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"Lighten Up!©" - The ARNG Weigh to Better Health
By LTC J. M. Ortiz, Chief, Preventive Medicine, Army National Guard
10 April 2008--Several years ago, SGM Keith Scott and his wife Denise returned from a vacation cruise and looked into their mirror and asked, "What happened to us?" After years of paying little attention to what they ate, they no longer recognized themselves in the mirror. They tried following dietary advice that they heard on various TV talk shows, featuring top weight loss experts, but still could not seem to get ahead. Finally, they enrolled in a commercial program that increased the number of meals consumed daily and that allowed food that was both nutritious and contributed to the maintenance of their muscle mass. Through this program the couple both lost between 30 to 40 pounds and have maintained their weight loss.
While this whole story may not apply to you directly, there are likely parts of it that you can relate to in some manner. A similar story can be seen today in our society as a whole: we are failing as a culture to take care of ourselves from a preventive health perspective, and our tendencies to overeat and not exercise are starting to have epidemic consequences. Our society should ask itself: how did we become a nation where over 60% of our citizens are now either overweight or obese and where 25% of all Americans don't exercise at all? Healthcare costs are also out of control with health-related expenditures estimated to become 20% of our total Gross National Product by the year 2020, while only about 5% of our health budget is currently spent on preventive health measures. This is despite having over 133 million Americans with at least one chronic disease. Clearly our current health system is approaching a crisis stage where the cost of continuing on this path will be unsustainable.
The Army National Guard (ARNG) cannot continue to accept the traditional expectations to fix medical and dental problems at the Mobilization platform; nor can we continue to wait until our Soldiers are broken before providing health support if we intend to sustain ourselves as an Operational Force. The ARNG as a culture must be more proactive in health maintenance in order to be able to meet the call of our Nation and of our Communities.
The Director of the ARNG, LTG Clyde A. Vaughn, strongly supports the Decade of Health, the ARNG's proactive and innovative approach to Health Promotion (For more information, log on to Decadeofhealth.com). He understands the importance of medical readiness in our Brigade Combat Teams and the clear need to invest in the "front-end" of health for our most critical asset: the human combat system. In addition, it's not just the War Fighter that needs to maintain a healthy weight, but as an organization everyone in supporting roles also need to do their part in maximizing their ability to contribute to the Global War on Terrorism or in support of Domestic Operations.
We all know the usual "diet and exercise" mantra for losing weight, and have also heard time and again about all the benefits of weight loss, yet many still struggle with it. "Mr. R", an ARNG Civilian, wrestled for years with weight gain, and had worsening sleep apnea, fatigue, and asthma until he finally saw a physician specialist. The physician took the time to explain the relationship between his medical problems and his weight and provided a thoughtful consultation on the importance of weight loss. "Mr. R" did some research and enrolled in a weight loss program that forced him to assess his current activity and dietary habits. After a few months, "Mr. R" had lost 33 pounds and was able to walk several blocks without being out of breath, has decreased the pressure on his continuous positive airway pressure (CPAP) machine (used for sleep apnea treatment), and no longer needs inhalers to treat his asthma. After observing the impact of "Mr. R's" weight loss, his regular physician was also subsequently able to take him off his blood pressure medication and one of the cholesterol medications.
Certainly, weight management can be very complex and more challenging for some people than others. For example, there may be significant behavioral and psychosocial factors to consider, such as stress, family dynamics, social customs, and peer influences. Such complex issues may require taking a more multidisciplinary approach and may need the expertise of dieticians, nutritionists, behavioral experts, or physical fitness specialists as well. However, there are a few simple steps that can get you started and give you a solid foundation for better health (SEVEN SIMPLE STEPS):
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WRITE IT DOWN. This means everything that you eat or drink during the day! Most people are simply not aware of what and why they eat and where their weight is on the spectrum of health. Keeping a food diary is the first step in awareness and will give you some clues as to places where you can improve. The same goes for your exercise habits and for any eating triggers that you may have. Once you are more aware of your existing habits and triggers then you can start to develop an overall weight goal and tailor your plan according to your own individual strengths and weaknesses. Your initial goals should be realistic and achievable otherwise you will be easily discouraged and not be able to focus your energy effectively. Your plan of attack should be like an Operations Order (OPORD) for health. One metric that may help you to determine your goal and your current level of health is your Body Mass Index (BMI). This is a simple calculation that uses your weight and your height to produce a number regarded by many experts as a general reflection of health. (For a simple BMI calculator, go to: http://www.hooah4health.com/4You/bmi.htm ). A normal BMI is between 18.5 -24.9, while overweight is a BMI range of 25 - 29.9; obese is a BMI of 30 or above. It's important to write down your BMI and to use it as a health screening frame of reference. This should not be used as a rigid measurement but rather as one piece of data to be considered as an overall gauge of your health.
