1
|
Troncoso MR, Wilson C, Scott J, Deuster PA. US Navy Sailors Modify Their Eating Behaviors to Pass Cyclic Physical Readiness Tests. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:611-621. [PMID: 38944798 DOI: 10.1016/j.jneb.2024.05.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE Investigate the influence of physical readiness tests (PRTs) on eating behaviors among US Navy Sailors. DESIGN Focused ethnography using interviews and military policies. SETTING Three US Naval installations. PARTICIPANTS Active-duty enlisted Sailors (n = 32). PHENOMENON OF INTEREST Eating behaviors. ANALYSIS Authors analyzed data iteratively with data collection using domain, taxonomy, and thematic analysis to identify culturally relevant codes, domains, and themes. RESULTS Five themes corresponded with PRT timing and Sailors' perceived ability to meet standards: (1) maintain usual eating habits, (2) get ready and switch it up, (3) make weight-damage control, (4) return to baseline-PRT is over, and (5) eat whatever-PRT is canceled. In contrast to the PRT policy's goal for Sailors to maintain standards and a healthy lifestyle, many Sailors modified their usual eating behaviors to pass the test. CONCLUSION AND IMPLICATIONS Changes in eating behaviors during PRT cycles highlight a culture of getting ready vs staying ready, suggesting many Sailors do not eat a nutrient-dense diet to maintain the minimum physical fitness and body composition standards. There is a need for nutrition education for healthy weight maintenance, weight gain prevention, and healthy weight loss among military personnel.
Collapse
Affiliation(s)
| | - Candy Wilson
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL
| | - Jonathan Scott
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
2
|
Chen Y, Christensen Pacella KA, Forbush KT, Thomeczek ML, Negi S, Doan AE, Wendler AM, Morgan RW, Rasheed SI, Johnson-Munguia S, Sharma AR. Examining associations between disordered eating and harmful substance use in a nationally representative sample of US veterans. Int J Eat Disord 2024; 57:1542-1554. [PMID: 38469980 DOI: 10.1002/eat.24194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The association between eating disorders (EDs) and harmful substance use (substance use that causes psychosocial impairment) is well recognized in the literature, and military veterans may be at heightened risk for both issues due to deployment-related stressors. However, little is known about which ED-related symptoms are associated with harmful substance use in veterans, and whether gender plays a differential role in this relationship. Our aims were to: (1) examine gender differences in ED-related symptoms; and (2) examine whether ED-related symptoms differentially predict harmful substance use in US veteran men and women who had recently separated from service. METHOD This study was based on a nationally representative four-wave longitudinal sample of post-9/11 veterans (N = 835; 61.2% female). Longitudinal mixed modeling was used to test whether specific ED-related behaviors at baseline predicted harmful substance use at follow-ups. RESULTS We replicated gendered patterns of ED-related symptoms observed in civilian populations, wherein men had higher weight-and-body-related concerns (including excessive exercise and muscle building) and negative attitude toward obesity, and women had higher bulimic and restricting symptoms. For women, alcohol, drug, and marijuana problems were predicted by higher bulimic symptoms, whereas for men, these problems were predicted by higher restricting symptoms. CONCLUSION Gender played a differential role in the relationship between EDs and harmful substance use. Bulimic symptoms were the most robust predictor for harmful substance use among veteran women, whereas restricting was the most robust predictor for harmful substance use among veteran men. PUBLIC SIGNIFICANCE The current study found that veteran women had higher bulimic symptoms (characterized by binge eating and purging) and restricting than veteran men. In women, bulimic symptoms predicted future harmful use of alcohol, marijuana, and other drugs. In contrast, veteran men had higher weight-and-body-related concerns (characterized by excessive exercise and muscle building) than veteran women. In men, restricting symptoms predicted future harmful use of alcohol, marijuana, and other drugs.
