Table of Contents
Introduction
Based on various studies and research conducted obesity is a common issue in the US. In fact, there are distracting news that obesity is common in the veteran people (Almond et al, 2008). Thus the question of why the veteran population is at high risk of obesity are concerning and the main focus of this investigation will be the common variables and phenomenon. The primary question: are veterans who suffer from PTSD at high risk of obesity compared to those who don’t? Post Traumatic Stress Disorder is a mental disorder that one develops after experiencing threatening or horrifying events (Pitman et al, 2012). Every day on our daily headline news we see reports of violence, deaths and injuries. PTSD is psychopathological most prevalent cause of trauma where it varies according to social background and residing country with the core features of this disorder being distressing, persistence of intense and fearful avoidance to events that reminds one of the horrible experience (Aga-Mizrachi, et al 2014) Those who suffer from PTSD normally relieve their experience through nightmares and flashbacks and they have difficulties in sleeping. Studies carried out recently have shown that incidences of PTSD and obesity are on the rise and that individuals who have PTSD are more likely to suffer from obesity. Post-traumatic disorder appears to increase the risk of obesity in which the link between the two occurs since PTSD influences eating behavior (Seal et al 2009).
Literature Review
This section will provide an assessment for resources that provide support to the hypothesis. A variety of this sources confirm that veterans members are suffering more from obesity than those not in the military service. Again the initial investigative question for this paper is to determine whether veterans with PTSD are at high risk of obesity and initial results support this hypothesis. A number of factors increase the risk of metabolic syndrome. For instance, excess calorie intake, stress, decreased activity and energy usage. The nurses’ health study II confirmed a lifetime trauma in 2008and food addiction in 2009. PTSD symptoms were strongly associated with food addiction. According to Violanti et al. (2006), the circumference shaped waist of police officers is related to PTSD since they are commonly exposed to traumatic events in their lives. Other researchers also found a relationship between PTSD and obesity (Rosenbaum et al., 2015)
Description of the Search Methods
A search onto the published literature was conducted that included PubMed, Cochrane and PsycINFO for articles. The search term used for this search on the information that links PTSD to obesity was used. Such terms included the following; PTSD, post-traumatic stress disorder, nutrition, disorder eating, obesity, eating behavior, and inactivity (Hryhorczuk, Sharma & Fulton, 2013). This study concentrated to military service members and veterans although it gave limited information thus expanding the search to include adults regardless of whether they are from military or veterans. Also, our medical library was consulted to make sure that the procedures we used for our search was appropriate and sufficient and it met our study objectives. We selected observational studies to estimate the prevalence of obesity in a sample of the population with PTSD and without PTSD. Recent research indicates that stress potentiates the development of obesity and other factors of metabolic syndrome in an experiment done by feeding a mice to sugary, fat and high caloric diet. When handling the mice, all the rules relating to the protection of live subjects was observed. Studies that gave information showing the relationship between PTSD and physical activities were included. However, since we are interested in the eating behavior that relates to PTSD, eating behaviors that had not separated binge eating from other forms of eating was not included in the study as well as those studies that didn’t show access to PTSD signs and symptoms (Worthen & Moering, 2011). Moreover, methodologically, studies that had a sample size of less than 25 were not used. Data collected from each research included the study designs, individuals who shown signs or symptoms of PTSD, study location, physical activity, initial results of the study and statistical association between PTSD and eating behavior.
Summarization of the Research Studies Used as Evidence
The following studies were used in support of the hypothesis and they have been listed alphabetically according to the author’s last name. This section will, therefore, include the components of every case to enable the readers to evaluate them as well as list their merits and their strengths and weaknesses.
The prevalence of overweight and obesity among US veterans by Almond, N., Kahwati, L., Kinsinger, L., & Porterfield, D. (2008). Military Medicine, 173(6), 544-549.
The increased overweight and obesity issues burden the defense department with costs whereby the time of printing the article a budget of $36 billion was incurred which double today. The research used a variety of data analysis for both veteran and nonveteran men and women from different races, different age and income. The results indicated that male veterans have a high risk to obesity than the nonveteran men and the female had a lower risk compared to their counterparts. Males in the military service aged 35-54 have a high risk of obesity than non-veterans men of the same age group. The write admitted too several research limitations like a lot of the data was self-supported. However, the article was strong in terms of the information availed. The author state that understanding the information provided will help in preventive efforts and also changing the behavior of the nonmilitary members.
Weight management for veterans: examining change in weight before and after MOVE! By Dahn, J. R., Fitzpatrick, S. L., Llabre, M. M., Apterbach, G. S., Helms, R. L., Cugnetto, M. L., … & Lawler, T. (2011). Obesity, 19(5), 977-981.
