) and weight standards. Don’t get me wrong, though, all of the branches of the military suffer from an increase of disordered eating and eating disorders.

So why the higher numbers in service members? Well, there isn’t great research on that. My professional and personal opinion would point to a multi-factorial cause:

• Trauma – people who have experienced trauma (whether physical, emotional or sexual) in their lives are at a greater risk for developing an eating disorder
• Control – when a person is in the military, they are pretty much owned by the government. They have no control over their day to day lives (at least not like civilians do). The eating disorder could be a way to maintain control in a world where nothing else can be.
• Perfectionism – some have hypothesized that the things that make up a good soldier are the exact same things that can breed eating disorders. Perfectionism is praised in the military – even receiving higher/better evaluations for better fitness scores.
• Body-shaming – in many instances I treated patients who were shamed by their higher-ups. Unfortunately, this is very common. These patients would often be referred to as “fat bodies” (a not so endearing term that military members use to label someone they feel is out of regulations).
• Unrealistic standards – the military measures body fat with the “tape method”- an non-researched and inaccurate measuring of different body parts where those measurements get put into a formula that spit out a certain body fat percentage. Research has shown that this is an inaccurate way to measure body fat when compared with gold standard of DXA or underwater weighing. Unfortunately, being able to use these gold standard methods would be too costly, thus the military continues to measure body fat with the “tape method”.
• Misinformation – many military members look to their recruiters (prior to joining) or their chain of command to see how to get into shape and/or lose weight. Disordered eating methods are so prevalent, unfortunately, because many of these folks have experience with trying to cut weight fast for a weigh-in. (Remember if standards aren’t met, they’ll get kicked out of the military).

As previously noted, I think that there are many reasons that military members are at higher risk and have a higher prevalence for ED. The real concern, however, is the need for these patients to get the specialized care for their eating disorder. Often, patients are sent to the closest dietitian or therapist when he/she may not be the most appropriate in treating the disorder.  If you are a service member, or know someone who is who suffers from ED, remember to advocate for your health; find a local specialist in disordered eating so that you can get the best treatment possible.

Sarah Voegtle, MS, RD, CSSD, LDN is a registered dietitian specializing in eating disorder and sports nutrition. If you’re ready to get specialized treatment and any nutrition needs, contact Chrysalis Center at (910) 790-9500 to schedule your initial appointment with Sarah.