Download Veterans and Binge Eating Disorder

Veterans and Binge Eating Disorder
According to the National Eating Disorders Association, binge eating disorder (BED) is
the most common eating disorder in the United Sates (US). In the general population of
individuals who are overweight or obese, approximately 30% of those seeking care for
weight management are diagnosed with BED, and most are female. Although the topic
has not been extensively researched in the veteran population, binge eating disorder
appears to impact a disproportionate number of US veterans, with some studies
showing that in veterans who are overweight or obese, nearly three-quarters, mostly
male, suffer from binge eating disorder.
Binge eating is defined as eating unusually large amounts of food, while experiencing a
subjective sense of loss of control, on average at least once a week for three months or
more. Those with BED are at greater risk for obesity-related illnesses than individuals
with overweight or obesity alone. In addition to obesity, major risk factors for BED
include a history of post-traumatic stress disorder (PTSD), and depression, and all of
these are prevalent in the veteran population.
Research findings
Statistics from the Veterans Health Administration (VHA) suggest that 77% of veterans
are classified as either overweight or obese. Researchers of a study on 481 veterans
who participated in two VHA weight management programs, ASPIRE and MOVE!, found
that 78% reported binge eating. Of these, 6% reported binge-eating five or more times
each week, while 77% reported binge-eating less than one time to up to four times each
week. Study participants were mostly older, male, and overweight or obese. The
researchers in this study noted that participants with high-frequency binge-eating had
worse weight loss outcomes, with those in the no binge-eating group experiencing
almost twice the weight loss and waist measurement compared to the high binge-eating
group.
A much larger study of more than 45 000 overweight or obese veterans found similar
results, with 78% of participants classified as “clinically meaningful binge eaters,” with
two or more binge eating episodes per week. The prevalence of binge eating was higher
for men (79%) than women (76%).
In this same study, Higgins, et al, also examined physical and mental health
comorbidities, and determined that binge eating behavior is more prevalent in those
veterans who also had diabetes and cardiovascular disease, as well as anxiety and
depression. Clinically meaningful binge eating was also associated with behavioral
conditions such as substance abuse, obsessive-compulsive disorder, and schizophrenia.
In addition, PTSD was associated with clinically meaningful binge eating, both in this
study, and another 2015 study on binge eating in US Iraq and Afghanistan veterans.
Weight management risk factors
Military personnel, including veterans, may have a wide range of calorie needs,
depending on the job requirements and status in their career. While studies show that
military personnel meet the recommended guidelines for physical activity, many do not
reach the recommendations for fruits, vegetables, and whole grains. Over time, because
of a less than ideal diet, and as their physical activity declines, these individuals may be
more likely to gain weight.
Other reasons for the common finding of overweight and obesity in veterans include: a
lack of lower calorie options available at workplace cafeterias or mess halls;
socioeconomic factors which encourage purchasing lower cost fast food meals, rather
than often more costly whole foods; the need to often eat on the run; and stress eating
which can be related to work responsibilities, deployment, or a permanent change of
station.
Recommendations for registered dietitian nutritionists
Given the large number of veterans who report episodes of binge eating, registered
dietitian nutritionists (RDNs) should be aware of the risk when counseling veterans for
weight management issues. Patient screening should include:
 Body mass index (BMI) assessment, since higher BMIs are associated with BED
 Review of any obesity-related diseases, especially cardiovascular disease and
diabetes, which may be poorly controlled due to BED
 History of any behavioral health issues, especially depression, anxiety, and PTSD
 A thorough diet history which includes questions about general meal time
patterns and food choices, as well as any binge eating patterns
Those veterans who are at greater risk may benefit from an individualized multispecialty
approach to weight management. Ideally, this would include a therapist to address any
behavioral health issues, as well as the RDN to assist the patient in planning structured
and balanced meals and to address other strategies to prevent and manage BED
triggers.
References and recommended reading
Higgins DM, Dorflinger L, MacGregor KL, Heapy AA, Goulet JL, Ruser C. Binge eating
behavior among a national sample of overweight and obese veterans. Obesity.
2013;21(5):900-903. Doi:10.1002/oby.20160.
Hoerster KD, Jakupcak M, Hanson R, et al. PTSD and depression symptoms are
associated with binge eating among US Iraq and Afghanistan veterans. Eat Behav.
2015;17:115-118. doi:10.1016/j.eatbeh.2015.01.005.
Hooks, A. Overweight in the military: causes and effects. Johnson & Wales University
website.
http://scholarsarchive.jwu.edu/cgi/viewcontent.cgi?article=1030&context=ac_symposiu
m. Published 2015. Accessed October 21, 2015.
Masheb RM, Lutes LD, Kim MH, et al. High‐frequency binge eating predicts weight gain
among veterans receiving behavioral weight loss treatments. Obesity. 2015;23(1):54-61.
Doi10.1002/oby.20931.
Smith TJ, Dotson LE, Young AJ, et al. Eating patterns and leisure-time exercise among
active duty military personnel: comparison to the healthy people objectives. J Acad Nutr
Diet. 2013;113(7):907-919. doi:http://dx.doi.org/10.1016/j.jand.2013.03.002.
Contributed by Anne Danahy, MS, RDN
Review date: 10/17/15