This was a program that only targeted the overweight and obese veterans and those who participate in the program lost some weight. This study was quasi-experimental and the data only examined the successfulness in execution and effectiveness of the program that happened in Miami. The demerits of the study are that it was only carried out for seven months, and only in one health center which doesn’t represent the other health centers.
Physical activity in the treatment of post-traumatic stress disorder: a systematic review and meta-analysis by Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015). Psychiatry research, 230(2), 130-136.
This article looked into the effects of physical activities on PTSD and it targeted people with this disorder. A search from electronic databases of physical activity of people with PTSD was used. The information is helpful since physical activity is used to improve the health of people with PTSD. Nevertheless, there was inadequte data to investigate the outcomes.
Violanti, J. M., Fekedulegn, D., Hartley, T. A., Andrew, M. E., Charles, L. E., Mnatsakanova, A., & Burchfiel, C. M. (2006). Police trauma and cardiovascular disease: association between PTSD symptoms and metabolic syndrome. International journal of emergency mental health, 8(4), 227-237.
This study was aimed at identifying the life expectancy of police officers and how trauma is associated with heart diseases. The sampling method was used to collect data of the expectancy level of police officers with PTSD and their chances of getting metabolic syndrome. This study, however, was not inclusive of everyone as it was limited to the white male officers only since women were few as well as the minority. This information can be used to help raise the expectancy level of police officers suffering from PTSD as well as the general public.
Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., … & Liberzon, I. (2012). Biological studies of posttraumatic stress disorder. Nature reviews. Neuroscience, 13(11), 769.
This article was obtained from Pub Med and gives us the general information concerning PTSD. PTSD is caused by traumatic events and experiences. Experimental studies like measuring the heart rate were used. Readers can better understand PTSD from the biological point of view. Abnormalities that influence the traumatic events have been identified in the study. The major limitation of this study is the reliance on the cross-sectional designs for PTSD patients as it is difficult and expensive to perform.
Hryhorczuk, C., Sharma, S., & Fulton, S. E. (2013). Metabolic disturbances connecting obesity and depression. Frontiers in neuroscience, 7.
The article examines the metabolic activities that have a relationship with depression and obesity. Obesity is experienced as a result of high energy intake. The data can help us in choosing the food to take and avoid emotional reactions to food. The difficulties experienced were in establishing a direct contact between obesity and metabolic syndrome.
Worthen, M. D., & Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders. Psychological Injury and Law, 4(3-4), 187-216.
This particular study suggests that veterans should be compensated for their services. There is a limited fund to care for the veterans. The information in this study is relevant to the hypothesis since veterans with PTSD need to feel supported and compensated for them to seek good medical care. The aim of the study was to list all compensation and exams that can be taken for PTSD and other mental illness and study them qualitatively.
Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American journal of public health, 99(9), 1651-1658.
The researchers provided us with data about the risks and trends for diagnosis of mental illness among veterans who fought in Iraq and Afghanistan. The authors used data from National Veteran Affairs. Age was also found to be a factor in those who are highly at risk for obesity and PTSD where youths had high rates of PTSD. Early interventions to help those joining the military would reduce mental illness.
Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C. (2014). The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA psychiatry, 71(1), 44-51.
The aim of this study is to determine whether women who have shown mental disorders symptoms can gain weight compared to their counterparts. The observational study was used after which trauma and PTSD symptoms were measured as well as questionnaires to acquire the weight and height of the participants.
We can do it today.
Hartley, T. A., Burchfiel, C. M., Fekedulegn, D., Andrew, M. E., & Violanti, J. M. (2011). Health disparities in police officers: comparisons to the US general population. International journal of emergency mental health, 13(4), 211.
Police officers due to the nature of their job are most exposed to PTSD as the data shows that they even have a circumference shaped waist. The events that they undergo and experiences increase their chances to mental disorders and other related diseases. Depression can affect the way police officers perform their duties hence health should be improved. Peer-reviewed publication and government reports or websites were used to obtain values and variables in this study.
Differences between the Two Chosen Articles
The quantitative article chosen is Weight management for veterans: examining change in weight before and after MOVE! By Dahn, J. R., Fitzpatrick, S. L., Llabre, M. M., Apterbach, G. S., Helms, R. L., Cugnetto, M. L., … & Lawler, T. (2011). Obesity, 19(5), 977-981 and for the qualitative article I chose Worthen, M. D., & Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders Psychological Injury and Law, 4(3-4), 187-216. The difference between these articles is the objective of this qualitative is to explore and discover ideas while the objective of a quantitative research is to examine cause, effect and relationship between variable. Also, the purpose of quantitative research is to quantify the data but for qualitative is to understand the reasons.
