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Potential Future Opportunities for the Armed Forces, Military Families, and Their Communities

The workshop’s final session provided time to reflect on the day’s discussions regarding promising strategies and future opportunities for overcoming the challenges posed by obesity and overweight among the armed forces, military families, and their communities, as well as the obstacles faced in implementing such initiatives. Bernadette Marriott invited the workshop’s four session moderators to share their reflections and engage in discussion with workshop participants.

MODERATORS’ REFLECTIONS

Lieutenant Pamela Gregory, Navy nutrition program manager, spoke about the close collaboration among stakeholders across the armed forces to address obesity and overweight. Observing that sharing resources and assets can build collective power toward achieving common objectives, she stressed the importance of reaching out to other sectors to identify and leverage additional opportunities for addressing the problem collectively, even though “trying to get others to come alongside us is not always the easiest thing to do.” Cross-sector collaboration is also important, she suggested, because obesity and overweight affect America’s national security.

Anne Utech, acting national director of nutrition and food service at the U.S. Department of Veterans Affairs (VA), remarked on the large number and wide variety of programs that exist to address health and weight issues. She speculated that, based on the vast amount of data that have been generated by the many military and VA programs, as well as other programs within the U.S. Department of Agriculture and the U.S. Depart-

ment of Health and Human Services, “we may be sitting on a gold mine of knowledge.” She suggested partnering with educational institutions to mine the data and disseminate them throughout the scientific community and government agencies. She believes that through this type of sharing, “we may be able to unlock something important.”

Lieutenant Colonel Renee Cole, deputy of the Military Nutrition Division and director of the Healthy Eating Behavior Initiative at the U.S. Army Research Institute of Environmental Medicine, lauded the synergy that the workshop had created and predicted that sustained progress would result from continued collaboration. She drew attention to the relative lack of information about service members’ eating behaviors compared with their physical fitness, and wondered about the potential to survey service members on a wider range of health-related behaviors. “What are the behaviors that are supporting health, resiliency, and readiness?” she asked, and “What are those behaviors that are maybe more detrimental?” She noted that this information, along with assessment of the military culture and environment, could help in tailoring efforts to address the needs of members of different ranks and occupational specialties.

Esther Myers, a 25-year Air Force veteran and chief executive officer of EF Myers Consulting, Inc., said she was struck by the change in attitude and culture that has occurred since her early experience in the military in 1976. She recounted a conversation with base food service personnel and dietitians: “At that time,” she said, “what they told us was that their job is to provide the food people like. If they need ‘healthy’ food, they go over to the hospital.” She recalled huge arguments about addressing “special dietary needs,” such as low-calorie, low-sodium, heart-healthy diets, at the food service level. She proclaimed it wonderful that people today recognize healthy eating as a shared responsibility across all parts of the military, not just the hospital. She also noted the significant progress made in accumulating accessible and available data on weight, food, physical activity, and nutrition in the military. She also highlighted the positive shift to applying a systems thinking, community-wide lens to the promotion of healthy living among the military community. And she emphasized the need to identify solutions and incentives for overcoming the attrition that affects many health promotion and weight control programs, given that multiple touch points are needed for success. “Nobody wants to be in a situation of lose the weight or lose your job,” she stressed.

DISCUSSION

During the final discussion period, workshop participants considered a number of opportunities for overcoming the challenge of obesity and overweight in the armed forces.

Cole described potential avenues for data sharing between the military and academic communities, which might include collaborative research agreements, memorandums of agreement, and leveraging of connections between military research facilities and their academic affiliates. Collecting and reporting data by ethnicity is a promising opportunity for understanding the impact of overweight on recruitment, suggested one participant. In response, another participant described some findings of a study that looked at data from the 2010 Cawley and Maclean study in terms of the relationship between different risk factors and demographic characteristics and the ability to meet body weight and body fat standards for each of the services. The study revealed some trends with race and ethnicity, this participant noted, but nothing definitive. Utech described work by the Veterans Health Administration on tracking disparities in clinical outcomes, as well as access to and utilization of programs.

A participant suggested that collecting health behavior data on students in junior Reserve Officer Training Corps (ROTC) programs is a promising opportunity, based on the assumption that these young people represent likely military entrants. Blanck identified another opportunity in capitalizing on students’ involvement in junior ROTC in schools to drive their participation in health and fitness programs.

Another participant cited frustration regarding the limitations presented by congressional allocations and U.S. Department of Defense (DoD) spending decisions related to feeding service members, which provide little flexibility beyond the standard of three daily meals. The participant insisted that, according to research, this pattern is not suited to eating for peak performance. According to another participant, reinstituting nutrition education at military leadership schools could help cultivate leaders who understand the importance of nutrition, which in turn could foster top-down support for policy and environmental changes to improve the healthfulness of food and physical activity environments on military installations. These broader changes, suggested another participant, in conjunction with education, would support individual efforts to make healthy choices by making those choices convenient, attractive, and affordable.

Cole noted the many barriers to healthier eating among service members, including challenges in the eating environment. She noted that many soldiers claim they do not use the dining facilities on base because they do not have the time to get there and wait in long lines, so they opt for a nearby fast food outlet instead. A related challenge, said Osgood, is that fast food establishments create revenue for military installations, and the legal and operational complexities associated with bringing outside quick service restaurants onto military installations can make it difficult to attract new establishments that could provide healthier offerings. Cole added that it will be important to measure whether changing the environment results

in behavior change. According to Gregory, another challenge is broad variation in the demographic and socioeconomic backgrounds of people who enter the military, including a wide range of food and nutrition literacy.

Military service participants suggested that civilian employees in DoD and the Defense Health Agency can help support health initiatives and prevent gaps in service from occurring when active duty staff deploy or migrate or contractors turn over.

In closing, Marriott stated that the day’s discussions had “shown how complex it is to look at the issues related to obesity and overweight within the military.” Highlighting a few statistics that speakers had shared about the negative consequences of excess weight among service members, she concluded, “these are pretty staggering pieces of information as we think about meeting this challenge.”