Collapse
Affiliation(s)
- Yiyang Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Sonakshi Negi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Alesha E Doan
- Department of Women, Gender, and Sexuality Studies, University of Kansas, Lawrence, Kansas, USA
- School of Public Affairs and Administration, University of Kansas, Lawrence, Kansas, USA
| | | | - R William Morgan
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Samiya I Rasheed
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Anjali R Sharma
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| |
Collapse
|
3
|
Herb Neff KM, Buta E, Fenn LM, Ramsey CN, Snow JL, Haskell SG, Masheb RM. Distinguishing probable atypical anorexia nervosa from weight loss alone in a national sample of U.S. Military Veterans: Disentangling the roles of weight suppression and cognitive concerns. Int J Eat Disord 2024; 57:827-838. [PMID: 38129986 DOI: 10.1002/eat.24116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Veterans are at high risk for eating disorders (EDs), and specifically for atypical anorexia nervosa (atypical AN). The current study aimed to better understand this under-studied disorder and how it differs from weight loss without ED cognitive features. METHOD Secondary analyses were conducted with data from a national study of Veterans (N = 882, 49.4% women). Participants were categorized into four mutually exclusive groups using the Eating Disorder Diagnostic Scale 5: probable atypical AN, a cognitive concerns group (Cog Only), a weight suppressed group (WS Only), and a no ED control group. Adjusted regression models were used to compare groups on measures of eating pathology and mental health. Three weight suppression thresholds (5%, 10%, and 15%) for probable atypical AN were also tested. RESULTS The sample was comprised of 12% probable atypical AN, 23.6% Cog Only, 16.3% WS Only, and 48.1% Control. The probable atypical AN group was most like the Cog Only group except for higher levels of dietary restraint. Atypical AN fared worse and was least like the Control group followed by the WS Only group. All weight suppression thresholds significantly predicted dietary restraint, with 5% being the best predictor. DISCUSSION Results found that probable atypical AN is a distinct clinical entity and that the exact weight suppression threshold associated with atypical AN is less important than having any weight suppression. Findings highlight the clinical significance of atypical AN and the importance of gaining a better understanding of how to address this clinical entity. PUBLIC SIGNIFICANCE Atypical anorexia nervosa is a relatively underexamined but highly prevalent eating disorder in the Veteran population. Results show that ED cognitive features are more closely linked to clinically significant eating pathology and poor mental health than weight suppression alone suggesting that negative thinking about weight gain and appearance, regardless of the presence or severity of weight loss, may signal the need for specialized intervention.
Collapse
Affiliation(s)
| | - Eugenia Buta
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Lindsay M Fenn
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Christine N Ramsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
- University of Texas at Austin, Austin, Texas, USA
| | - Jennifer L Snow
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
4
|
Heissel JA, Healy OJ, Burke O, Lopez C. Standing Tall: Do Height-Based Accountability Incentives Predict Artificial Increases in Measured Height Among Sailors in the U.S. Military? Mil Med 2024; 189:e259-e266. [PMID: 37540569 DOI: 10.1093/milmed/usad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION The objective of this study was to investigate the changes in men's and women's measured height in response to weight gain above standards for the U.S. Navy and to quantify associated distortions in body mass index (BMI). We expected that some servicemembers would manipulate their measured height to comply with service standards. MATERIALS AND METHODS The study was a retrospective observational study. The data were housed in the Person-Event Data Environment, an individual-level administrative registry from the United States Department of Defense. All participants were active-duty U.S. Navy sailors aged 21-50 during the years 2010-2019. The main outcomes were height and weight as recorded during twice-yearly physical fitness assessments and BMI calculated as: height in pounds × 703/(height in inches)2. We assessed whether weight gain above standards was associated with an increase in height at the subsequent height-weight assessment. RESULTS Among the 489,020 sailors, individuals were nearly 1.5 times as likely to measure taller when they gained weight that put them above military height-weight standards as compared to those who continued to remain within standards. Men were more often out of standards and therefore their measured height increased during subsequent assessments more often than women. Increases in height depressed measures of BMI slightly. CONCLUSIONS Among U.S. sailors, taller height was correlated with surpassing height-based weight limits, where taller individuals were allowed to weigh more and still meet professional weight standards. Results underscore that current height-weight accountability standards may distort behavior, leading servicemembers to manipulate measurements rather than improve job-relevant fitness. Instead, greater reliance on fitness-based measures of health, such as fitness tests, may hold promise for upholding servicemember readiness. Our results highlight that when stakes are attached to a measure, individuals may work to raise their performance using strategies that are misaligned with the policy intent.
Collapse
Affiliation(s)
- Jennifer A Heissel
- Department of Defense Management, Naval Postgraduate School, Monterey, CA 93908, USA
- IZA Institute of Labor Economics, Bonn 53113, Germany
| | - Olivia J Healy
- School of Public Policy, Jeb E. Brooks School of Public Policy, Ithaca, NY 14850, USA
| | - Ollieanna Burke
- Manpower, Personnel, and Training, U.S. Navy, Arlington, VA 22203, USA
| | - Cristina Lopez
- Combat Development and Integration, U.S. Marine Corps, Quantico, VA 22134, USA
| |
Collapse
|
5
|
Touma DA, Quinn ME, Freeman VE, Meyer EG. Eating Disorders in U.S. Active Duty Military Members and Veterans: A Systematic Review. Mil Med 2023; 188:1637-1648. [PMID: 35788384 DOI: 10.1093/milmed/usac180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Feeding and eating disorders can be difficult to treat and frequently co-occur with other mental health conditions. The last systematic review of eating disorders in a military and veteran population was published in 2015. An updated review is warranted to re-examine the current literature on eating disorders in the active duty and veteran populations. MATERIALS AND METHODS A systematic review that described the prevalence, co-occurrence of other disorders and/or events, and health care utilization of U.S. active duty members and veterans was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases and Medical Subject Headings (MeSH) terms used are listed in Appendix A. Each category of the literature was extracted and graded using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Twenty-one studies revealed prevalence estimates with varying rates based on demographic information. Trauma exposure is consistently associated with eating disorder development. Individuals diagnosed with eating disorders had greater health care utilization. CONCLUSIONS Research on eating disorders in the military and veteran populations has expanded in recent years. Limitations of the evidence included in this review stem from the use of self-reported questionnaires, changes to medical record systems, and limited generalizability to the overall population of patients with eating disorders. Further research should investigate the impact of demographic factors and trauma exposure on the development of an eating disorder within the military and veteran populations.
