Sending Office: Honorable Seth Moulton
Sent By:
Christine.Raymond@mail.house.gov

        Request for Signature(s)

SUPPORT GAO STUDY REQUEST FOR EATING DISORDERS IN THE MILITARY & MILITARY FAMILIES

Dear Colleague,

Please join us in requesting that the Government Accountability Office Comptroller, General Dodaro, conduct a comprehensive study on the Department of Defense’s TRICARE and Military Health System to evaluate the scope, prevention, and treatment of eating
disorders affecting military members and their families. 

Eating disorders, including anorexia, bulimia, and binge eating disorder, affect 30 million Americans during their lifetime, encompassing every age, gender, body size, socioeconomic status, and race.[1]  Eating
disorders have the highest mortality rate of any psychiatric illness[2], with suicide rates being 23% higher than that of the general population.[3]  Studies show that
eating disorders affect our servicemembers and veterans at a higher rate than the civilian population, with estimated rates of up to 10% of male and female military personnel affected by an eating disorder.[4]
[5]
[6]
  Research suggests there may be an even greater prevalence rate due to lack of reporting, with 34% of female active duty servicemembers and 20% of children of servicemembers scoring at risk for an eating disorder.[7] 
Additionally, a study of female veterans found significant relationships between increased risk of eating disorders and military members with history of Post-Traumatic Stress Disorder (PTSD) and sexual trauma.[8]

Despite research demonstrating higher incidence of eating disorders among servicemembers and their families, we have much to learn on how we can help our warriors and their families with this life-threatening illness.  We ask that you join us on this GAO
Request, by contacting Raymond Celeste on Congressman Walter Jones’ staff at
Raymond.Celeste@mail.house.gov
and Christine Raymond on Congressman Seth Moulton’s staff at
Christine.Raymond@mail.house.gov  to
sign-on by Friday, June 8, 2017.

Sincerely,

Seth Moulton                                                                           Walter Jones

MEMBER OF CONGRESS                                                    MEMBER OF CONGRESS


[1] 1. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.
Biological Psychiatry, 61(3), 348-358.

[2] Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.
Archives of General Psychiatry, 68(7), 724-731.

[3] Harris, E. C. & Barraclough, B. (1997). Suicide as an outcome for mental disorders: a meta-analysis.
British Journal of Psychiatry, 170(3), 205-228.

[4] Bodell, L. P., Forney, K. J., Keel, P. K., Gutierrez, P. M., & Joiner, T. E., Jr. (2014). Consequences of making weight: a review of eating disorder symptoms and diagnoses in the United States military.
Clinical Psychology: Science and Practice, 21(4), 398-409.

[5] Forman-Hoffman, V. L., Mengeling, M., Booth, B. M., Torner, J., & Sadler, A. G. (2012). Eating disorders, post-traumatic stress, and sexual trauma in women veterans.
Military Medicine, 177(10), 1161-1168.

[6] Carlton et al. Mil Med. 2005;170:663-7; Lauder et al. Med Science Sport Exer. 1999;31:1265-71; McNulty. Mil Med. 1997;162:753-8; McNulty. Mil Med. 2001;166:53-8.

[7] Bodell, L. P., Forney, K. J., Keel, P. K., Gutierrez, P. M., & Joiner, T. E., Jr. (2014). Consequences of making weight: a review of eating disorder symptoms and diagnoses in the United States military.
Clinical Psychology: Science and Practice, 21(4), 398-409.; Waasdorp, C. E., Caboot, J. B., Robinson, C. A., Abraham, A. A., & Adelman, W. P. (2007). Screening Military Dependent Adolescent Females for Disordered Eating. Military Medicine, 172(9),
962-967. doi:10.7205/milmed.172.9.962

[8] Forman-Hoffman, V. L., Mengeling, M., Booth, B. M., Torner, J., & Sadler, A. G. (2012). Eating disorders, post-traumatic stress, and sexual trauma in women veterans.
Military Medicine, 177(10), 1161-1168.

 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

June XX, 2018

The Honorable Gene L. Dodaro

Comptroller General of the United States

Government Accountability Office

441 G Street NW

Washington, D.C. 20548

 

Dear Comptroller General Dodaro:

We request that the Government Accountability Office (GAO) conduct a comprehensive study on the Department of Defense’s (DOD’s) TRICARE and Military Health System to evaluate the scope, prevention, and treatment of eating disorders affecting military members
and their families.