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PUT FRUIT AND SALAD FRONT AND CENTER: Shoot for two to three cups of fruits and two to three cups of vegetables each day, although some dietary experts encourage even more. Avoid fad diets and tailor your eating habits to fit your likes/dislikes while trying to limit the meat, fats, or carbohydrates to the portions indicated for your age and weight by the USDA's MyPyramid (http://hooah4health.com/body/nutrition/pyramid.htm). Varying the colors in a salad or fruit bowl ensures a good balance of vitamins and other nutrients. Fruits and vegetables contain more water and fiber, which can help to make you feel full and decrease your appetite. This does not mean that you must necessarily give up eating steak or carbohydrates, but rather you should favor more moderation in such food groups, by enjoying them in smaller portions. However, caution should always be practiced by anyone with medical conditions such as diabetes, and such individuals should first consult a health professional (e.g. a dietician, nutritionist, physician, etc…) prior to making any significant modifications in eating habits.
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HYDRATE SMARTLY: While many past experts have emphasized more hydration for everyone, no clear science-based guidance had been provided until the Institute of Medicine (IOM) published its "Dietary Reference Intakes" Report in 2004. The IOM recommendations discuss the wide variety of additional sources of water, such as food or other beverages that should also be considered in one's hydration status. According to one interpretation, the IOM report comes close to advocating an additional eight glasses of water a day as potentially beneficial for most people under "normal" circumstances. However, under other situations, particularly when one is exercising during adverse environmental conditions, excess fluid intake may not only be dangerous, but also fatal, particularly in cases where the water dilutes the sodium in the bloodstream too much. The bottom line is that better awareness of thirst and drinking more water under "normal conditions" is probably beneficial, but strategies for other circumstances may be neither beneficial nor safe when gender, certain medical conditions, various levels of exercise, and weather conditions are carefully considered together. Drinking more water may be most beneficial if used as a substitute to sugar-sweetened beverages or if increased moderately around mealtime, in order to enhance stomach fullness and potentially decrease one's appetite.
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NO MEAL IS A BAD DEAL. Don't skip meals, including breakfast. The reason for this is to program your body to expect a steady and balanced flow of nutrition because it can build excess fat stores in anticipation of periods of starvation when eating patterns are irregular. You should eat at a minimum 3 meals plus a snack each day according to most nutrition experts, depending on your own individual metabolism. Many dietary experts note that skipping meals may also lead to poor or unhealthy snacking habits.
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CALORIE CUTTING - START SMALL: You can easily start to eliminate or limit high calorie foods by cutting corners in simple ways. For example, change from creamy salad dressings to the more low fat types and use a maximum of one teaspoon, which is enough to flavor even a sizable salad. Eliminating sugary soft drinks in your diet can make a huge difference. Substitute less healthy foods with lower calorie ones such as carrots or whole grains, and limit or avoid combination foods such as lasagna that hide a large number of calories in each serving. Alcoholic beverages are high in calories but otherwise low in overall nutritional value, and any more than 1 drink per day for women or 2 drinks daily for men will eliminate any potential healthy effects they may have. Moderation is once again key, finding and buying fruits and vegetables you to stock your refrigerator may be the essential initial step you need to take to start some healthy eating habits for you and your family.
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SCHEDULE FUN EXERCISE: Develop an exercise regimen that is both fun and realistic. There's a common misperception that all exercise must be all-out sprints or be done to the point of collapse. In fact, for basic health maintenance, the Centers for Disease Control and Prevention (CDC) recommends just 30 minutes of moderate exercise each day, with moderate exercise defined as any physical activity that you can comfortably talk while doing. More intense and/or longer workouts may be necessary for more ambitious weight loss goals. If possible, integrate music, family, and friends into your routine, and actually schedule exercise on your calendar as both a reminder and as a sign of your commitment. Simply walking or hiking are acceptable forms of exercise that can be done in short spurts (10-15 minutes) just about anywhere. If you have medical problems, always consult your medical provider first, and it is wise to start slowly and progress gradually to more intense regimens.
