Eating disorders (EDs), encompassing conditions like anorexia nervosa and bulimia nervosa, significantly impair physical and mental health. Several factors contribute to EDs in military populations, including trauma, PTSD, depression, and substance dependence. Pre-pandemic ED prevalence was estimated at 0.91% globally, with higher rates observed in military women (5-8%). The COVID-19 pandemic exacerbated EDs due to social restrictions, disrupted routines, and increased stress. Governments increasingly relied on armed forces during the pandemic, making this group vulnerable to behavioral problems. While some research has highlighted stressors such as nervousness and sadness among Peruvian military personnel during the pandemic, limited evidence exists on its impact on eating behaviors. This study aimed to determine the prevalence and associated factors of eating disorders among military personnel in Lambayeque, Peru, during the COVID-19 health emergency in 2021.

Existing literature highlights the increased risk of eating disorders in military personnel due to various factors such as military-related trauma, exposure to violence, strict physical fitness requirements, and the mental health challenges associated with military service. Pre-pandemic studies indicated a significant prevalence of eating disorders, particularly among female military personnel. The COVID-19 pandemic introduced additional stressors, including social isolation, changes in lifestyle, and increased fear and anxiety, all of which have been shown to contribute to the development or worsening of eating disorders in the general population. However, research specifically addressing the impact of the pandemic on eating disorders within the military context remains limited, particularly in settings like Peru.

This study utilized a secondary data analysis from an analytic cross-sectional observational study conducted between November 2nd and 9th, 2021, in Lambayeque, Peru, a region heavily impacted by COVID-19. The primary study included 710 military personnel (86.6% of the 820-person population) actively involved in COVID-19 defense activities. This secondary analysis focused on 550 participants who completed the Eating Attitudes Test-26 (EAT-26), a self-report questionnaire assessing eating disorder symptoms. A score of 20 or more was considered indicative of eating disorder symptomatology. Other instruments used included the Insomnia Severity Index (ISI), Household Food Insecurity Assessment Scale (HFIAS), International Physical Activity Questionnaire (IPAQ-S), Connor-Davidson Resilience Scale (CD-RISC), Fear of COVID-19 Scale, Maslach Burnout Inventory, Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the PTSD Checklist-Civilian Version (PCL-C). Data were analyzed using descriptive statistics, chi-square tests, and generalized linear Poisson regression models to identify factors associated with eating disorder symptoms.

The study revealed a prevalence of eating disorder symptoms in 10.2% (56 out of 550) of the military personnel. Bivariate analysis showed significant associations between eating disorder symptoms and longer work duration (7–12 months and 19+ months), insomnia, fear of COVID-19, burnout syndrome, depression, anxiety, and post-traumatic stress disorder (PTSD). Multiple regression analysis confirmed that working 7–12 months (PR: 2.97; 95% CI: 1.24–7.11) or 19+ months (PR: 2.62; 95% CI: 1.11–6.17) in COVID-19 defense activities, fear of COVID-19 (PR: 2.20; 95% CI: 1.26–3.85), burnout syndrome (PR: 3.73; 95% CI: 1.90–7.33), and PTSD (PR: 2.97; 95% CI: 1.13–7.83) were independently associated with a significantly higher prevalence of eating disorder symptoms. While anxiety and depression were associated in the bivariate analysis, these associations were not maintained in the multiple regression model.

The findings indicate a concerning prevalence of eating disorder symptoms among Peruvian military personnel involved in the COVID-19 response. The association with prolonged work duration during the pandemic aligns with previous research showing increased eating disorder risk in essential workers facing prolonged exposure to high-stress environments. The strong association with fear of COVID-19, burnout, and PTSD suggests that the psychological burden of the pandemic and the demanding nature of frontline work significantly contributed to the development of eating disorders. The lack of association between anxiety and depression in the multiple regression model might be attributed to the masking effects of other significant variables, such as prolonged work exposure, burnout, and PTSD. Further research is needed to explore these complex relationships and to fully understand the mediating and moderating factors involved.

This study reveals a substantial prevalence of eating disorder symptoms among Peruvian military personnel engaged in the COVID-19 response. Prolonged work exposure, fear of COVID-19, burnout syndrome, and PTSD emerged as significant risk factors. These findings emphasize the urgent need for comprehensive mental health support and prevention programs tailored to address the unique needs of military personnel during and after crises. Future research should explore potential interventions to mitigate the risk of eating disorders in this population and investigate the long-term impact of pandemic-related stress on mental health and eating behaviors.

The cross-sectional design limits the ability to infer causality. Non-response bias and membership bias could affect the generalizability of the findings. Information bias associated with self-reported data and the use of a risk assessment tool (EAT-26) rather than a definitive diagnostic instrument should also be considered. The study's focus on a specific region of Peru limits the generalizability to other regions or countries. The absence of variables such as race, sexual disorder, social media addiction, self-esteem, and body satisfaction, which could be associated with eating disorders, should also be noted.