Military-Related Weight Stigma Prospectively Predicts Dietary Restraint During Pregnancy in US Military Active-Duty Service Members: A Longitudinal Observational Study

Background: The most common type of stigma that active-duty US military service members report experiencing is body shape/weight stigma. One third of service members (male and female) engage in aberrant restrictive eating in response to stigma. After a postpartum grace period, service members are required to meet strict body composition standards to maintain service eligibility. Approximately 50% to 90% of pregnant civilian individuals experience food cravings, which are associated with lower diet quality and excess energy intake. However, no prospective study has examined military-related weight stigma in relation to eating behaviors in pregnant service members. Objective: The study examined prospective associations of military-related weight stigma in the prior year with dietary restraint and food cravings in pregnant active-duty service members. Design: In this longitudinal observational study, participants completed surveys assessing military-related weight stigma in the past year and eating behaviors at 2 times, 3 months apart (during the second and third trimesters). Given the online nature of the study, participants were not geographically limited. Enrollment took place between April and October 2023. Participants: One hundred eighty active-duty service members (ages 20–41 years, 66% White, 23% Black/African American) who were between 12 and 27 weeks’ gestation participated in the study. Main Outcome Measures: The Eating Disorder Examination Questionnaire (EDE-Q) assessed cognitive/behavioral dietary restraint, and the Food Craving Inventory for Pregnancy assessed food cravings. Statistical Analyses Performed: Linear regression models evaluated associations of military-related weight stigma in the past year (assessed at the second trimester) with dietary restraint and food cravings (third trimester). Covariates included baseline scores on outcome measures, age, gestation, race, pre-pregnancy body mass index (BMI), gestational weight gain, and military rank. Results: Approximately 47% of pregnant service members reported experiences of being laughed at because of their weight or shape. Adjusting for covariates, weight stigma in the past year was prospectively associated with greater third-trimester dietary restraint (β = .35, SE = 0.07; P < .001) but not food cravings (β = .10, SE = 0.07; P = .15). Conclusions: Service members’ military-related weight stigma experiences may exacerbate dietary restraint during pregnancy. Because weight gain is expected and healthy during pregnancy, research should investigate potentially modifiable institutional sources of stigma.