July 2013
Eating Patterns and Leisure-Time Exercise among Active Duty Military Personnel: Comparison to the Healthy People Objectives
Overweight and obesity continue to be a growing problem for many Americans. As a society we view health professionals, dietitians, and military personnel as the "healthy" Americans but studies are showing that there is a similar health risks associated with overweight status for active duty military personnel based on eating patterns and leisure-time activity. According to the World Health Organization (WHO), 33.8% of Americans are obese and since 1980, the world supports more than twice the obese population. Being overweight or obese increases the risk for developing chronic disease. Current military personnel are in line with the world population, 60% service members are overweight or obese.
The Healthy People 2010 objectives were used to assess active duty military personnel health status and risk for overweight and obesity. The objectives used for this study include physical activity and fruit, vegetables, and whole-grain consumption. Lifestyle factors and eating patterns were also addressed and the relationship to self-reported weight gain over the past year. The healthy people objectives are released by the US Dept of Health and Human Services every 10 years based on the information in the Dietary Guidelines for Americans (DGA) which are revised and released every 5 years. These guidelines are in place to maintain calorie balance over time to achieve and sustain a healthy weight, and consume nutrient-dense foods and beverages. The Healthy People objectives are implemented as a guideline for Americans to follow for making informed decisions regarding health and preventative measures.
The participants for this study include various rankings of active duty military personnel from the four branches of US military (Army, Navy, Marine Corps, and Air Force) male and female, with a variety of sociodemographic backgrounds. Food frequencies were used to determine the consumption of fruit, vegetables, whole-grains, lean meats, breakfast, fast food/food from outside the home, and other lifestyle factors such as smoking and alcohol abuse. Self-reported physical activity was also surveyed. Self-reported height and weight was used to determine BMI and recent weight gain over the past year was recorded. The DGA were used to determine the levels and quality of intake for the questionnaires. The final sample consisted of 16,146 active duty military personnel.
The results of the study show an extremely low prevalence of the population consuming at least one fruit and <10% reported eating vegetables three or more times per day. The majority of the population was in the overweight category for BMI. The consumption of whole-grains was also very low. More personnel reported consuming more low-fat or fat free dairy than regular dairy products as well as lean meats over other protein sources. Only 3% of all military personnel met the Healthy People 2010 objectives for fruit, vegetable, and whole-grain intake.
The participants reported eating meals
from home the most frequently. Dinner
was the most frequent meal eaten at home.
Breakfast was the most commonly skipped meal and lunch was the most
common meal eaten at a military dining facility or restaurant. Individuals who skipped breakfast were tat
least twice per week were significantly less likely to meet the objectives than
individuals who did not skip breakfast.
Individuals who ate out at least twice per week were also less likely to
meet the objectives for moderate or vigorous exercise and food intake. Those individuals who reported weight gain in
the past year were more than twice as likely to have skipped breakfast or
consumed a meal at or from a restaurant at least two times per week.
The primary aim of the study was to
determine the number of active duty military personnel who met the Healthy
People 2010 objectives. And to determine if there is a relationship between
demographic characteristics, lifestyle factors, and eating patterns on
achieving diet and exercise related objectives.
The military personnel met the objectives for exercise which may be due
to their physical fitness testing requirements but did not meet the objectives
for food intake.
There were significant relationships
between meeting the dietary and physical activity-related objectives and
demographic characteristics. The
likelihood of meeting the objectives in both categories decreased with an
increase in age. Consuming foods at or
from a restaurant and skipping breakfast also had an inverse relationship with
meeting the objectives for physical activity and dietary intake.
Comparing these findings with the
national statistics, the military population appeared to have better success in
meeting the objectives for daily vegetable and whole-grain intake than their
nonmilitary peers. Even with this
success in the military population in meeting dietary intake goals, neither
population is consuming the recommended amounts for fruits, vegetables, and
whole-grains. This is a concern for long
term health risks such as overweight and obesity, hypertension, diabetes, and cardiovascular
disease. Military personnel met the
physical activity objectives almost twice as much as their nonmilitary peers.
