Young adults 18-25 years of age, the largest demographic of the military, experience a high burden of obesity and eating disorders (ED) despite an emphasis on physical fitness, body composition, and operational readiness. Etiologic models for obesity and ED suggest body dissatisfaction (BD), dieting, negative affect (NA), and affect regulation represent potentially shared pathways. However, no studies have examined these factors and their shared pathways in military personnel, including ROTC cadets. The overarching aim of this dissertation research was to investigate if ED symptoms were associated with body mass index (BMI), an indicator of obesity, and to describe potential correlates of their development. Three specific aims of this research focus on: 1) the prevalence and correlates of ED risk classification and symptoms in ROTC cadets, 2) the association between ED symptoms and BMI, and their potentially shared mechanisms, psychological inflexibility related to BD and dieting, and 3) the gaps in knowledge about eating behaviors and mediators of eating behaviors within the ROTC context and from perspective of ROTC cadets.In 2018, US Army ROTC cadets (n = 205) were recruited from two Midwestern universities and completed questionnaires about demographics, military-specific eating behaviors and mediators of eating behaviors, ED symptoms, and anthropometric measures. Chi-square, multivariable logistic regression, and multiple linear regression were performed in determining the rate of ED risk classification and correlates of ED risk classification and symptoms (Aim 1). Two measures of psychological inflexibility related to BD and dieting, in addition to the data for Aim 1, were used in mediation path analysis to examine the association of ED symptoms to BMI, and the indirect effects as mediated by psychological inflexibility related to BD and dieting (Aim 2). A purposively selected sample of eighteen cadets participated in one-on-one, semi-structured telephone interviews on eating behaviors and their mediators in the context of ROTC (Aim 3). Interviews were analyzed using thematic analysis to identify the most important themes and determinants related to eating behaviors in ROTC cadets.We found that ED symptoms and ED risk classification are prevalent in a sample of US Army ROTC cadets (10.1% of sample). Correlates associated with greater likelihood of ED risk classification and elevated ED symptoms were: sex, dieting, and military contextual factors such as attempting dieting and weight loss to meet body composition standards, and peers' comments on weight. Total ED symptoms scores were positively associated with BMI and partially mediated by psychological inflexibility related to BD and dieting. Cadets discussed perceived determinants of eating behaviors which included traditional determinants (e.g. time, money, nutrition knowledge) and ROTC-context specific determinants (e.g. preparation for body composition assessments and body image perceptions), which contributed to unhealthy weight control behaviors (dieting) and negative body image perceptions (BD) for some cadets. In conclusion, the prevalent correlates for eating disorder symptoms and risk in the sample of US Army ROTC cadets in this study were factors related to the enforcement of body composition standards and body image perceptions in the military context which may contribute to the development of dieting, BD, and NA. Longitudinal and/or intervention studies on this important topic may benefit our understanding of how ED symptoms and obesity develop over time and how targeting dieting, BD, NA, and affect regulation may be leveraged to mitigate ED and obesity to promote physical fitness, operational readiness and health in military personnel.
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