Racial, ethnic, and sex differences in eating disorder onset among US military service members.

Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. This study examined independent associations and interactions among sex, race, ethnicity, and probable BED and BN onset. The sample included 91 413 and 96 245 service members and veterans from the Millennium Cohort Study for BED and BN analyses, respectively. Up to 4 data points (2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, multiracial, Black, and Asian/Pacific Islander (API) service members, whereas BED was less likely among Black and API participants compared with non-Hispanic/Latinx White service members. Interactions revealed a greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed among racially and ethnically diverse groups to prevent and detect EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.