Collapse
Affiliation(s)
- Danielle A Touma
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
| | - Meghan E Quinn
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Vanessa E Freeman
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Eric G Meyer
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
| |
Collapse
|
6
|
Boutelle KN, Afari N, Obayashi S, Eichen DM, Strong DR, Peterson CB. Design of the CHARGE study: A randomized control trial evaluating a novel treatment for Veterans with binge eating disorder and overweight and obesity. Contemp Clin Trials 2023; 130:107234. [PMID: 37210072 PMCID: PMC10409628 DOI: 10.1016/j.cct.2023.107234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023]
Abstract
A large number of Veterans experience binge eating and overweight or obesity, which are associated with significant health and psychological consequences. The gold-standard program for the treatment of binge eating, Cognitive Behavioral Therapy (CBT), results in decreases in binge eating frequency but does not result in significant weight loss. We developed the Regulation of Cues (ROC) program to reduce overeating and binge eating through improvement in sensitivity to appetitive cues and decreased responsivity to external cues, an approach that has never been tested among Veterans. In this study, we combined ROC with energy restriction recommendations from behavioral weight loss (ROC+). This study is a 2-arm randomized controlled trial designed to evaluate the feasibility and acceptability of ROC+, and to compare the efficacy of ROC+ and CBT on reduction of binge eating, weight, and energy intake over 5-months of treatment and 6-month follow-up. Study recruitment completed in March 2022. One hundred and twenty-nine Veterans were randomized (mean age = 47.10 (sd = 11.3) years; 41% female, mean BMI = 34.8 (sd = 4.7); 33% Hispanic) and assessments were conducted at baseline, during treatment and at post-treatment. The final 6-month follow-ups will be completed in April 2023. Targeting novel mechanisms including sensitivity to internal cures and responsivity to external cues is critically important to improve binge eating and weight-loss programs among Veterans. Clinicaltrials.govNCT03678766.
Collapse
Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Niloofar Afari
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
| | - Saori Obayashi
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, F282/2A West 2450 Riverside Ave, Minneapolis, MN 55454, USA
| |
Collapse
|
7
|
Troncoso MR, Wilson C, Scott JM, Deuster PA. Exploring Influences of Eating Behaviors Among Emerging Adults in the Military. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:331-342. [PMID: 37164549 DOI: 10.1016/j.jneb.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Identify factors influencing eating behaviors among emerging adults in the military. DESIGN Focused ethnography using interviews, observations, and artifacts for data. SETTING Three US Naval installations. PARTICIPANTS Thirty-two active-duty Sailors aged 18-25 years. ANALYSIS Qualitative data were organized in NVivo and analyzed sequentially to categorize culturally relevant domains and themes using a social ecological model (SEM). Descriptive statistics were used to describe questionnaire data in SPSS (version 27.0, IBM, 2020). RESULTS Leaders encouraged healthy eating through policies and messages, but cultural contradictions and environmental barriers undermined Sailors' efforts to eat healthily. Stress and resource constraints (intrapersonal), peer pressure (social), unhealthy food environments and lack of access to food preparation (environmental), and eating on the go because of mission-first norms (cultural) promoted unhealthy eating behaviors. Nutrition and culinary literacy (intrapersonal); peer support and leadership engagement (social); access to healthy, convenient, and low-cost foods (environmental); and indoctrination to healthy eating during recruit training (cultural) positively influenced eating behaviors. CONCLUSION AND IMPLICATIONS The eating behaviors of service members are influenced by many modifiable factors. Targeted education, leadership engagement, and policies that make nutritious foods easily accessible, appealing, and preferred are needed.
