Disordered Eating Behaviors and Associated Behavioral Health Diagnoses in Active-Duty Soldiers: A Comparison by Army Body Composition Program Class Attendance
Jake L Walsh, Emily B Raab, Jordan M Armstrong, Joetta M Khan, Susan Stankorb, Paul Rosbrook, Priscilla L Rumph, Nissa Fuller, Maria J Stukenborg, William R ConkrightAbstract
Introduction
Biannual body composition assessments and the pressure to maintain a “Soldierly appearance” have been identified as aspects of military service that may contribute to the development of disordered eating behaviors (DEB) among Soldiers. DEB encompass a spectrum of problematic eating behaviors and distorted attitudes toward food, weight, body shape, and appearance. These behaviors are multifactorial and are linked to behavioral health diagnoses (BHD), including depression, anxiety, and post-traumatic stress disorder, which are prevalent among Soldiers. Soldiers failing to meet body composition standards are enrolled in the Army Body Composition Program (ABCP), which exposes them to more frequent body composition testing and can negatively affect career progression. DEB are associated with adverse health outcomes, such as low bone mineral density and decreased cognition. While research exists for DEB prevalence among active-duty service members and veterans, to our knowledge, no studies have examined the relationship between participation in ABCP-related classes, DEB, and BHD. This study aimed to (1) describe the prevalence of DEB, (2) investigate the association between DEB and attendance at ABCP-related nutrition classes, and (3) examine the link between BHD and DEB among active-duty Soldiers.
Materials and Methods
From February 2021 through March 2024, data were collected from 1,047 active-duty U.S. Army Soldiers stationed at Joint Base Lewis-McChord, WA. Participants were included if they were military-aged (17-64 years) and had completed the Eating Disorder Examination Questionnaire-Short (EDE-QS). DEB presence was defined as an EDE-QS score of 15 or higher, indicating risk of probable eating disorder. ABCP cohort assignment was used as a proxy for presumed enrollment and was defined by attendance at ABCP-specific nutrition classes. Behavioral health and eating disorder diagnoses were extracted from medical records. Missing demographic data were addressed using Multiple Imputation by Chained Equations (MICE). Univariate and multivariable logistic regression analyses were used to examine associations between DEB, ABCP-related class attendance, and BHD. Statistical significance was set at P < .05.
Results
The final sample included 1,047 Soldiers who were 58% male (n = 616) and 74% White (n = 775), with an average age of 25.8 ± 5.9 years. A total of 38.9% of participants had an EDE-QS score of ≥15. Soldiers attending ABCP-related classes had significantly higher EDE-QS scores (16.1 ± 6.9) compared to those not attending (7.2 ± 7.3) (P < .001). In unadjusted univariate models, diagnosed anxiety (OR: 1.96) and depression (OR: 2.29) significantly increased the odds of DEB. However, after adjusting for demographic and clinical covariates using pooled imputed data, only diagnosed anxiety (OR: 1.74; 95% CI: 1.20-2.54) and increased age (OR: 1.03; 95% CI: 1.01-1.05) remained significant independent predictors of DEB presence.
Conclusion
This study highlights significant associations between ABCP-related class attendance, anxiety, and DEB among active-duty Soldiers. These findings underscore the need for education, training, and screening for the prevention, early identification, and treatment of DEB in Soldiers. Future longitudinal research tracking Soldiers before, during, and after ABCP enrollment is needed to clarify the impact of body composition policies and inform future Army weight-management programs.