Attitudes toward Intentional Weight Loss and Dietary Behavior among U.S. Army Reserve Soldiers during Annual Training

Military Medicine, Jul 2006 by Harrow, Jeffrey J, Cordovés, Raquel I, Hulette, Robert B

Objective: The command of a U.S. Army Reserve Combat Support Hospital designed this study to evaluate soldiers' behavior related to and attitudes toward skipping meals while on annual training (AT). Methods: The command administered an anonymous survey on attitudes about weight loss and weight-loss behavior while on AT. Of 180 soldiers given the opportunity to respond, 100 responses were received (55%). Results: Before AT, 50% of reservists responding thought about losing weight while on AT, 62% of soldiers were trying to lose weight while on AT, and 25% of soldiers skipped meals. Soldiers who felt that they were overweight had a 2.9-fold increased risk for skipping meals, and those who thought about losing weight before AT had a 3.0-fold risk. Neither age, gender, rank, nor history of previously being on weight control was a predictor of skipping meals. Conclusion: Most soldiers considered and tried to lose weight while at AT, and soldiers who considered themselves overweight or thought about losing weight were at increased risk for skipping meals.

Introduction

On the second day of the 14-day annual training (AT) exercise of the 324th Combat Support Hospital, one of the soldiers developed exhaustion, near-syncope, and nausea in the afternoon, during heat category 3, which required evaluation at a local emergency room. This event was initially thought to be simple heat exhaustion. However, upon further questioning, the soldier claimed that she was drinking adequate water, but admitted to having skipped breakfast and lunch. This led to consideration of alternative diagnoses such as hypoglycemia or hyponatremia.

An informal discussion among the staff revealed knowledge of soldiers bragging about their plans to lose weight during AT. Additionally, staff dietitians pointed out a 5% discrepancy between the number of personnel on the ground and the number of soldiers signing for field rations. They also noted that some soldiers were signing for their meals, but taking minimal food to eat. This information led to concern that skipping meals as the index soldier did might not be an isolated phenomenon.

Furthermore, the dietitians reported that many soldiers were on a weight-loss program before AT, such as the Atkins or South Beach Diets. Restriction of carbohydrates (CHO) leads to decreased energy production, which may predispose the soldier to suboptimal performance and increased propensity to fatigue, which is a common problem on AT even following a normal diet due to the demanding training schedule and increased energy expenditure.

Consequently, due to concerns about safety given the increased susceptibility for heat injury generated by the practice of these diets or of meal-skipping during AT, the command designed and administered a survey of soldiers' attitudes about intentional weight loss and their dietary practices while on AT.

Methods

The survey was a voluntary, anonymous cross-sectional written questionnaire. Of 180 members, 100 responded. The survey (Fig. 1) was provided to the soldiers on the day before flying home. The soldiers were instructed that the surveys were voluntary and anonymous. Information that could identify the soldier, such as height, weight, or exact age was purposefully excluded from the questionnaire. A survey return box was provided in a manner so that the identity of the soldier was confidential.

We used SAS (Cary, North Carolina) to perform descriptive statistics and χ^sup 2^ tests of significance between soldiers' attitudes and their nutritional practices, setting p

Results

The demographics of the responders are in Table I. The median age was 38.5 years, with 47:53 male:female ratios. The results of the nutritional survey are in Tables II and III, with the questions separated into decisional variables (Table II), for which there was only one answer, and attitudinal variables (Table III), for which more than one answer could be indicated. Because the questionnaire was voluntary and unsupervised, and the questions were not written to force a response, the number of soldiers responding differed from question to question.

"Thinking about losing while on AT before AT" ("Contemplation") was found to be significantly associated with "having a numerical goal" ("Goal") (p

Table IV shows the effect of BWSI on "Contemplation" and "Skipping." Of the soldiers who considered themselves overweight, 69% had "Contemplation" and 43% had "Skipping." This contrasts with those who thought their weight was normal, in whom only 34% had "Contemplation" and 16% had "Skipping." and to those considering themselves underweight, in whom 20% had "Contemplation" and 0% had "Skipping." Of soldiers with "Contemplation," 56% had promised to lose weight, compared to 0% of those who had not. In terms of relative risks for "Skipping." Table V shows the relative risks for factors associated with meal skipping. "Contemplation" resulted in a relative risk of 3.0, compared to seeing oneself as overweight (relative risk = 2.9), and promising to lose weight (relative risk = 2.0).