Collapse
Affiliation(s)
- Melissa R Troncoso
- Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA.
| | - Candy Wilson
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jonathan M Scott
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
8
|
Gaviria D, Ammerman A. Eating disorders and disordered eating in servicemen and women: A narrative review. J Clin Psychol 2023; 79:316-373. [PMID: 35938917 DOI: 10.1002/jclp.23424] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/09/2022] [Accepted: 07/14/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are mental illnesses impacting all aspects of an individual's life. Recent research has examined EDs and disordered-eating behaviors in the military, a population subject to body composition standards, fitness requirements, and extreme stress. The purpose of this narrative review was to investigate ED and disordered-eating prevalence and their risk factors in ROTC (reserve officers' training corps), active-duty, and veteran servicemembers. The secondary purpose was to provide policy recommendations to reduce the burden of these conditions in the military. METHODS PubMed and PsycINFO were reviewed for relevant articles. All studies including data on EDs or disordered eating in U.S. active-duty, ROTC, or veteran populations were considered. RESULTS Results revealed a high burden of EDs and disordered eating with bulimic- and binge-type behaviors being the most common. Servicemembers exposed to trauma, including military sexual assault, and those with comorbidities like PTSD showed a higher prevalence. Body composition and fitness testing were also associated with a higher risk. Qualitative studies suggest these conditions serve as coping mechanisms for aspects of military life. CONCLUSIONS The high prevalence of EDs and disordered eating in the military points toward the importance of identification, treatment, and prevention. Policy change is necessary to protect servicemembers.
Collapse
Affiliation(s)
- David Gaviria
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alice Ammerman
- Center for Health Promotion and Disease Prevention, Department of Nutrition, Schools of Public Health and Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
9
|
Koltun KJ, Bird MB, Lovalekar M, Martin BJ, Mi Q, Nindl BC. Changes in eating pathology symptoms during initial military training in men and women and associations with BMI and injury risk. Eat Behav 2023; 48:101687. [PMID: 36463664 DOI: 10.1016/j.eatbeh.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Nutritional fitness, which comprises food choices, meal timing, and dietary intake behaviors, is an important component of military service member health and performance that has garnered recent attention. This study utilized generalized linear mixed effects modeling (GLMM) to investigate changes in eating pathology symptoms in men and women during initial military training (Marine Corps Officer Candidates School (OCS)). Associations among eating pathology, musculoskeletal injury risk and BMI were also assessed. This investigation includes data from the Eating Pathology Symptoms Inventory (EPSI) and BMI at the start of OCS (n = 598: Male n = 469, Female n = 129) and end of the 10-week program (n = 413: Male n = 329, Female n = 84), and injury surveillance throughout. At baseline, female candidates presented with greater body dissatisfaction, binge eating, purging, and restricting, but lower negative attitudes toward obesity compared to male candidates (p < 0.001). Eating symptoms changed during military training indicated by decreased body dissatisfaction in women (p = 0.003), decreased excessive exercise and negative attitudes toward obesity in men (p < 0.001), decreased cognitive restraint (p < 0.001), restricting (p < 0.001), purging (p = 0.013), and muscle building (p < 0.001) and increased binge eating (p < 0.001) in both sexes. Changes in restricting were significantly related to changes in BMI during training (p < 0.05). The likelihood of future injury was 108 % higher in female candidates than males and decreased by 5 % for each unit increase in excessive exercise. Eating attitudes and behaviors change during military training environments and are associated with military health and readiness outcomes including BMI and injury risk.
Collapse
Affiliation(s)
- Kristen J Koltun
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA.
| | - Matthew B Bird
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Mita Lovalekar
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Brian J Martin
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Qi Mi
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| |
Collapse
|
10
|
Morse JL, Dochat C, Wooldridge JS, Herbert MS, Materna K, Blanco BH, Hernandez J, Afari N. Baseline Characteristics and Their Associations with Body Composition of Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program. Mil Med 2022:usac242. [PMID: 35960850 DOI: 10.1093/milmed/usac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Increasing rates of overweight and obesity among military service members (SMs) necessitate the implementation of weight management interventions. Evidence for the effectiveness of military weight management interventions is mixed. Effectiveness may be impacted by individual sociodemographic, psychiatric, psychological, and behavioral factors. Baseline data from SMs who were overweight/obese or at risk of failing body composition or physical fitness tests and enrolling in a weight management randomized controlled trial were used to examine (1) individual characteristics of this sample as a whole and by gender and (2) relationships between those characteristics and body composition metrics that are targeted by military weight management interventions. Understanding these relationships may inform intervention approaches. MATERIALS AND METHODS Active duty SMs (N = 178) who enrolled in a randomized clinical trial of the Navy's weight management program "ShipShape" at a large military hospital provided data at their baseline visit. Because of gender differences in average body fat percentage (BF%) and underrepresentation of women SMs in research, independent samples t-tests and chi-square analyses were used to examine differences between male and female SMs across study variables. Multiple regression analyses were used to examine relationships of sociodemographic, psychiatric, psychological, and behavioral variables with body composition metrics, including weight, body mass index (BMI), BF%, and waist circumference (WC). RESULTS Participants (61% female; Mage = 29.66 ± 6.92 years; 59.60% White) had an average BMI in the "obese" range (MBMI = 33.1 ± 3.9 kg/m2). Female participants had significantly higher BF% and significantly lower weight and WC than male participants. Compared to male participants, females reported significantly higher rates of pain and headache diagnoses, lifetime diagnosis of an anxiety disorder, lifetime treatment for a mental health concern, lifetime experiences of sexual trauma/harassment and military sexual trauma, and higher current anxiety and post-traumatic stress disorder symptoms. Across all SMs, body composition metrics were significantly associated with several demographic variables, including gender, age, marital status, Asian race, and Black race. Higher weight-related stigma was significantly associated with higher weight, BMI, BF%, and WC. Additionally, more emotional eating was significantly associated with higher BF%, and higher weight-loss confidence was significantly associated with higher BMI. Sociodemographic, psychiatric, psychological, and behavioral variables predicted the greatest variance in BF% compared to other body composition metrics evaluated. CONCLUSIONS Participants in this study were more likely to be female, relatively young members of the Navy with overweight/obesity, who endorsed pain-related medical conditions, probable mental health conditions, and traumatic experiences at relatively high rates. Despite high endorsement of anxiety, depression, and post-traumatic stress disorder symptoms in this group, only weight-related stigma consistently emerged as significantly associated with body composition metrics. Regression results varied by body composition metric, with the most variance explained in BF%, suggesting that BF% may relate most strongly to sociodemographic, psychiatric, psychological, and behavioral variables associated with weight management. These results highlight the need for weight management programs that address weight-related stigma and mental health concerns of SMs to maximize the effectiveness of intervention efforts.