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IGNORE THE HYPE: Unscrupulous diet ads and junk science promise miracles without any valid basis in fact. We all know that if something seems too good to be true then it probably is. Ads that promise a magic pill or a miracle device to lose weight prey on the emotions of those who want an easy way out but don't want to commit to more meaningful and sustainable lifestyle changes. The fact is that no pill can give anyone neither motivation nor the behavioral tools to change deeply entrenched perceptions of food and traditionally poor eating habits.
Conclusion: This article is a summary of some key points about weight management based on a broad review of both the scientific and popular literature. It's interesting to note that many of the challenges people have with weight management are more behavioral, attitudinal, and cultural in nature than anything else.
As with many complex issues, it is best to keep it simple when developing an overall healthy lifestyle plan. Start with the "7 Simple Steps" outlined here, develop a plan tailored to your own goals, and consult a health or behavioral specialist, if necessary. You may be surprised to see how much just having a positive attitude, involving your family and friends, and focusing on your overall progress can make all the difference in the world in accomplishing what many naysayers are too quick to view as impossible.
The ARNG "Lighten Up!" Campaign promotes healthy weight management in the ARNG in 2008 and beyond. ARNG leaders and health providers are encouraged to take advantage of the resources and tools provided by the DOH Support Team (www.decadeofhealth.com). Taking simple steps now to promote healthier habits and lifestyles of our units, Soldiers, Families, and communities is key to our future success in sustaining medical readiness. The ARNG is a foundation of many of our communities and must take the lead in fighting the excess weight epidemic in order to be "Always Ready, Always There …and Always Healthy."
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Benefits of healthy weight management:
- Decreases the risk for heart attack, stroke, high blood pressure, diabetes, osteoarthritis, gallbladder disease, and some cancers (including breast and colon cancers)
- Improves physical and mental well being.
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7 Simple Steps:
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WRITE IT DOWN: Writing down your own eating and exercise habits or triggers is the first step towards creating an OPORD for a healthier lifestyle. Document your BMI as a general gauge of your current health and as a means to document health improvements.
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PUT FRUIT AND SALAD FRONT AND CENTER: 3 cups of fruits and 3 cups of vegetables daily are low calorie density sources of high nutrition which may also help to decrease your appetite and help fight certain diseases.
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HYDRATE SMARTLY: Deliberately increasing one's water intake based on thirst (e.g. drinking eight glasses of water daily) may be beneficial to most people under "normal" circumstances. However, caution should be practiced in other situations, particularly during exercise under challenging environmental conditions (e.g. during a long run on a hot day by an inadequately conditioned individual.).
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NO MEAL IS A BAD DEAL: Don't skip breakfast and shoot for 3 meals and a healthy snack daily, tailored to your own metabolism and needs.
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CALORIE CUTTING - START SMALL: Smaller and healthier portions, eliminating or minimizing sweetened drinks, and drinking a maximum of 1-2 alcoholic drinks daily may be the first critical steps to lose weight and to sustain such losses.
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SCHEDULE FUN EXERCISE: Exercise does not have to be extreme, and integrating family, friends, or music into your workout schedule may also improve your quality of life.
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IGNORE THE HYPE: Looking for a "magic pill" for weight management is a losing proposition when fundamental lifestyle changes and behavior shifts are typically the underlying sources of successful weight management.
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Resources and references
The Centers for Disease Control and Prevention. BMI - Body Mass Index Overview page. Available at: http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm#Interpreted. Accessed 4 March 2008
The United States Department of Agriculture. MyPyramid Questions and Answers. Available at: http://www.mypyramid.gov/global_nav/media_questions.html. Accessed 13 March 2008.
The United States Army Center for Health Promotion and Preventive Medicine. Healthy Weigh - Owner's Manual for Managing Your Weight. Available at: http://chppm-www.apgea.army.mil/documents/TG/tg245.pdf. Accessed 8 April 2008.
Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med. 2002; 162: 2074-2079.
Eisenson, Howard J.; Binks, Martin. The Duke Diet. New York, NY: Balantine Books, 2007.
Krebs-Smith, SM, DA Cook, AF Subar, L Cleveland, and J Friday. Assessing fruit and vegetable intakes: Toward the year 2000. Am J Publ Health 85:1623-1629. 1995.
The Centers for Disease Control and Prevention. Chronic Disease Overview page. Available at: http://www.cdc.gov/nccdphp/overview.htm. Accessed 8 April 2008.
Dietary Guidelines for Americans 2005. Available at: http://www.health.gov/dietaryguidelines/dga2005/document/html/chapter5.htm. Accessed 8 April 2008.
Institute of Medicine's Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. Available at: http://www.iom.edu/?id=18495&redirect=0. Accessed 8 April 2008.
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