Eating disorder diagnoses among military personnel are up 26 percent over a five-year period, according to a new military study that suggests the actual incidence of such illnesses is even higher.
The study, published in the Defense Health Agency's Medical Surveillance Monthly Report, found that incidence rates had risen steadily from 2013 to 2016 before decreasing slightly last year.
Diagnoses rose from 2.3 per 10,000 to 3 per 10,000 in 2016, before dropping to 2.9 per 10,000 last year.
"Results of the current study suggest that service members likely experience eating disorders at rates that are comparable to rates in the general population, and that rates of these disorders are potentially rising among service members," the study said. "These findings underscore the need for appropriate prevention and treatment efforts in this population."
Estimates of the prevalence of eating disorders in the general U.S. population vary widely, depending on study methods and populations. In a nationally representative U.S. sample, lifetime prevalence estimates of anorexia and bulimia were 0.9% and 1.5% among women, and 0.3% and 0.5%, respectively, among men.
Far more women than men were diagnosed with an eating disorder in all services. More than two-thirds of cases involved female troops and the overall incidence rate among women, at 11.9 cases per 10,000, was more than 11 times that of men.
"Of note, the overall incidence rate of all eating disorders among female Marine Corps members was nearly twice that among female Army members," the study said. Among men, rates were highest in the Army and Marines.
Less than one-eighth of the diagnoses were for anorexia, a well-known and potentially fatal disorder that is especially evident because of dramatic, excessive weight loss.
Bulimia -- binging and purging through vomiting and laxative use -- accounted for nearly 42 percent of diagnoses. More than 46 percent were classified as other or unidentified eating disorders. Included in the "other" category was binge eating, defined as recurrent episodes of eating large quantities of food, often very quickly and to the point of discomfort; a feeling of a loss of control during the binge; and experiencing shame afterward.
Binge eating is the most common eating disorder in the United States, according to the National Eating Disorders Association.
Others include eating disorders that don't meet diagnostic criteria for anorexia or bulimia but are nonetheless problematic.
Diagnoses guidelines have changed in recent years, accounting for some of the apparent increase in military diagnoses, the study noted.
But diagnoses from records of servicemembers' medical encounters "undoubtedly resulted in underestimates of the true incidence and prevalence of eating disorders" in the military, the study said.
That's because people with eating disorders don't usually seek medical care, and except for anorexia are able to conceal their eating disorders.
"Their body weights and appearances are not suggestive of disordered eating, and their binge eating and compensatory behaviors usually take place in private," the study said.
Military service could increase the risk of developing an eating disorder, due to potential exposure to trauma and the need to meet physical fitness and weight requirements, the study said.
"It is well recognized that factors that increase emphasis on weight and shape elevate the risk of eating disorders among both women and men," the study said.
Under Defense Department policy, diagnosed eating disorders lasting longer than three months are medically disqualifying for accession into military service and could result in medical separation for active duty personnel.