Collapse
Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92093, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Karla Materna
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Brian H Blanco
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| |
Collapse
|
11
|
Carr MM, Serowik KL, Na PJ, Potenza MN, Martino S, Masheb RM, Pietrzak RH. Co-occurring alcohol use disorder and obesity in U.S. military veterans: Prevalence, risk factors, and clinical features. J Psychiatr Res 2022; 150:64-70. [PMID: 35358833 DOI: 10.1016/j.jpsychires.2022.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Obesity and alcohol use disorder (AUD) are two of the most prevalent and costly clinical conditions among U.S. military veterans, and these conditions often co-occur. However, little is known about the clinical correlates of co-occurring obesity and AUD, which is critical to informing effective interventions. The current study analyzed data from a nationally representative sample of 4069 (3463 males, 479 females) veterans, who completed an online survey. The Alcohol Use Disorder Identification Test was used to identify veterans who screened positive for probable AUD (pAUD) and self-reported height and weight was used to calculate body mass index and identify veterans with obesity. Multinomial logistic regression was used to examine differences between four groups: controls (no current AUD or obesity), pAUD only, obesity only, and pAUD + obesity. A total of 1390 (36.1%) veterans had obesity, 10.5% (n = 359) had pAUD, and 3.7% (n = 124) had pAUD and obesity. Relative to veterans without AUD, Veterans with pAUD were less likely to have normal/lean weight (14.6% versus 21.4%) and more likely to have overweight (49.6% versus 41.7%). Veterans with pAUD + obesity were nearly twice as likely than veterans with pAUD to report three or more adverse childhood experiences. The results of this study help inform the clinical presentation and needs of veterans with co-occurring obesity and AUD. They also underscore the importance of regularly monitoring weight among veterans with AUD, and considering the role of childhood adversity as a risk factor for co-occurring AUD and obesity.
Collapse
Affiliation(s)
- Meagan M Carr
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA.
| | - Kristin L Serowik
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; Department of Neuroscience, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; Child Study Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA; Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Steve Martino
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Robin M Masheb
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave., New Haven, CT, 06516, USA; Department of Social and Behavioral Sciences, Yale School of Medicine, 60 College St., New Haven, CT, 06510, USA
| |
Collapse
|
12
|
Herrmann T, Preib E, French M, Beckstrom J, Nazarenko E, Lackner R, Marchand WR, Yabko B. Veterans’ experiences with mindfulness-based eating: A mixed methods study on MB-SAVOR. Complement Ther Clin Pract 2022; 47:101548. [DOI: 10.1016/j.ctcp.2022.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/30/2021] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
|
13
|
Etuk R, Shirk SD, Klein KM, Masheb RM, Potenza MN, Park CL, Keeler K, Kraus SW. Examining the Clinical Correlates of Overeating and Binge-Eating Behaviors Among U. S. Veterans. Mil Med 2021; 187:297-303. [PMID: 34962274 DOI: 10.1093/milmed/usab533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/26/2021] [Accepted: 12/15/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Pressure to meet U.S. military weight requirements during service may predispose some service members to develop psychiatric disorders such as eating disorders or unhealthy eating behaviors, which may persist after military discharge. Specifically, research examining U.S. military veterans has found that in weight management programs, veterans with binge-eating behaviors have shown poor treatment outcomes. Overall, previous research suggests that veterans experience considerable and persistent disordered eating problems, and in addition may experience a higher prevalence of disordered eating in comparison to the general U.S. population. Research on Post-9/11 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans is needed as this group frequently presents with high rates of medical and psychiatric disorders. The current study used clinician-administered structured interviews to examine relationships between psychiatric, health, and demographic variables in a sample of Post-9/11 OEF/OIF/OND veterans with binge-eating or overeating behavior or neither. MATERIALS AND METHODS This article presents secondary analyses of the baseline phase from data obtained for the Survey of the Experiences of Returning