Women Veterans’ Treatment Preferences for Disordered Eating

Abstract

Objective: Disordered eating, which includes subclinical and clinical maladaptive eating behaviors, is common among women, including those served by the Veterans Health Administration (VA). We used qualitative methods to determine whether and how women veterans want to receive treatment for disordered eating. Method: Women veterans participated in one of seven focus groups/interviews and completed in-person demographic and psychological questionnaires. We used thematic analysis of focus groups/interviews to understand preferences for disordered eating treatment. Results: Participants (N=20) were mostly women of color (55%); mean age was 48 (SD= 15) and 65% had significant psychological symptoms. Few participants described being assessed for disordered eating, but all thought VA should provide treatment for disordered eating. Through thematic analysis, we identified six preferences: 1) Treatment for disordered eating should be provided in groups; 2) Treatment for disordered eating should provide concrete skills to facilitate the transition out of structured military environments; 3) Treatment for disordered eating should address the relationship between eating and mental health; 4) Disordered eating can be treated with mindfulness and cognitive behavior therapy; 5) Disordered eating treatment providers should be experienced and take an interactive approach to care, but can come from diverse disciplines; and 6) Referrals to treatment for disordered eating should be open-ended, occur early, and allow for ongoing, flexible access to treatment. Conclusions: Women veterans are interested in treatment for disordered eating. Preferences align with existing treatments, could be offered in conjunction with weight loss or primary care services, and should provide social support and interactive learning.

Qualitative exploration of factors influencing women veterans’ disordered eating symptoms and treatment preferences in VHA primary care.

“…Our results align with prior work in several ways, including those suggestive of unique cultural risks associated with DES in veterans (e.g., weight standards, high rates of trauma exposure), and that addressing DES is a potential means to manage negative affect (Bartlett & Mitchell, 2015;Masheb et al, 2021). Treatment preferences largely aligned with prior work (Breland et al, 2016) suggesting high acceptability of interdisciplinary care. Novel contributions include insights into biopsychosocial influences on women veterans' DES, potential treatment targets (e.g., body dissatisfaction), and description of what would make for acceptable patient-centered treatment in VHA IPC (e.g., skillsfocused, health/wellness-oriented).…”

Eating disorders and disordered eating in servicemen and women: A narrative review

“…The military environment, such as boot camp, being on base, stressful events, pressures from being female, lack of weight management and health support, the coupling of weight with job performance, rotating work, body‐related comments from peers, and the transition from military to civilian life were also found to be associated with ED behaviors (Berg & Moore, 1996; Breland et al, 2016, 2017; Donaldson, 2016; George, 2019; Kiselica et al, 2015; McNulty, 1997a, 1997b, 2001; Nieves et al, 2015). Specifically, the military food environment placed servicemembers at risk by negatively impacting food choice and consumption, impacting weight status, and subjecting them to negative health consequences (Smith et al, 2009).…”

“…Should the SERVE Act become law, it will remove the age restriction for treatment, expand coverage, and increase provider education (Congress, 2019). Providers with ED treatment experience should be hired, and servicemembers and veterans provided with flexible treatment schedules and quick referrals (Breland et al, 2016). Treatment should address body image concerns given the body‐centric culture of the military (Carlton et al, 2005; Rosenbaum et al, 2016).…”

Hidden Veterans: A Review of the Literature on Women Veterans in Contemporary Society

“…Understanding why women leave the military is not fully understood; however, what we do know is that many women leave earlier than planned (Dichter & True, 2015). Feelings of being unprepared to reestablish their lives and lacking skills that enable a healthy and fulfilling transition (Breland, Donalson, Dinh, Nevedal, & Maguen, 2016).…”

“…Feelings of being unprepared to re-establish their lives and lacking skills that enable a healthy and fulfilling transition (Breland, Donalson, Dinh, Nevedal, and Maguen, 2016).…”