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Objective: Despite unique experiences that may increase eating disorder risk, U.S. military service members are an understudied population. The current study examined incidence and prevalence of eating disorder diagnoses in U.S. military personnel. Method: This retrospective cohort study utilized Military Health System Data Repository (MDR) data on eating disorder diagnoses (2016–2021). Active duty, Reserve, and National Guard U.S. military service members who received care via TRICARE Prime insurance were identified by ICD‐10 eating disorder diagnostic codes. Results: During the 6‐year surveillance period, 5189 Service members received incident eating disorders diagnoses, with a crude overall incidence rate of 6.2 cases per 10,000 person‐years. The most common diagnosis was other/unspecified specified eating disorders, followed by binge‐eating disorder, bulimia nervosa, and anorexia nervosa. There was an 18.5% overall rise in total incident cases across the surveillance period, but this trend was not statistically significant (p = 0.09). Point prevalence significantly increased across the 6‐year timeframe for total eating disorders (p < 0.001). Period prevalence for 6‐year surveillance period was 0.244% for total eating disorders, 0.149% for other/unspecified eating disorder, 0.043% for bulimia nervosa, 0.038% for binge‐eating disorder, and 0.013% for anorexia nervosa. Discussion: Overall crude incidence estimates for total eating disorders were higher than reported in prior research that included only active duty Service members and required an eating disorder diagnosis code in the first or second diagnostic position of the medical record. Comprehensive and confidential studies are needed to more thoroughly characterize the nature and scope of eating disorder symptomatology within U.S. military personnel. Public Significance: U.S. military service members are a vulnerable population with regard to eating disorder symptoms. Previously reported incidence and prevalence estimates using data from the Military Health System may have been underestimated due to overly stringent case definitions. Given personal and occupational barriers (e.g., career consequences), confidential studies of military personnel may provide more complete data on the scope of eating disorders to inform screening and clinical practice guidelines for military populations. [ABSTRACT FROM AUTHOR]

Objective: Adolescent children of US service members (i.e., military‐dependent youth) face unique stressors that increase risk for various forms of disinhibited eating, including emotional eating. Difficulties with adaptively responding to stress and aversive emotions may play an important role in emotional eating. This study examined emotion dysregulation as a potential moderator of the association between perceived stress and emotional eating in adolescent military dependents. Method: Participants were military‐dependent youth (N = 163, 57.7% female, Mage = 14.5 ± 1.6, MBMI‐z = 1.9 ± 0.4) at risk for adult binge‐eating disorder and high weight enrolled in a randomized controlled prevention trial. Prior to intervention, participants completed questionnaires assessing perceived stress and emotional eating. Parents completed a questionnaire assessing their adolescent's emotion dysregulation. Moderation analyses were conducted using the PROCESS macro in SPSS and adjusted for theoretically relevant sociodemographic covariates. Results: The interaction between adolescent perceived stress and emotion dysregulation (parent‐reported about the adolescent) in relation to adolescent emotional eating was found to be significant, such that higher emotion dysregulation magnified the association between perceived stress and emotional eating (p =.010). Examination of simple slopes indicated that associations between perceived stress and emotional eating were strongest for youth with above‐average emotion dysregulation, and non‐significant for youth with average or below‐average emotion dysregulation. Discussion: Findings suggest that greater emotion dysregulation may increase risk for emotional eating in response to stress among military‐dependent youth at risk for binge‐eating disorder or high weight. Improving emotion regulation skills may be a useful target for eating disorder prevention among youth who are at risk for emotional eating. Public Significance: Prior research has shown that adolescent military dependents are at increased risk for eating disorders and high weight. The current study found that emotion dysregulation moderated the relationship between perceived stress and emotional eating among military‐dependent youth. There may be clinical utility in intervening on emotion regulation for adolescent dependents at particular risk for emotional eating and subsequent eating disorders. [ABSTRACT FROM AUTHOR]