Veterans. Using structured phone interviews, we cross-sectionally examined patterns of medical comorbidities between sociodemographic, health, eating, and psychiatric variables in 846 recently deployed U.S. veterans with binge-eating behaviors (reporting both overeating and loss of control [LOC] eating), overeating behaviors (overeating without LOC), or healthy controls (absence of any disordered eating). Study procedures were approved by the Department of Veterans Affairs (VA) Institutional Review Boards, and informed consent was obtained from the participants. A series of chi-square and analysis of variance tests revealed significant bivariate between-group differences in sociodemographic, health, eating, and psychiatric variables. Variables with significant group differences (P < .05) were entered into a multinomial logistic regression to examine relationships between psychiatric, health, and eating factors and binge-eating severity. RESULTS Results of the multinomial logistic regression analysis showed that women relative to men were less likely to overeat. When comparing the binge-eating group and controls, higher body mass index was associated with higher odds of binge eating. Furthermore, for the overeating group in comparison to controls, fasting behavior was associated with higher odds of overeating. For the psychiatric variables, the binge-eating and overeating groups were associated with higher rates of compulsive buying when compared to healthy controls. Additionally, the overeating group was associated with higher rates of alcohol dependence. Lastly, binge-eating and overeating behaviors were positively associated with specific psychiatric and health comorbidities. CONCLUSIONS Further research is needed to inform the development of effective treatments for disordered eating problems, as evidenced by an anticipated increase of veterans entering the VA healthcare system and the high rate of binge eating observed in our study and prior research in Post-9/11 veterans. Moreover, our study findings suggest the relevance of screening veterans for compulsive buying. This study was limited by its relatively small sample which only examined disordered eating behaviors. Future studies could simultaneously explore binge-eating behaviors and binge-eating disorder diagnoses in larger samples. Study strengths include a diverse sample of Post-9/11 veterans with sizable female representation.
Collapse
Affiliation(s)
- Repairer Etuk
- Department of Psychology, University of Nevada, Las Vegas, NV 89154-5030, USA
| | - Steven D Shirk
- VISN 1 New England MIRECC, Bedford Healthcare System, Bedford, MA 01730, USA.,Department of Psychiatry and Population and Quantitative Health Sciences Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Kelly M Klein
- Department of Veterans Affairs, Brockton Division, VA Boston Healthcare System, Boston, MA 02301, USA.,Department of Psychiatry, Harvard University Medical School, Boston, MA 02215, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA.,Department of Neuroscience, Yale University, New Haven, CT, USA
| | - Crystal L Park
- Department of Psychological Science, University of Connecticut, Storrs, CT 06269, USA
| | - Kerri Keeler
- Department of Veterans Affairs, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV 89154-5030, USA
| |
Collapse
|
14
|
Vaught AS, Piazza V, Raines AM. Prevalence of eating disorders and comorbid psychopathology in a US sample of treatment-seeking veterans. Int J Eat Disord 2021; 54:2009-2014. [PMID: 34338326 DOI: 10.1002/eat.23591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Eating disorders (EDs) are a well-studied public health issue in the general population. Less is known, however, about the prevalence of such conditions and levels of comorbid psychopathology among military and veteran populations. The current study sought to describe the probable prevalence of EDs and levels of comorbid psychopathology using a racially diverse treatment-seeking sample of US veteran men and women. METHOD Veterans (N =254) presenting for routine clinical care completed self-report questionnaires assessing EDs, posttraumatic stress disorder, depression, and shame. RESULTS Thirty-one percent of the sample met probable criteria for either bulimia nervosa (BN), binge-eating disorder, or purging disorder. Although overall ED prevalence estimates were similar across men and women, estimates of BN were higher among Black veterans compared to White veterans or veterans who identified as a race other than Black or White. Further, mean levels of psychopathology were significantly higher in veterans with a probable ED compared to those without. DISCUSSION This study extends previous research and highlights the importance of establishing dedicated ED screening programs within the Veterans Health Administration.
