“This country has not seen and probably will never know the true level of sacrifice of our veterans.” – Thomas M. Smith
Those who serve in the military do more for our country than most of us will ever fully comprehend. Veterans Day offers an opportunity to honor and give thanks to those who have served our country. It also provides an opportunity to highlight the voice, perspective and experiences of military servicemembers. At Reasons, we would like to shed light specifically on the issue of eating disorders in military communities.
Due in part to advocacy from the Eating Disorders Coalition (EDC) and more than 30 bipartisan government representatives, the Government Accountability Office (GAO) recently released a new report: “Department of Defense: Eating Disorders in the Military.” This report examines how the Department of Defense handles eating disorders screening, prevention and treatment within the TRICARE® health insurance program offered to military members and their beneficiaries. As a TRICARE® eating disorders treatment provider, Reasons is encouraged to see increased attention around the issue of eating disorder screening, prevention and treatment in the military and wanted to share a few key pieces of information from the report.
Prior to enlisting, each potential servicemember receives a mental health screening as part of their medical qualification process. Military members also receive pre- and post-deployment health assessments and annual health screenings. However, these screenings may miss critical cues and signs of an eating disorder among those who are enlisting or serving.
For example, post-deployment and annual health assessments include screenings for symptoms of post-traumatic stress disorder, but do not include specific assessments for eating disorders. Yet eating disorders often co-occur with post-traumatic stress disorder and other mental health issues. Data from the National Institute of Mental Health indicates that more than 50 percent of individuals with anorexia have a co-occurring disorder, more than 90 percent of individuals with bulimia have a co-occurring disorder, and more than 75 percent of individuals with binge eating disorder have a co-occurring disorder. Given these statistics, we believe that eating disorder screening and assessment is a crucial consideration for servicemembers.
The GAO’s report also illustrates room for improvement in the diagnosis of eating disorders within the Department of Defense. While the Department of Defense medical professionals do screen for physical signs of eating disorders, such as weight loss, vital changes, and loss of menstruation among females, to name a few, physical signs and symptoms are only a portion of the picture of an eating disorder diagnosis. Some eating disorders can be entirely invisible from a physical point of view. A complete eating disorder assessment must consider physical and mental health simultaneously.
We believe that the lack of comprehensive diagnostic tools exacerbates the underreporting of eating disorders among servicemembers. According to a 2018 report by the Department of Defense, only 1,738 servicemembers, or 0.13% of the active duty servicemember population, received an eating disorder diagnosis between 2013 and 2017. But, statistics within the eating disorder treatment community approximate that 10-15% of all Americans suffer from some type of serious eating disorder. The disparity between these statistics is emblematic of how far we have yet to go in effectively diagnosing and treating eating disorders within military populations.
Beyond gaps in screening and diagnosis, unfortunately, many gaps also exist in the realm of eating disorders treatment. According to the EDC, there are only 79 facilities in 20 states that are in-network with TRICARE®, and only 58 of in-network eating disorder treatment facilities serve adult patients. While Reasons is honored and proud to be a TRICARE® provider, these figures illustrate a significant lack of treatment options available to those who serve and their families.
Our servicemembers sacrifice so much on behalf of our country. They should not also have to sacrifice healing from an eating disorder. This Veterans Day, we urge you to not only honor the servicemembers in your life, but to look upon them with fresh eyes. How can you support those you love, who have sacrificed so much on behalf of our country? How can you remain vigilant in observing and supporting their health and wellness? Remember to keep eating disorders in mind and look for the signs and symptoms. And, if you or a loved one are struggling, please reach out to us for help. We are committed to serving those who serve.