Body Mass Index and Disordered Eating Behaviors Are Associated with Weight Dissatisfaction in Adolescent and Young Adult Female Military Recruits

Military Medicine, Feb 2008 by Garber, Andrea K, Boyer, Cherrie B, Pollack, Lance M, Chang, Y Jason, Shafer, Mary-Ann

ABSTRACT Objective: To examine factors associated with weight dissatisfaction, a risk factor for eating disorders, among female Marine recruits. Methods: A diverse adolescent/young adult sample of 2,157 female recruits completed a questionnaire upon entering Marine Corps training. Weight dissatisfaction was the main variable of interest. Results: Body mass index (BMI), disordered eating history, and worry about meeting military "weight" were related highly to weight dissatisfaction. Women with BMIs near the upper limit of the Marine Corps weight standard (23.5 kg/m^sup 2^) reported the highest rates of weight dissatisfaction. Those who reported vomiting, binging or pill use, or being worried about "making weight" were four and five times, respectively, more likely to report weight dissatisfaction. Conclusions: New female Marine recruits with higher BMIs, disordered eating histories, and worries about "making weight" are significantly more likely to be weight dissatisfied. Such findings may identify those at risk for developing eating disorders when exposed to strict military weight standards.

INTRODUCTION

Military weight standards have come under increasing scrutiny as the general population in the United States becomes more overweight. A recent study showed that 43% of 17- to 20-year-old adolescent and young women in the general population were over the maximum allowable weight to join the military.1 Based on these findings, the U.S. surgeon general has recognized obesity as a potential threat to national security.2 Among active duty military personnel, overweight is a major problem. In 2002, more than 50% of active duty Air Force personnel were overweight by the standards of the general population, which is a body mass index (BMI) >25 kg/m^sup 2^.3 In a sample of Army soldiers, 40% of women and 60% of men had a BMI >25 kg/m^sup 2^.4 Overweight in the military is associated with performance concerns, increased medical costs, and lost workdays.3 Therefore, military weight standards are still firmly in place and those who fail to meet them may be denied promotion and eventually face separation. This may result in increased pressure on adolescents and young adults who are entering or considering entering the military today, particularly women of racial/ethnic minorities, who are more likely to exceed the upper limit of the current weight standards.1

Studies of active duty military personnel have documented widespread "disordered eating," a wide spectrum of unhealthy dieting practices, including binging, purging, laxative or pill use, and fasting, that worsens around the time of fitness testing or weigh-in.5-9 A recent study by Carlton et al.9 reported high rates of disordered eating behaviors in over 400 active duty Navy men and women: 10% binged at least twice per week (34% binged "at some time"), 5% purged, 18% used laxatives and/or pills, and 25% fasted. These behaviors worsened right before fitness testing and weigh-in: 24% of the total sample reported going on a "crash diet" and 67% of those who had reported purging said they were more likely to do it within 2 months of testing.9 Lauder and colleagues5 have described this phenomenon as a "situational eating disorder," whereby individuals resort to disordered eating behaviors under the stress of "making weight." The Department of Defense has recognized the possibility that weight standards may encourage unhealthy weight control behaviors and compromise performance,10 and an effort is underway to encourage healthy behaviors and create more equitable weight standards for individuals.11

Weight dissatisfaction (a component of body image) is a known risk factor for the development of eating disorders in adolescent and young women12-14 that covaries with other risky health behaviors, including dieting practices, use of alcohol, tobacco, and drugs, and sexual activity.15-17 Studies have demonstrated that overweight adolescents are significantly more dissatisfied with their weight18-20 and are more likely to take extreme measures to control it with diet pills, laxatives, diuretics, or vomiting, as compared to their normal weight counterparts.20 This association holds true for military personnel who are overweight.5-9,21 In fact, being forced into a weight control program has been identified as one of the strongest predictors of disordered eating among military women.8 In one study, women who entered a military weightmanagement program after failing to make weight were two to five times more likely to exhibit purging behaviors than normal-weight military women.21 It is notable, however, that military personnel may fail to "make weight" or perceive themselves to be overweight when they are still normal by the standards of the general population. At the time of the current study, the maximum allowable weight for women in the U.S. Marine Corps was consistent with a BMI of approximately 23.5 kg/m^sup 2^.1 In a study of women in the U.S. Navy, those with a BMI of 23.0 kg/m^sup 2^ began to report heightened worry about failing to make weight.9 Thus, military weight standards effectively lower the bar for "overweight" and may contribute to weight dissatisfaction and disordered eating among individuals who are normal in weight.

Many of the military personnel who are dissatisfied with their weight and engaging in disordered eating behaviors meet the criteria for a full-blown eating disorder. In the civilian population, the prevalence is approximately 1% for anorexia nervosa (AN), 3% for bulimia nervosa (BN), and between 3 and 35% for eating disorder not otherwise specified (EDNOS).22 In comparison, McNulty8 found an overall prevalence of 1.1% for AN, 8.1% for BN, and 62.8% for EDNOS among women in all military branches. Of note, the highest rates occurred among women in the U.S. Marines, who reported AN at 4.9%, BN at 15.9%, and EDNOS at 76.7%.8 Although it is likely that the use of a self-administered questionnaire in this study revealed higher rates than what can be diagnosed clinically in the general population, this study and others6,7 indicate that the prevalence of eating disorders among military personnel is high.