Senators on the Armed Services Committee introduced bipartisan legislation Wednesday that would expand access to eating disorder treatment for service members, their families and retirees.

The proposed bill, the Supporting Eating Disorders Recovery Through Vital Expansion, or SERVE, Act, is similar to one introduced in May by combat veterans and House members Brian Mast, R-Florida, and Seth Moulton, D-Massachusetts, that would require military leaders be trained to recognize the signs of eating disorders in service members and expand coverage for care.

The legislation would require Tricare to cover inpatient or residential services, partial hospitalization and intensive outpatient or outpatient services at facilities certified by the military health program that can demonstrate their treatment programs are effective.

The bill also seeks to provide services to military family members “without regard to the age of the dependent.”

While eating disorder diagnoses among active duty personnel remain relatively rare, they do carry grave consequences for those who struggle with them.

Eating disorders have the second highest mortality rates of any mental health illness, due to physical risks and elevated risk of suicide, second only to substance use disorders.

Between 2013 and 2017, 1,788 active duty service members were diagnosed with an eating disorder -- either anorexia nervosa, bulimia nervosa or unspecified eating disorder -- according to the Armed Forces Health Surveillance Branch.

The rate among military women was 11 times the rate among men. At highest risk for developing eating disorders were white women ages 20 to 24, according to the June 2018 Medical Surveillance Monthly Report.

By service, female Marines had the highest rate of diagnosed eating disorders, nearly twice that of the other military services, at 20.4 per 10,000 persons. The Army was second at 11.9 per 10,000, the Navy third, 11.4 per 10,000, followed by the Air Force, at 10.4 per 10,000.

For men, the rates were 1.2 per 10,000 in the Army, 1.1 per 10,000 in the Marine Corps and .9 and .8 per 10,000 respectively for the Air Force and Navy.

“Results of the current study suggest service members likely experience eating disorders at rates comparable to rates in the general population and that rates for these disorders are potentially rising among service members,” the authors noted.

But the Eating Disorders Coalition, a consortium of associations, facilities and family members who advocate for eating disorder research, education and legislation, argues that military members and families actually have higher prevalence rates of eating disorders than the civilian population, and an estimated 7 percent to 8 percent of all troops may be affected.

“Particularly, research shows that 34 percent of female active-duty service members and 20 percent of female adolescent dependents are at risk of an eating disorder, and 16 percent of female veterans are affected by an eating disorder,” Coalition members wrote in a release.

Tricare, the military’s health program currently covers eating disorder treatments as part of its mental health coverage, but it does not cover treatment at freestanding eating disorder centers “as they don’t meet the requirements to be Tricare-authorized providers,” according to the Tricare website.

Adequate care also can be challenging for patients to obtain given the mental and physical aspects of eating disorders such as anorexia nervosa and bulimia, which often require a team of physicians to address.

The SERVE Act would broaden treatment options for military personnel, retirees and their family members and increase early identification in troops, Shaheen and McSally said in a release.

“Eating disorders are serious mental health illnesses that should be treated with the same urgency as any physical illness, and that’s especially true for our service members," Shaheen said.

“Over 30 million Americans suffer from an eating disorder with our service members and their families suffering at even higher rates than their civilian counterparts,” McSally said. “The SERVE Act would ensure that those who fought for us can access necessary recovery treatment under Tricare and that our commanders and supervisors are equipped to identify the signs and symptoms of mental health disorders.”

Both bills have been referred to their chambers’ respective Armed Services committees.

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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