Senior Military Officers' Educational Concerns, Motivators and Barriers for Healthful Eating and Regular Exercise

Military Medicine, Oct 2005 by Sigrist, Lori D, Anderson, Jennifer E, Auld, Garry W

The increasing trend of overweight in the military, the high cost of health care associated with overweight, and the failure to meet some Healthy People 2000 objectives related to diet identify the need for more appropriate nutrition and fitness education for military personnel. The purpose of this study was to assess senior military officers' concerns on various health topics, educational preferences for nutrition and health topics, eating habits, and barriers and motivators for eating healthfully and exercising regularly. The survey was completed by 52 resident students at the U.S. Army War College. Fitness, weight, and blood cholesterol were top health concerns, and respondents wanted to know more about eating healthfully on the run. The primary barrier to eating healthfully and exercising regularly was lack of time, whereas health and appearance were top motivators. Health interventions for this population should include their topics of concern and should address perceived barriers and motivators.

Introduction

Health promotion and military readiness are top priorities in the U.S. military. The 2003 update of Health Promotion Directive 1010.10 continues to "establish the Department of Defense requirement to implement health promotion and dis ease and injury prevention programs to improve and sustain military readiness and the health, fitness, and quality of life of military personnel, Department of Defense personnel, and other beneficiaries."1 A goal of the Health Promotion Directive is to "enhance mission readiness, unit performance, and the health and fitness of military personnel, beneficiaries, and civilian employees through the creation of a culture within the Department of Defense that values health and fitness and empowers individuals and organizations to actualize those values and achieve optimal health."1

Physical activity and diet are major factors that influence morbidity and mortality rates in the United States.2"5 Sixty-four percent of U.S. adults are overweight or obese, as defined by a body mass index of >25.0 kg/m^sup 2^, an increase of >25% in the past three decades.6 Additionally, one-fourth of U.S. adults do not engage in any leisure-time physical activity.7 According to the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel, 58.4% of military personnel >20 years of age were classified as overweight, an increase of 8% from the 1995 survey.8 Excess body weight incurs significant costs to the military, in terms of both direct costs for increased health care and indirect costs for lost workdays. Total estimated costs (including direct and indirect costs) associated with overweight in the Air Force were $22.8 million in 1997, whereas the total annual cost to the U.S. Navy for obesity-related inpatient care was expected to be $5.8 million in 1998 dollars.9'10

Numerous studies have shown a strong association between a healthy diet and a lower risk for cardiovascular disease, obesity, and certain cancers. 'M3 Specific national recommendations include restricting total fat to

Emphasis has been placed on evaluation and improvement of the health and physical fitness of military personnel since the inception of Department of Defense Directive 1308.1 Physical Fitness and Body Fat Program in 1981.17 The senior service colleges at the National Defense University in Washington, DC, and the U.S. Army War College (USAWC) in Carlisle, Pennsylvania, have been conducting health and fitness programs for senior military officers attending these courses. In general, senior male military officers who participated in these programs were normotensive and nonobese, had a high aerobic capacity, and were at low risk for developing cardiovascular disease.18·19 Senior female military officers were reported as being more fit and having lower cardiovascular risk factors than their civilian counterparts attending the USAWC.20 However, in the 1996 Army Food and Nutrition Survey, 55% of officers reported consuming less than two servings of fruits per day and -87% consumed less than three servings of vegetables per day.21 When military personnel were asked whether they thought their diet was too low, too high, or just about right for fat content, 55% of male personnel and 57% of female personnel in the >400 -year age group reported that they thought their diet was too high in fat.17 When asked about attitudes on diet, 46% of all military personnel surveyed thought that it was very important to have a diet low in saturated fat and 51% thought that it was very important to have a diet with plenty of fruits and vegetables.

The increasing trend of overweight in the military, the high cost of health care associated with overweight, the failure to meet key Healthy People 2000 objectives related to diet (such as fat and sodium intake), and service members' beliefs about their diets identify the need for more appropriate nutrition and fitness education for military personnel. In general, educational interventions are more effective when they are tailored to the needs and preferences of the target population.22 However, educational preferences of various segments of the military have not been reported in the literature. This article identifies the health concerns, educational preferences for nutrition and fitness, barriers and motivators for eating healthfully and exercising regularly, and eating habits of senior military officers enrolled in the residence course at the USAWC. This information can aid in the development of targeted educational programs for this population.

Methods

A Nutrition and Fitness Educational Needs Assessment Survey was developed and validated to assess senior military officers' concerns on various health topics, educational preferences for nutrition and health topics, eating habits, and barriers and motivators for eating healthfully and exercising regularly. It was given to resident students enrolled in the academic year 2002 USAWC course at Carlisle, Pennsylvania.

Approval to survey the resident students was obtained from the Colorado State University Human Research Committee and the Director of Institutional Assessment at USAWC. The survey and a cover letter describing the purpose of the study and point of contact were sent electronically to 292 active duty U.S. military officers. A consent form was not necessary because the study was given exempt status by Colorado State University. Completion of the survey was voluntary but not completely anonymous because completed surveys were sent electronically to the investigators. However, confidentiality was maintained by not reporting and identifying individual responses.

The survey consisted of 15 questions. The first four questions were related to demographic data and included age, gender, military status, and marital status. Six questions measured respondents' attitudes, on a 5-point Likert scale from strongly agree to strongly disagree, regarding their health concerns, educational topics they wanted to know more about, and barriers and motivators for eating healthfully and exercising regularly. Additionally, respondents were asked to subjectively rate both their eating habits and fitness levels as excellent, good, fair, needs improvement, or poor and were asked specific questions about the number of times they dined out each week and the number of days per week they consumed breakfast and lunch. Descriptive analyses were performed with Statistical Package for the Social Sciences, version 11.5 (SPSS, Chicago, Illinois), by calculating mean scores for the attitude responses and computing frequencies and percentages for all responses.