Results
This study involves samples ranging from treatment; those seeking treatment and those not seeking treatment in a community, military service members and veterans. Difficulties in summarizing the data were faced due to sample heterogeneous although it added the strength of generalization. A total of 113, 56,150 results were generated from PubMed, Cochrane and PsycINFO respectively. Although there are a large number of articles on post-traumatic stress disorder and health in the previous years, few articles focused on the relation between PTSD and eating behavior together with physical activity that could lead to obesity. Nine studies on PTSD and obesity were found and five studies on PTSD and eating behavior and physical activities were identified hence it is only 13 studies were found to be eligible. A series of studies show that there is an association between PTSD and obesity in veterans where patients with PTSD are more likely to develop obesity and cardiovascular diseases due to poor health lifestyles including lack of exercise and smoking. In a study carried out, veterans returning from war countries like Iran and Afghanistan were found to be obese (Hartley et al, 2011). These patients with PTSD are often on psychotropic medication which has an impact on weight gain conflicts the relation between PTSD and obesity (Dahn et al 2011). After reviewing both local and national health databases, PTSD was shown to be the most risk factor to obesity. Comparing men and women, veteran women with PTSD had a more probability of contracting obesity than their male counterpart (Spitzer et al, 2009; Kubzansky et al, 2014)
An analysis approach was not possible to be used given the different study designs and methodologies used. During the experiment, different instruments were used hence PTSD outcome was not consistent throughout and also the methods used to examine the results were different as still is the case with dietary and physical activity resulting to the use of comprehensive and descriptive data review of the literature. The prevalence of obesity issues was common to veterans who have PTSD compared to those who did not have the disorder. Also, women had higher rates of obesity than men by 69%. The results from the observation of the study were slightly different with half of the studies showing a negative relation between PTSD and physical activity and the remaining half showed positive results between the relation of PTSD and obesity.
Discussion
Studies have shown that individuals who suffer from PTSD are likely to suffer from obesity. As the facts continue to be presented showing the increased risk of obesity among those who have PTSD so the health community admits that PTSD is more than just mental illness. Despite some limitation, individuals who suffered from PTSD were found to be at a higher risk for obesity. The key limitation is that the study was based on primarily and blinded studies. Also, the evidence found had unclear applicability to veterans and even though the majority of the studies were conducted to military service members, most of them were on active duty. Thus individuals with PTSD should be placed under good care and given the right medication to minimize the risk of obesity. Although those various researches showed an association between PTSD and obesity, there needs to be more research to explain this association in details.
- Dahn, J. R., Fitzpatrick, S. L., Llabre, M. M., Apterbach, G. S., Helms, R. L., Cugnetto, M. L., … & Lawler, T. (2011). Weight management for veterans: examining change in weight before and after MOVE!. Obesity, 19(5), 977-981.
- Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015). Physical activity in the treatment of post-traumatic stress disorder: a systematic review and meta-analysis. Psychiatry research, 230(2), 130-136.
- Violanti, J. M., Fekedulegn, D., Hartley, T. A., Andrew, M. E., Charles, L. E., Mnatsakanova, A., & Burchfiel, C. M. (2006). Police trauma and cardiovascular disease: association between PTSD symptoms and metabolic syndrome. International journal of emergency mental health, 8(4), 227-237.
- Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., … & Liberzon, I. (2012). Biological studies of posttraumatic stress disorder. Nature reviews. Neuroscience, 13(11), 769.
- Hryhorczuk, C., Sharma, S., & Fulton, S. E. (2013). Metabolic disturbances connecting obesity and depression. Frontiers in neuroscience, 7.
- Worthen, M. D., & Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders. Psychological Injury and Law, 4(3-4), 187-216.
- Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American journal of public health, 99(9), 1651-1658.
- Spitzer, C., Barnow, S., Völzke, H., John, U., Freyberger, H. J., & Grabe, H. J. (2009). Trauma, posttraumatic stress disorder, and physical illness: findings from the general population. Psychosomatic Medicine, 71(9), 1012-1017.
- Hartley, T. A., Burchfiel, C. M., Fekedulegn, D., Andrew, M. E., & Violanti, J. M. (2011). Health disparities in police officers: comparisons to the US general population. International journal of emergency mental health, 13(4), 211.
- Aga-Mizrachi, S., Cymerblit-Sabba, A., Gurman, O., Balan, A., Shwam, G., Deshe, R., … & Zubedat, S. (2014). Methylphenidate and desipramine combined treatment improves PTSD symptomatology in a rat model. Translational psychiatry, 4(9), e447.
- Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C. (2014). The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA psychiatry, 71(1), 44-51.
- Almond, N., Kahwati, L., Kinsinger, L., & Porterfield, D. (2008).The prevalence of overweight and obesity among US veterans. Military Medicine, 173(6), 544-549.