Backing the SERVE Act: Eating Disorder Care in the Military
When I started my military career, the thought of me developing an eating disorder was improbable and impossible. Less than a year later, a near-death experience as a volunteer firefighter triggered the development of Post-Traumatic Stress Disorder (PTSD), which was accompanied by depression, anxiety, and ultimately an eating disorder.
My eating disorder initially presented as a renewed interest in intentional movement and mindful eating, proving that “wellness” can be a dangerous thing. My story is not unique—there is a strong correlation between PTSD (as well as military sexual trauma) and the development of eating disorders. You cannot tell who has an eating disorder just by looking at their weight. Despite this, insurance companies frequently use Body Mass Index (BMI) to determine whether individuals are “sick enough” to qualify for eating disorder treatment.
In the grand scheme of things, I was lucky. I was the stereotypical eating disorder patient—an underweight, white woman, refusing to eat, and terrified of weight gain. My disorder was noticed, and I got treatment. Most people are not as fortunate. I’m a military physician and psychiatry resident who still struggled to get the care I needed under TRICARE despite the help of an engaged team of healthcare providers and intimate personal knowledge of the healthcare system. If I found the process so challenging, despite all of these advantages, how can we expect our junior sailors and soldiers to navigate this system for themselves and their families?
Getting treatment isn’t easy, even if you have insurance. Finding an eating disorder specialist who takes insurance is a challenge, and treatment is prohibitively expensive without insurance support. At times, my primary care doctor, a nurse case manager, a nonmedical case manager, the eating disorder helpline, and the alumni services coordinator from the treatment center I attended all helped me try to identify an eating disorder dietitian who took my insurance. We found one practice, but they weren’t taking new patients. I ended up disengaging with my dietitian due to cost, which ultimately set my recovery back. And resorting to seeing whichever provider is covered isn’t a good alternative. Seeing a provider who isn’t well-informed about eating disorders can be as harmful as no treatment at all.
Finding providers who take insurance and have experience treating eating disorders is possibly more challenging than recovery itself. Given the number of affected individuals, this is surprising. Roughly 30 million Americans will be affected by an eating disorder in their lifetime—that’s nearly 1 in 10. Within the military it is estimated that 1/3 of active duty females are at risk for developing eating disorders and 1/5 of children of active duty service members are also at risk—a rate 3 times higher than their civilian peers. Early recognition and prompt treatment are crucial and can change the disease trajectory, but that’s nearly impossible right now. Ironically, not treating an eating disorder is more expensive to the U.S. economy and government than treating it. A recent report from Harvard University’s STRIPED, Academy for Eating Disorders, and Deloitte Access Economics estimated that eating disorder cost society and the American economy $64.7B per year.
However, there is a bipartisan proposal in Congress from Reps. Moulton and Mast and Sens. Shaheen and McSally aimed at addressing the issue of eating disorders in the military called the SERVE Act. It is currently being considered for inclusion within the FY21 National Defense Authorization Act (NDAA). If enacted, the SERVE Act would remove restrictions that make it difficult for freestanding treatment facilities, which cover 80% of the residential treatment programs in the U.S., to contract with TRICARE. The SERVE Act will also make it easier for military dependents to access treatment for eating disorders. Right now, only those under the age of 21 can access residential treatment, which can be a lifesaving step in the recovery process.
At its core, this is an education problem. Eating disorders are misunderstood, even when compared to other mental illnesses. They are the second deadliest mental illness, following opioid use disorder. And they are about far more than food and weight and body image. We need to expand education about eating disorders, in our healthcare providers, in our schools, and in our leaders. The SERVE Act will target this as well — expanding the education and training on mental illness early identification that is provided to Commanding Officers and Supervisory personnel. My eating disorder nearly killed me. It nearly ended my military career. If there’s something, anything, that we can do to help more people access care for these deadly illnesses, why haven’t we? Eating disorders are not a quirk or a character flaw or a diet. They’re a life threatening mental illness, and it’s time that we started treating them as such.
*The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.
Meghan Quinn, MD is a psychiatry resident who has served as a military officer.