In conclusion, the number of meals
consumed at or from a restaurant is negatively correlated with meeting the
Health People objectives as well as skipping breakfast at least two times per
week. Military personnel are not exempt
from the low numbers of meeting the objectives but are doing significantly
better than their nonmilitary peers. The
US as a whole is not meeting the recommendations set by the Dietary Guidelines
for Americans for maintaining calorie intake and achieving and sustaining
healthy weight. Eating family meals at
home in the United States is associated with a nutrient-rich diet including fruits
and vegetables, less saturated and trans
fat, and more fiber.
Other research has investigated the
increasing trend of overweight in the military and the failure to meet some of
the Healthy People objectives related to diet and physical activity. One study assessed the senior military officers’
concerns on health topics, educational preferences for nutrition, eating
habits, and barriers and motivators to eating healthfully and exercising
regularly. Lack of time was the primary
barrier identified by this population for why individuals didn’t eat more
healthy diets and didn’t exercise regularly.
Other articles:
Sigrist, L. D.,
Anderson, J. E., & Auld, G. W. (2005). Senior military officers’
educational concerns, motivators, and barriers for healthful eating and regular
exercise. Military Medicine. 170(10),
841-845.
Shrestha, M.,
Combest, T., Fonda, S. J., Alfonso, A., & Guerrero, A. (2013). Effect of an
accelerometer on body weight and fitness in overweight and obese active duty
soldiers. Military Medicine. 178(1),
82-7. doi:10.7205/MILMED-D-12-00275
posted by Unknown @ 1:14 PM
3 comments
3 Comments:
This study found eating breakfast and reducing the number of meals eaten outside or from outside the home was associated with higher success for meeting the Healthy People objectives for military personnel. Eating family meals at home is associated with a nutrient-rich diet including fruits and vegetables, less saturated and trans fat, and more fiber. Military personnel are more successful than their civilian peers, however there is still concern with the number of individuals not meeting the Dietary Guidelines for Americans.
Question 1: In our overweight and obese society, employers and executive boards are hiring people to come up with programs to aid in the health and wellness of their staff for insurance and other health cost benefits. What programs would you design and implement for the population in this study to improve health and increase the number of active duty military personnel that meet the Healthy People 2010 objectives? What barriers might you face when developing these programs?
Beth shared the possible barrier of an inconsistent schedule in this population including deployment and personnel unable to prepare their own meals and providing education to these individuals is key. She mentioned an incentive might be helpful in initiating the motivation for better eating. Finally, she suggested examining the meals provided on the military base and providing healthy recipes for personnel to take home and use with their families.
Lynetta decided education targeting the two greatest barriers from the study would be the best place to start, including cooking demos. She set some specific goals for an education program including decreasing reliance on restaurants for meals and preparing easy, healthful meals instead, she included breakfast ideas.
Kaitlin suggested a program with a reward system to reduce healthcare cost or insurance cost. She mentioned flexibility and a variety of training sessions would help overcome challenges that Beth pointed out with this population.
Emily suggested including nutrition education as part of their training required for active duty members discussing general healthy eating specifically for military personnel. A challenge with this is motivation to change when the population is required to participate.
Sarah S would focus a program more on nutrition and healthy eating including healthier choices at dining centers as well as at home. She would also examine the menus of dining halls and see if adjustments can be made in the food being offered.
Aria suggested a fitness program that might fill in the gaps of what is available on a military base. She also suggested a reward system to be implemented as an incentive for participants.
Courtney shared the importance of looking at the food being served on the base; increasing the amount of healthy foods available and displayed to increase the healthy foods being eaten. She also suggests creating recipes to take home and utilize.
Carly would provide nutrition education to both military members and their families in an online module format. A stricter PT test requirement and penalty for failing could be implemented. Providing MRE’s nutrition facts would also be helpful.
Many agreed providing nutrition education in the form of required classes or online modules may be helpful as well as nutrition facts and recipes for military personnel and their families. Also, looking into the dining halls menus and food items to increase the availability of healthy foods would benefit. Some barriers include lack of interest and motivation as well as defiance for required education. Many suggested a rewards program to deter some of the negative feelings of a required class or something online.
This is all a summary from Alyssa D.