Objective: The offspring of US military service members may be at increased risk for eating disorders. However, no epidemiological studies to date have evaluated eating disorder incidence rates and prevalence estimates among military‐dependent youth. Method: This retrospective cohort study examined eating disorder diagnoses in the military healthcare system (MHS) from 2016 through 2021. Active duty and national guard military‐dependent youth, aged 10–17 years, who received care in the MHS via TRICARE Prime insurance, were identified by one or more ICD‐10 codes indicative of an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge‐eating disorder, and other‐specified eating disorders). Results: During the 6‐year surveillance period, 2534 dependents received incident diagnoses of eating disorders, with a crude overall incidence rate of 1.75 cases per 10,000 person‐years. The most common diagnosis was other‐specified eating disorder, followed by anorexia nervosa, bulimia nervosa, and binge‐eating disorder. The crude annual incidence rate of all eating disorder diagnoses increased by nearly 65% from 2016 to 2021. Rates for all diagnoses were highest in 2020 and 2021. Period prevalence estimates were.08% for any eating disorder diagnosis,.01% for anorexia nervosa,.004% for bulimia nervosa,.004% for binge‐eating disorder, and.06% for other‐specified eating disorders. Discussion: The observed increase in eating disorder diagnoses during the surveillance period appeared to be driven by female dependents. More military dependents experienced a new‐onset diagnosis during the COVID‐19 pandemic compared to previous years. These findings highlight the need for eating disorder screening, identification, and treatment for dependents within the MHS. Public Significance Statement: Children of US military service members may be at increased risk for eating disorders. Results indicate new‐onset eating disorder cases increased 65% from 2016 to 2021, primarily among girls compared to boys. The most diagnosed and fastest growing diagnosis was other‐specified eating disorder. Rates of anorexia nervosa increased following the COVID‐19 pandemic. Findings highlight the need for eating disorder screening, identification, and treatment within the military healthcare system. [ABSTRACT FROM AUTHOR]

Objective: The COVID‐19 pandemic and public health mitigation measures have negatively impacted individuals with eating disorders (ED). We evaluated changes in and predictors of ED symptoms, pandemic‐related ED concerns, and anxiety symptoms across the first 12 months of the COVID‐19 pandemic among individuals with self‐reported EDs in the United States (US), Sweden (SE), and the Netherlands (NL). Method: Participants in the US (N = 510), SE (N = 982), and NL (N = 510) completed an online survey assessing ED symptoms (binge eating, restriction, compensatory behaviors, and anxiety about being unable to exercise), general anxiety symptoms, and pandemic‐related ED concerns about accessing food, lack of structure and social support, being in a triggering environment, and food and treatment costs. In the US and NL, respondents completed surveys beginning April 2020 and continuing monthly for a year. In SE, respondents completed baseline surveys in May 2020, a six‐month follow‐up around December 2020, and a 12‐month follow‐up in May 2021. Results: Three patterns emerged: (1) a curvilinear course with the highest level of symptoms at baseline, declining through November 2020, and increasing through the rest of the year; (2) a linear declining course over time; and (3) a stable course with no changes. Worries about COVID‐19 infection, lockdown, concerns about lack of structure and social support, and concerns about accessing food consistent with one's recovery meal plan predicted increases in ED symptoms. Discussion: ED symptoms tracked with pandemic‐related concerns in people with EDs. Conceptualizing predictors of symptoms may inform therapy and public health resources that reduce the impact of pandemics on mental health. Public Significance: Our findings suggest that the COVID‐19 pandemic had negative impacts on people with eating disorders, including amplification of mental health symptoms and stressors around peak periods of infection and COVID‐19 restrictions. These findings inform medical providers, policy‐makers, and community‐based supports about the information and resource needs of this group to ensure efficient dissemination in future public health emergencies and during the ongoing COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: Eating disorder recovery research has emphasized the absence of symptoms over the presence of adaptive aspects like positive body image and healthy eating attitudes. The current study examined how body appreciation and intuitive eating related to eating disorder recovery using a comprehensive recovery definition (physical, behavioral, and cognitive recovery). Method: Data were collected from 66 women with an eating disorder history and 31 controls with no history of eating pathology. Participants completed an online survey followed by a phone interview. Results: The fully recovered group did not differ from controls on body appreciation, with both groups endorsing significantly higher levels of body appreciation than the partially recovered and current eating disorder groups. Similarly, the fully recovered group did not differ from controls on overall intuitive eating, with both groups endorsing significantly higher levels of overall intuitive eating than the partially recovered and current eating disorder groups. Discussion Positive psychological constructs such as body appreciation and intuitive eating relate to eating disorder recovery status. Understanding recovery within a strengths‐based framework may inform intervention and relapse prevention. