Demetrios A. Julius

Posttraumatic stress disorder as a risk factor for obesity among male military veterans

Objective:  Obesity is a significant public health problem in the United States, particularly among military veterans with multiple risk factors. Heretofore, posttraumatic stress disorder (PTSD) has not clearly been identified as a risk factor for this condition.

Posttraumatic Stress Disorder and Body Mass Index in Military Veterans: The Richmond Experience

ABSTRACT Military veterans suffering from Posttraumatic Stress Disorder (PTSD) often have comorbid conditions including obesity. They may become disabled either from these comorbid conditions or from PTSD (or from both). Service-connected disability (SCD) is a concept employed by both the Department of Defense and the Department of Veterans Affairs to identify and compensate military veterans with such disabilities. SCD could serve as a measure of the functional impact of PTSD and comorbid obesity and other medical conditions. We reviewed the database of the recently constituted PTSD program at Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia. Variables assessed included 1) age, 2) decade of life, 3) height, 4) weight, 5) sex, 6) race, 7) employment status, 8) presence or absence of comorbid psychiatric conditions, 9) presence or absence of comorbid medical conditions, and 10) degree of disability. From the height and weight measurements, we calculated body mass index (BMI). We used SCD to estimate degree of disability in terms of total disability (total SCD) and disability ascribed to PTSD (PTSD-SCD). Results indicated that the mean BMI of the study population was 30.3±5.7 kg/m2. This value was consistent with the current definition of obesity. 83.8% of our study population was either overweight or obese. This rate exceeded the US general population level of 64.5%. SCD and comorbid medical conditions had statistically significant relationships with obesity. Race was almost a statistically significant predictor of obesity. Decade of life, employment status and presence/absence of comorbid psychiatric condition did not separate the obese veteran from the non-obese veteran. Analysis of variance (ANOVA) revealed statistical significant differences in BMI (df = 4, F = 2.921, p = 0.022)among various levels of SCD suggesting a threshold effect. PTSD-related SCD, however, did not have a significant relationship with BMI. The prevalence of overweight and obesity among our sample of veterans with PTSD exceeded current U.S. population rates. Comorbid medical conditions may predispose veterans with PTSD to obesity. SCD had a significant relationship with BMI in that there was a threshold effect in which 30% or greater SCD identified veterans with obesity. The cross-sectional nature of the study and the absence of control populations limit the conclusions that may be drawn from our study. Clearly, more definitive studies are needed with much larger study populations.

Biculturalism and International Interdependence

One of the most intensely motivating forces in the last few decades has been the urge within the individuals of the modern world to get back to their origins. There has begun a deep and probing search for one’s roots, one’s basis, one’s foundation. Continuously over these years, voices have been raised in defense of and in proud declaration of their own particular racial or ethnic origins. In an effort to counteract feelings of alienation, emptiness, and meaninglessness engendered by our increasingly complex and technological world, individuals have turned to re-discovering, embracing, and asserting their perceived basic origins. This urge is certainly apparent in the Black Movement, the American Indian Movement, and even in the Youth Movement of the 1960’s which urged “a return to the land” and a return to basic values. Consequently, many of the ethnic groups have had a resurgence of pride in their heritage. This has been especially fostered by the younger members of these groups.

Acculturation Stress of Americans Overseas

Hundreds of thousands of Americans have travelled to foreign lands in search of adventure and financial gain. These people have worked for the U.S. military, the U.S. Foreign Service, the oil companies, and various other multinational corporations. Many have left the United States believing that adjustment would be no problem, and that the rewards far outweighed the risks. Some were led to this thinking by incomplete or incorrect orientation by their sponsoring organizations; others deceived themselves and their family members into thinking all would be just as in the United States; and still others had no choice since unemployment in the United States was the alternative to a job in Baghdad.