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Weight management

Introduction

Unhealthy body weight and excess body fat negatively impact on physical and mental health, and increases the risk of musculoskeletal injury and becoming unfit for duty.

Addressing weight management issues will improve your morale, effectiveness and ‘fitness for task’ in the Army.

Overweight and obesity are associated with increased injury risk, poorer mental health and increased incidence of chronic non-communicable diseases (e.g. high blood pressure and type-2 diabetes).  All of which contribute to health-related absenteeism (i.e. downgrading) and medical discharges from the Army.  Addressing weight management issues would therefore positively contribute to your physical fitness, morale and quality and life, which in turn would improve your effectiveness in your military role.

The Army is a physically demanding job, with an increased risk of musculoskeletal injury (MSKI).  This risk is reduced if you are physically fit and of a healthy body weight.  Service personnel are also required to be mentally and physically prepared to operate in austere conditions and environmental extremes.  Excess body fat would make you less effective in such circumstances, and increases your risk of heat illness.

Complex lives

People live complex lives and it is this that makes losing body weight or changing health behaviours genuinely difficult.

Traditional models of weight loss assume that 'a calorie is a calorie' and that if you “…eat less and exercise more” you will lose body weight.  Although these assumptions are correct according to the basic Laws of Physics, experience shows that it is much more difficult for an individual to both achieve and sustain weight loss.  There are many aspects of life that work against those who are trying to lose weight.

Individuals are motivated to eat by internal and/or external cues.  These cues can drive us to overeat and need to be identified and managed to meet weight loss goals.  Internal cues come from within the individual (e.g. feelings of hunger and fullness).  Hormones and chemical messengers in the brain drive our desire to eat and signal us to stop eating.  Foods and drinks that are high in sugars and/or fats can override feelings of fullness and cause us to overeat due to their pleasurable taste.  These types of foods are often energy-dense, which may contribute to weight gain.  External cues come from the environment (e.g. the sight or smell of food, eating in response to advertisements and eating because of emotions).  Individuals tend to ‘eat more if they see more’ (e.g. the more food served, in bigger portions, the more an individual will eat).

Advances in technology have reduced the physical demands of many everyday occupational and leisure activities (e.g. cars, escalators, lifts, dishwashers, computer games).  In addition, the reduction in physical activity levels due to the time demands and pressures of working in the military (where Command can expect personnel to be sat at desks for long hours).  These changes in physical activity behaviours are likely to encourage overweightness/ obesity.

Approaches to aid weight loss

Dietary interventions:

Eating patterns.  Research has shown that skipping breakfast is associated with an increased risk of obesity.  It is recommended that individuals eat regularly and do not skip meals.

Diet quality.  A healthier diet (e.g. increasing fruit, vegetable, fish and wholegrain intake) can have beneficial effects on health, independent of weight loss.

Low-fat diets.  Reducing dietary fat intake usually lowers energy intake, and is associated with weight loss.

500-600 kcal deficit.  Modest reductions in energy intake (i.e. of 500-600 kcal per day) may be more sustainable for long-term weight loss compared with very-low-calorie diets.

Physical activity interventions:

  • Reducing sedentary behaviour (e.g. time spent watching television)
  • Increasing activities of daily living (e.g. walking rather than using transport)
  • Undertaking structured exercise

Using physical activity as a sole intervention to manage overweightness and obesity has disappointing outcomes due to the amount of activity required to induce a large energy deficit.  Physical activity should be combined with dietary modifications in changing health behaviours.  However, focussing upon diet and exercise alone does not affect the instinctive, social, genetic and environmental factors at play.  Successful interventions take into account all of these complexities by being long-term, intensive and multi-disciplinary.  The use of behavioural, cognitive, nutritional and exercise advice, situational guidance and counselling improves weight loss outcomes.

The content of weight management interventions supported by the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE) include: nutrition advice, physical activity, structured follow up and psychological support / behaviour change.  Successful interventions also account for the many changes that occur in our lives along the way (e.g. someone who uses food to cope with stress must be helped to find a new way of coping).

Golden Rule

Addressing weight management issues is not simply of case of “…eating less and exercising more”.  Excess body weight is accrued over time; it is a chronic condition that will only be successfully addressed through long-term behaviour change.  Thus, it is recommended that weight-loss interventions are multicomponent and combine dietary changes, physical activity and behaviour modification.