Collapse
Affiliation(s)
- Amanda S Vaught
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
| | - Vivian Piazza
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,Atlas Psychiatry, New Orleans, Louisiana, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA.,School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| |
Collapse
|
15
|
Sharp KJ, Vitagliano JA, Weitzman ER, Fitzgerald S, Dahlberg SE, Austin SB. Peer-to-Peer Social Media Communication About Dietary Supplements Used for Weight Loss and Sports Performance Among Military Personnel: Pilot Content Analysis of 11 Years of Posts on Reddit. JMIR Form Res 2021; 5:e28957. [PMID: 34605769 PMCID: PMC8524331 DOI: 10.2196/28957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 01/16/2023] Open
Abstract
Background Over 60% of military personnel in the United States currently use dietary supplements. Two types of dietary supplements, weight loss and sports performance (WLSP) supplements, are commonly used by military personnel despite the associated serious adverse effects such as dehydration and stroke. Objective To understand peer-to-peer communication about WLSP supplements among military personnel, we conducted a pilot study using the social media website, Reddit. Methods A total of 64 relevant posts and 243 comments from 2009 to 2019 were collected from 6 military subreddits. The posts were coded for year of posting, subreddit, and content consistent with the following themes: resources about supplement safety and regulation, discernability of supplement use through drug testing, serious adverse effects, brand names or identifiers, and reasons for supplement use. Results A primary concern posted by personnel who used supplements was uncertainty about the supplements that were not detectable on a drug test. Supplements to improve workout performance were the most frequently used. Conclusions Our pilot study suggests that military personnel may seek out peer advice about WLSP supplements on Reddit and spread misinformation about the safety and effectiveness of these products through this platform. Future directions for the monitoring of WLSP supplement use in military personnel are discussed.
Collapse
Affiliation(s)
- Kendall J Sharp
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Julia A Vitagliano
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Elissa R Weitzman
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Susan Fitzgerald
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Suzanne E Dahlberg
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
16
|
Betancourt JA, Granados PS, Pacheco GJ, Reagan J, Shanmugam R, Topinka JB, Beauvais BM, Ramamonjiarivelo ZH, Fulton LV. Exploring Health Outcomes for U.S. Veterans Compared to Non-Veterans from 2003 to 2019. Healthcare (Basel) 2021; 9:healthcare9050604. [PMID: 34070037 PMCID: PMC8158130 DOI: 10.3390/healthcare9050604] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 02/04/2023] Open
Abstract
The physical demands on U.S. service members have increased significantly over the past several decades as the number of military operations requiring overseas deployment have expanded in frequency, duration, and intensity. These elevated demands from military operations placed upon a small subset of the population may be resulting in a group of individuals more at-risk for a variety of debilitating health conditions. To better understand how the U.S Veterans health outcomes compared to non-Veterans, this study utilized the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset to examine 10 different self-reported morbidities. Yearly age-adjusted, population estimates from 2003 to 2019 were used for Veteran vs. non-Veteran. Complex weights were used to evaluate the panel series for each morbidity overweight/obesity, heart disease, stroke, skin cancer, cancer, COPD, arthritis, mental health, kidney disease, and diabetes. General linear models (GLM’s) were created using 2019 data only to investigate any possible explanatory variables associated with these morbidities. The time series analysis showed that Veterans have disproportionately higher self-reported rates of each morbidity with the exception of mental health issues and heart disease. The GLM showed that when taking into account all the variables, Veterans disproportionately self-reported a higher amount of every morbidity with the exception of mental health. These data present an overall poor state of the health of the average U.S. Veteran. Our study findings suggest that when taken as a whole, these morbidities among Veterans could prompt the U.S. Department of Veteran Affairs (VA) to help develop more effective health interventions aimed at improving the overall health of the Veterans.
Collapse
|
17
|
Wooldridge JS, Herbert MS, Dochat C, Afari N. Understanding relationships between posttraumatic stress disorder symptoms, binge-eating symptoms, and obesity-related quality of life: the role of experiential avoidance. Eat Disord 2021; 29:260-275. [PMID: 33459212 PMCID: PMC8285449 DOI: 10.1080/10640266.2020.1868062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire-II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.
Collapse
Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, California, San Diego, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| |
Collapse
|
18
|
Masheb RM, Ramsey CM, Marsh AG, Snow JL, Brandt CA, Haskell SG. Atypical Anorexia Nervosa, not so atypical after all: Prevalence, correlates, and clinical severity among United States military Veterans. Eat Behav 2021; 41:101496. [PMID: 33711788 DOI: 10.1016/j.eatbeh.2021.101496] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/11/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE DSM-5 Atypical Anorexia Nervosa (AAN), a new eating disorder diagnosis, presents similarly to Anorexia Nervosa (AN) in the absence of severe underweight. The prevalence of AAN and other DSM-5 eating disorders was estimated in a sample of Veterans. Sociodemographic, mental health, and eating behavior correlates were examined. METHOD Iraq and Afghanistan war era Veterans (N = 1137, 51.6% female) completed the Eating Disorder Diagnostic Scale-5 for probable AAN diagnosis, and validated measures of eating pathology and mental health, between February 2016 and October 2019. Multivariate analyses compared Veterans with AAN to those with and without any DSM-5 eating disorder. RESULTS Among completers, 13.6% of women and 4.9% of men in the sample met criteria for probable AAN and 19.2% of women and 13.9% of men for another eating disorder. Mean age was 41 years, and on average BMIs were classified as overweight (BMI = 28.8, SD = 5.6) despite being at least 10% lower than their lifetime highest weight. Two-thirds reported dietary restraint on more than half the days in the past month. On measures of mental health, the AAN group had worse functioning than the no eating disorder group, similar functioning to Veterans with Binge Eating Disorder (BED), and better functioning than Veterans with Bulimia Nervosa (BN). DISCUSSION Results support AAN as a highly prevalent and clinically significant diagnosis. Findings highlight the need to identify and address eating disorders, particularly other specified eating disorders not meeting criteria for AN, BN, or BED, in active military and Veteran, and other high-risk and underserved, populations.