Eating disorders, including anorexia, bulimia, and binge eating disorder, affect 30 million Americans during their lifetime, encompassing every age, gender, body size, socioeconomic status, and race.[1]  Eating
disorders have the highest mortality rate of any psychiatric illness[2], with suicide rates being 23% higher than that of the general population.[3]  Studies show that
eating disorders affect our servicemembers and veterans at a higher rate than the civilian population, with estimated rates of up to 10% of male and female military personnel affected by an eating disorder.[4]
[5]
[6]
  Research suggests there may be an even greater prevalence rate due to lack of reporting, with 34% of female active duty servicemembers and 20% of children of servicemembers scoring at risk for an eating disorder.[7] 
Additionally, a study of female veterans found significant relationships between increased risk of eating disorders and military members with history of Post-Traumatic Stress Disorder (PTSD) and sexual trauma.[8]

Untreated eating disorders can lead to co-occurring issues including suicide, PTSD, substance use disorder, as well as physical issues like stress fractures, cardiac arrhythmias, obesity, and cognitive issues like slowed reaction time, and decrements in
executive function.[9]  Given the need to ensure the quality of mental health and wellness for our military members and their families, and guarantee military readiness, it is critical to ensure the access and
availability of treatment and care for our military members and their families with eating disorders. Specifically, we request that GAO assess DOD’s TRICARE and Military Health System to answer the following questions:

  1. What steps is the military taking to screen for and prevent eating disorders within servicemembers during the entire life cycle of service including recruitment, basic training, active duty service, physical fitness test requirements, and discharge?
  2. How many military members and military family members have sought treatments for an eating disorder?
  3. A comprehensive review of the availability and access to eating disorder treatment for military members and their families, including, but not limited inpatient, residential, partial hospitalization, day program, intensive outpatient, and outpatient
    treatment, including:

    1. TRICARE coverage for all Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM 5) eating disorders for military members and their families of all ages, including anorexia nervosa, bulimia nervosa, and binge eating disorder;
    2. Geographical proximity for military members and their families for all levels of care, including inpatient, residential, partial hospitalization, day program, intensive outpatient, and outpatient treatment; and
    3. Any eating disorder treatment limits for military members and their families to receive comprehensive treatment.

We request this study be completed before December 14, 2018. We also request periodic briefings on your joint findings at least every three months prior to the release of the final report. Please contact Raymond Celeste on Congressman Walter Jones’ staff
at Raymond.Celeste@mail.house.gov and Christine Raymond on Congressman Seth Moulton’s staff at
Christine.Raymond@mail.house.gov  with any questions.

Thank you for your timely attention to this request. We look forward to working with you and learning more about the challenges and opportunities surrounding military members and their families with eating disorders and treatment thereof. 

Sincerely,

Seth Moulton                                                                           Walter Jones

MEMBER OF CONGRESS                                                    MEMBER OF CONGRESS

 


[1] 1. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.
Biological Psychiatry, 61(3), 348-358.

[2] Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.
Archives of General Psychiatry, 68(7), 724-731.

[3] Harris, E. C. & Barraclough, B. (1997). Suicide as an outcome for mental disorders: a meta-analysis.
British Journal of Psychiatry, 170(3), 205-228.

[4] Bodell, L. P., Forney, K. J., Keel, P. K., Gutierrez, P. M., & Joiner, T. E., Jr. (2014). Consequences of making weight: a review of eating disorder symptoms and diagnoses in the United States military.
Clinical Psychology: Science and Practice, 21(4), 398-409.

[5] Forman-Hoffman, V. L., Mengeling, M., Booth, B. M., Torner, J., & Sadler, A. G. (2012). Eating disorders, post-traumatic stress, and sexual trauma in women veterans.
Military Medicine, 177(10), 1161-1168.

[6] Carlton et al. Mil Med. 2005;170:663-7; Lauder et al. Med Science Sport Exer. 1999;31:1265-71; McNulty. Mil Med. 1997;162:753-8; McNulty. Mil Med. 2001;166:53-8.

[7] Bodell, L. P., Forney, K. J., Keel, P. K., Gutierrez, P. M., & Joiner, T. E., Jr. (2014). Consequences of making weight: a review of eating disorder symptoms and diagnoses in the United States military.
Clinical Psychology: Science and Practice, 21(4), 398-409.; Waasdorp, C. E., Caboot, J. B., Robinson, C. A., Abraham, A. A., & Adelman, W. P. (2007). Screening Military Dependent Adolescent Females for Disordered Eating. Military Medicine, 172(9),
962-967. doi:10.7205/milmed.172.9.962

[8] Forman-Hoffman, V. L., Mengeling, M., Booth, B. M., Torner, J., & Sadler, A. G. (2012). Eating disorders, post-traumatic stress, and sexual trauma in women veterans.
Military Medicine, 177(10), 1161-1168.

[9] Hudson et al. Biol Psychiatry. 2007;61:348-58; Treasure et al. Anorexia nervosa. Nat Rev Disease Primers. 2015;1:15074

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