O3329: Prevalence and risk factors of disordered eating behavior in military dependent adolescents seen for well visits

Background: Disordered eating behavior (DEB) is increasingly common, and military personnel and their dependents may be at increased risk. DEB prevalence in the general military dependent population, and the risk that gender and sex confer on DEB risk in military dependents, have not been well described. We recently found DEB prevalence in military dependents seen in adolescent subspecialty clinic was 13%, with no difference between males and females.

Objective: 1) Estimate the prevalence of DEB in military dependents seen in general pediatric (GP) clinic and investigate whether female gender, sex, and obesity are associated with higher DEB risk to internally validate previous findings. 2) Compare DEB in GP clinic to adolescent clinic.

Methods: Retrospective cross-sectional internal validation study of military dependents aged 11–19 years seen in the GP clinic at a naval medical center for routine health encounters. We excluded patients with diabetes, significant developmental delay, and those presenting for acute concerns. We collected data from electronic health record abstraction, including results of Children’s Eating Attitude Test-26 (ChEAT-26) disordered eating screening questionnaire. We estimated DEB risk by obesity, gender, sex using bivariate generalized linear models. We performed a pooled secondary analysis with previously collected adolescent clinic data and tested for effect modification by clinic.

Results: Of 127 participants in GP clinic, 104 had complete data including ChEAT-26 scores. The population was 55% female gender (two participants with male sex had female gender) and 16% had obesity. DEB prevalence was seven percent. There was no significant higher risk of positive screen by obesity or female sex or gender. When analyzing the associations with overall ChEAT-26 scores, 1-unit higher BMI z-score was associated with a higher ChEAT-26 score (unadjusted β 0.32, 95% CL 0.11 to 0.53). Gender, sex, and other BMI variables were not associated with a higher ChEAT-26 score. In the secondary analysis, there was no difference in positive DEB screen or ChEAT-26 score between clinics. In the combined analysis, there was a higher risk of positive ChEAT screen per 1-unit higher BMI (adjusted RR 1.1, 95% CL 1.04 to 1.17), 1-unit higher BMI z-score (adjusted RR 1.92, 95% CL 1.24 to 2.98), and 10-unit higher BMI percentile (adjusted RR 1.3, 95% CL 1.06 to 1.58). Gender and sex were not associated with a higher risk of a positive screen. There was no significant effect modification based on clinic.

Conclusion: DEB prevalence in military dependents seen for annual health visits is estimated at 7-13% regardless of type of clinic, and higher BMI is associated with higher risk of DEB in this population. Military-dependent males may have comparable DEB prevalence to females, reinforcing the importance of universal DEB screening in adolescents, and of changing the narrative of who is at risk for DEB.