Collapse
Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America.
| | - Christine M Ramsey
- Yale School of Medicine, New Haven, CT, United States of America; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
| | - Alison G Marsh
- VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Jennifer L Snow
- VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, CT, United States of America; Yale School of Medicine, New Haven, CT, United States of America
| |
Collapse
|
19
|
Cognitive disinhibition and infrequent moderate-to-intense physical activity linked with obesity in U.S. soldiers. Eat Weight Disord 2021; 26:973-981. [PMID: 32476104 DOI: 10.1007/s40519-020-00932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/16/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To explore the relationship between body weight status and neurocognitive functioning in soldiers. METHODS U.S. soldiers (N = 109) answered survey questions and completed neurocognitive tests including simple reaction time, code substitution, procedural reaction time, go-no-go, matching to sample, code substitution recall, and four versions of the Stroop test including congruent (color and meaning of word agreed); incongruent (color and meaning of word differed); neutral (nonsense words appeared), and emotional (combat-related words such as "I.E.D" and "convoy" appeared). Self-reported heights and weights were used to calculate BMI. A BMI ≥ 30.00 kg/m2 was categorized as obese. Multivariate analysis of variance was used to analyze weight status differences (p ≤ 0.05) across neurocognitive variables. Binomial logistic regression analysis with obesity as the dependent variable was used to ascertain the contributions (p ≤ 0.05) of exercise and the neurocognitive measures that differed based on weight status. RESULTS Twenty-nine participants (26.6%) were obese. The obese group had significantly lower scores on code substitution, and both neutral and emotional Stroop tasks. Only Stroop emotional scores, p = 0.022, OR = 0.97, and frequency of moderate/intense physical activity, p = 0.009, OR = 0.10, were significant predictors of weight status. CONCLUSIONS Obesity was associated with less frequent moderate/intense physical activity and compromised executive functioning, namely decrements in response inhibition. Given the design and sample size, additional research is needed to better understand the direction of the relationship between these variables and to inform research related to the treatment and prevention of obesity within military populations. LEVEL OF EVIDENCE Level III, case-control analytic study.
Collapse
|
20
|
|
21
|
Carr KD. Homeostatic regulation of reward via synaptic insertion of calcium-permeable AMPA receptors in nucleus accumbens. Physiol Behav 2020; 219:112850. [PMID: 32092445 PMCID: PMC7108974 DOI: 10.1016/j.physbeh.2020.112850] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/23/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
The incentive effects of food and related cues are determined by stimulus properties and the internal state of the organism. Enhanced hedonic reactivity and incentive motivation in energy deficient subjects have been demonstrated in animal models and humans. Defining the neurobiological underpinnings of these state-based modulatory effects could illuminate fundamental mechanisms of adaptive behavior, as well as provide insight into maladaptive consequences of weight loss dieting and the relationship between disturbed eating behavior and substance abuse. This article summarizes research of our laboratory aimed at identifying neuroadaptations induced by chronic food restriction (FR) that increase the reward magnitude of drugs and associated cues. The main findings are that FR decreases basal dopamine (DA) transmission, upregulates signaling downstream of the D1 DA receptor (D1R), and triggers synaptic incorporation of calcium-permeable AMPA receptors (CP-AMPARs) in the nucleus accumbens (NAc). Selective antagonism of CP-AMPARs decreases excitatory postsynaptic currents in NAc medium spiny neurons of FR rats and blocks the enhanced rewarding effects of d-amphetamine and a D1R, but not a D2R, agonist. These results suggest that FR drives CP-AMPARs into the synaptic membrane of D1R-expressing MSNs, possibly as a homeostatic response to reward loss. FR subjects also display diminished aversion for contexts associated with LiCl treatment and centrally infused cocaine. An encompassing, though speculative, hypothesis is that NAc synaptic incorporation of CP-AMPARs in response to food scarcity and other forms of sustained reward loss adaptively increases incentive effects of reward stimuli and, at the same time, diminishes responsiveness to aversive stimuli that have potential to interfere with goal pursuit.
Collapse
Affiliation(s)
- Kenneth D Carr
- Departments of Psychiatry and Biochemistry and Molecular Pharmacology, New York University School of Medicine, 435 East 30th Street, New York, NY 10016, United States.
| |
Collapse
|