Since returning from Iraq a veteran fights the same battle every night. Once his wife and kids go to sleep, he finds it difficult to control how many chips, cookies and beers he consumes before hiding evidence of this behavior and not falling asleep until long after midnight. The next morning the veteran feels depressed and guilty, and is resolved not to do it again. In an attempt to compensate for the weight he's gained, and the previous night's caloric intake, he skips breakfast and lunch. But later that night he begins feeling irritable again, overwhelmed by intrusive memories that make it difficult to sleep. Alone with his thoughts, his binge eating and drinking cycle starts again.
With new research making inroads in hot-button issues such as suicide prevention and military sexual trauma, why should we care about eating disorders in veterans? Because binge eating disorder (BED), officially recognized as the most prevalent eating disorder in the U.S., may disproportionately affect our military servicemen and women, exacting a heavy toll on their physical and mental health, and placing a financial burden on our health care system.
Indulging in food is a staple of American culture, such that individuals who binge eat often don't realize their regular overeating behavior coupled with feelings of being out of control, is linked to an eating disorder. They're not alone. BED has only recently been included in the May 2013 release of the official "rule-book" for mental health diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). While we know being overweight significantly increases the likelihood of a range of diseases from heart disease to cancer, those who binge eat are even more at risk, acting as a vulnerable subgroup of the overweight population.
As many as 30 percent of overweight Americans who seek weight-loss treatment are affected by BED, making it more prevalent than both anorexia and bulimia combined. New data show that the rate of BED in the veteran population is similar to the civilian population, but that very high rates of eating symptoms are present even in those not fully meeting the diagnosis. Another recent study of over 45,000 veterans seeking weight loss treatment through the Veterans Health Administration (VHA) found that over 78 percent of veterans report binge eating behavior. Just engaging in the behavior, regardless of the full diagnosis, is related to health problems. Comparisons of overweight veterans who do and do not engage in binge eating behavior show that the former have an approximately 60 percent greater chance of having type 2 diabetes.
For veterans, who are more likely to be overweight and to binge eat than most Americans, the findings mean they are even more at risk for life threatening conditions. The same study cited above found that veterans affected by overweight or obesity were more likely not only to have type 2 diabetes, but were more likely to have coronary artery disease, hypertension and high cholesterol. They were more likely to have substance abuse problems and to suffer from mental health issues such as depression, anxiety, PTSD, obsessive compulsive disorder, bipolar disorder and schizophrenia. Binge eating also makes it more likely that weight loss attempts will be less successful.
As the veteran population ages and increasingly develops medical conditions that require care, the cost will extend beyond these individuals and their families to our health care system. Already, the estimated total U.S. economic cost of direct medical care for diabetes alone in 2012 was $176 billion, a 41 percent increase from the last study in 2007. As veterans from Iraq and Afghanistan age, it isn't hard to imagine an even sharper increase in the coming years.
While many of the health effects of binge eating on veterans are similar to what has been found in civilian populations, it is clear that the disorder doesn't affect them exactly the same. With little research done on eating behavior in veterans, we have yet to understand why there are such high rates of binge eating in this population. It is also unclear why male veterans are more likely to binge eat than female veterans when sex differences are consistently reverse in civilian populations.
There is some hope. We do know that a range of behavioral, medical and self-help interventions have proven effective not just for reducing and eliminating binge eating, but also for improving health outcomes. But without further research and investment in understanding and treating binge eating, our veterans will continue to be at high risk.
Given how promising the potential treatments are, it is well worth investing in this area of research to improve the health of veterans.
The opinions expressed are those of the author and not of the Veterans Health Administration, and any similarities to real individuals are coincidental.
If you're struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.