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to examine potential predictors of a comprehensive operationalization of eating disorder recovery, characterized by physical, behavioral, and cognitive recovery, focusing on constructs related to self‐concept, personality, and negative affect. Method: Participants were women with a history of an eating disorder who provided data via survey and interview at two time points separated by about 7–8 years and who met criteria for an eating disorder diagnosis at baseline (N = 36). Results: Logistic regression models revealed that self‐esteem was a significant predictor of recovery status (OR = 1.12, p =.039) such that individuals with higher self‐esteem at baseline demonstrated significantly greater odds of being in full recovery at follow‐up. However, when self‐esteem was considered in a set along with baseline imposter phenomenon and anxiety, no single construct emerged as a significant unique predictor of recovery in logistic regression analyses. Discussion These results highlight the potential importance of self‐esteem in relation to recovery, with clinical implications related to bolstering self‐esteem as part of eating disorder treatment. Future research should continue to explore predictors using a comprehensive operationalization of eating disorder recovery in larger, more diverse samples to optimally identify factors associated with achieving recovery. [ABSTRACT FROM AUTHOR]

Objective: We aimed to replicate the concurrent validity of a comprehensive definition of eating disorder recovery (physical, behavioral, and cognitive indices) in a sample followed up 7–8 years from baseline, and to examine, for the first time with this comprehensive definition, predictive validity. Method: Participants were 66 women with a history of an eating disorder and 31 age‐matched controls who completed an online survey and phone interview. Results: In general, women who were fully recovered were statistically indistinguishable from controls and had significantly less eating disorder attitudes and behaviors than the partially recovered and eating disorder groups. Being fully recovered at baseline was a robust predictor of stability: of those fully recovered at baseline, 80% remained fully recovered at follow‐up. One‐third of those with an eating disorder and one‐half of those in partial recovery at baseline attained full recovery at follow‐up. Discussion: These findings support the current operationalization of eating disorder recovery, encompassing physical, behavioral, and cognitive indices, as valid and highlight that full recovery is not only possible but predicts full recovery years later. Future research should examine this operationalization in diverse samples and study trajectories of recovery to identify predictors. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders are present among middle‐aged women, yet most eating disorder knowledge comes from adolescents and young adults. There is arguably a need for research specific to middle‐aged women and eating pathology. One biological factor that may contribute to eating disorder symptoms and is unique to middle‐aged women is menopause, given the changes in body shape and weight that direct women's bodies away from the young, thin beauty standard. Method: This study explored group differences in disordered eating and body image by menopausal status. Participants were 310 middle‐aged women between the ages of 40 and 68. They completed an online survey about their menopausal status, disordered eating, and body image concerns. We compared disordered eating behaviors and attitudes across three groups: premenopausal women, perimenopausal women, and postmenopausal women. Results: Results indicated no group differences on either disordered eating or body image concerns by menopausal status. Discussion: These findings suggest the perimenopausal period may not be a window of vulnerability for women in general. Given these mixed findings, future research should examine moderators to determine when there are menopausal status group differences on eating pathology. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Adolescent emotional-eating, referring to eating in response to negative affective states, is frequently reported by those with loss of control (LOC) eating. Although LOC eating has been shown to predict exacerbated disordered eating and excess weight/adiposity gain, the extent to which emotional-eating, either alone or in combination with LOC, predicts adverse outcomes has not been determined. Thus, we examined associations of baseline emotional-eating with changes in disordered eating, BMI, and adiposity over 1-year, and to what degree the presence or absence of baseline LOC moderated these associations. Methods 189 non-treatment-seeking youth (15.4 ± 1.4y; 66% female; 67% non-Hispanic White, 38% overweight [BMI ≥ 85th %ile]) completed the emotional-eating Scale for Children/Adolescents and the Eating Disorder Examination interview at baseline and again at 1-year. Air displacement plethysmography assessed adiposity at both time points. Results Baseline emotional-eating alone was not significantly associated with the development of objective binge eating or changes in disordered eating attitudes, BMI or adiposity 1-year later. However, baseline emotional-eating interacted with the presence of baseline LOC in the prediction of 1-year outcomes. Among adolescents with LOC eating, greater baseline emotional-eating was related to increased disordered eating attitudes ( p = .03), BMI ( p = .04), and adiposity ( p = .04) at 1-year, after correcting for false discovery rate. Discussion Emotional-eating among youth also reporting LOC was associated with adverse outcomes over 1-year. Adolescents who report both behaviors may represent a subset of individuals at especially high risk for exacerbated disordered eating and excess weight gain. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:551-560) [ABSTRACT FROM AUTHOR]