Question 2: The results of this study show the importance of eating breakfast daily for optimal health and consuming an overall healthier diet. The article aimed at health and nutrition professionals explains the importance of breakfast to decrease overeating throughout the day and the promotion of more efficient energy use by increasing thermogenesis, decreasing BMI. How would you explain to a client the importance of eating breakfast to prevent overweight and obesity or maintain a healthy weight? What strategies would you use as a dietitian to promote breakfast to the general population?
Beth would provide healthy and quick foods to grab on the go and would provide education explaining the reasons why skipping breakfast is not beneficial for weight loss.
Lynetta provided three take-home messages for the client, eating breakfast reduces hunger and fat storage leading to weight gain after night time fasting during sleep, setting the stage for healthy choices throughout the day, and providing energy in the morning helping you feel more energized throughout the day and possibly increasing your success with an exercise regimen.
Julie emphasized the need for one’s body to be re-charged or “gassed” up for the day like a vehicle. Also, waiting too long to eat can lead to being over-hungry and a person is likely to consume more than they need and possible making poor choices of foods. She also suggests being realistic and finding food items that the client enjoys or is willing to eat for breakfast as well as overcoming barriers of skipping breakfast.
Kaitlin suggests providing the importance of consistent meals throughout the day beginning with breakfast. She feels providing guidelines and goal setting to initiate behavior change is often the step people or missing.
Emily suggests identifying research findings with a client showing skipping breakfast does not help with weight loss; it tends to have the opposite effect. She suggests general healthy eating presentations which emphasize small, frequent meals and good food choices.
Sarah suggested explaining that eating breakfast helps stay full longer to avoid over eating at lunch time. She also suggested providing ideas for breakfast on the go so people are less likely to skip breakfast.
Carly pointed out the misconception many people have of what breakfast has to include when in reality it can be something small and quick grab items. She suggestions emphasizing protein be incorporated into breakfast as well. She would also provide recipes that can be made ahead of time and reheated quickly.
Again summary from Alyssa D.
Question 3: The study identifies eating at or from a restaurant as another factor for decreasing a nutrient rich diet. Individuals who consumed a meal at a restaurant/takeout at least two times per week were 50% less likely to meet the Healthy People objectives for dietary intake and 20% less likely to meet the physical activity-related objectives. Consuming fast food at least three times per week as associated with a 25% less likelihood of meeting the objectives for fruit intake. What suggestions could you provide clients to promote eating at home and preparing healthy, family meals? How would you address the barriers of convenience, time restrictions, and taste (cooking ability and preparing healthy meals, etc.)?
Beth shared the importance of determining foods the client enjoys and providing healthy recipes that are quick and can be made at home. She also suggests emphasizing the importance of cooking and eating as a family.
Lynetta suggests making family meals a habit. Increase the number of meals eaten together each week and choose recipes and grocery shop together. She also suggests setting aside an afternoon each week to prepare meals for the week and freeze them for quick reheating when time is short.
Julie agrees starting small with family meals and making them habit is a great idea. She also states making reasonable goals is important. Suggesting a family who eats out most of their meals each week to eat every meal at home is not setting them up for success. She also suggests keeping cooking simple in the beginning so people who are used to eating out don’t feel overwhelmed with the cooking. Using leftovers and freezing casserole recipes are also great suggestions.
Kaitlin shares she would develop an education comparing the nutritional value of meals outside the home to those prepared in the home using visuals of sodium and fats in each meal to get the point across the benefits of eating meals prepared in the home. She would also address planning ahead to increase the convenience and overcome some barriers clients have with time constraints.
Emily suggests determining barriers first and making suggestions to overcome those with the client and being client specific in her education and goal setting depending on the level of cooking ability and other barriers.
Sarah would remind clients of the health benefits and the family bonding time of family meals and eating in the home. Preparing meals at home is also much more cost effective. She would also address the other barriers clients have and suggest easy, quick recipes.
Many agreed determining the barriers of each client would be a first step as well as emphasizing the importance of family meals and the benefits of cooking at home including quality control and cost effectiveness. Each client will have various boundaries and many stated to start slow with the changes and set reasonable goals with the clients to promote successful transitions and making family meals a habit to stick with.
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