Little is known about eating disorder screening, diagnosis, and treatment beyond specialized clinics and settings designed primarily for adolescents and young adults. Procedures to address eating disorders are lacking in United States healthcare systems.
Researchers at Yale School of Medicine, University of California San Francisco, and the U.S. Department of Veterans Affairs interviewed U.S. military veterans to obtain perspectives on how this is done in general healthcare settings.
The military and veteran population has become an important population for understanding eating disorders given their heightened risk. Trauma exposure and the need to meet stringent military weight criteria are just two of the reasons for this increased risk.
Veterans with an existing eating disorder diagnosis in their electronic medical record were invited to be interviewed as a part of the study. Patients often self-diagnosed their eating disorder before discussing it with a provider. Most individuals reported that they themselves, as well as their providers, had difficulty distinguishing between struggles with eating from weight.
It is unsurprising then that a large portion were referred for weight loss or weight management services rather than for eating disorder treatment. This often led to feelings of being misunderstood or stigmatized. Weight stigma is particularly prevalent in healthcare settings and is related to poor medical care and outcomes, and weight gain.
Eating disorders among adults is rarely considered because of the high association with overweight and obesity. Unlike non-veteran eating disorder samples studied, the median veteran age of men was 65 years and of women was 51 years, in 2017.
“Onset of psychiatric illnesses such as depression and anxiety, and addictive behaviors such as smoking typically begin or show signs in adolescence. We don’t think of these as conditions that don’t exist in adulthood the way we do with eating disorders,” said Robin M. Masheb, PhD, professor of psychiatry and director of the Veterans Initiative for Eating and Weight at the VA Connecticut Healthcare System in West Haven.
Masheb is first author of the paper, published in the International Journal of Eating Disorders.
Many veterans who participated in the study supported eating disorder screening and felt that therapy, and especially group support, could be beneficial but needed to be accessible.
The Veterans Health Administration (VHA) is the largest healthcare system in the U.S. with robust weight management and nutrition services. Masheb said the researchers hope the new findings will help educate shareholders on the importance of addressing eating disorders, and other related problems such as food insecurity, to improve care and reduce healthcare weight stigma.