Reducing Obesity in Veterans
Obesity in the United States has reached an epidemic level, with 34.9% of Americans obese. The estimated annual medical cost of obesity in the U.S. is $147 to $210 billion per year, with the cost for people who are obese $1,429 higher than those who aren't obese.
The obesity rate has more than doubled since the 1970s, and it's even worse for veterans. The obesity rate for U.S. veterans is 80%. Obesity can lead to many of the major causes of death for Americans: heart disease, stroke, type 2 diabetes, and several types of cancer.
Why the Obesity Rate for Veterans is Alarmingly High
According to Eating Disorders Review, who reviewed a University of Minnesota study that mostly involved veterans of the Vietnam and Iraqi wars, found that many servicemen and servicewomen learned to eat rapidly during boot camp. Later, it became a way to deal with stressful situations. Some reported having to eat fast in order to survive during conflict.
After leaving the service, many reported several eating patterns that contribute to obesity, including:
- binge eating
- nighttime eating
- hiding food
- cravings for sweets
These patterns are consistent among prisoners of war and survivors of the Holocaust. Not surprisingly, study participants reported substance abuse that started either during or after their service.
To help understand why this happens, we have to look at the body's response to stress, which includes the release of adrenaline and cortisol. Adrenaline will make you feel less hungry as your blood goes away from your organs to prepare for fight or flight. Afterward cortisol signals your body to replenish the lost energy from responding to the stressful event.
Traumatic memories from combat can haunt veterans, signaling the release of adrenaline and cortisol, without the large expenditure of calories. In this way overeating has a calming response, often referred to as "stress eating." This drive often leads people to reach for foods that are higher in fat, sugar, and salt.
In addition to the stress of military service, many veterans face additional stresses when they return to civilian life: finding employment, housing, resuming normal relationships, and living a normal life. And many veterans have to deal with post-traumatic stress disorder (PTSD).
One of the most difficult problems that veterans face that's connected to PTSD is insomnia. According to the National Center for PTSD, the most common symptom of PTSD among veterans from Afghanistan and Iraq was insomnia. Insomnia is reported to occur in 90-100% of Vietnam era veterans with PTSD.
According to Dr. Eve Van Cauter, a professor in the Department of Medicine at the University of Chicago, called sleep deprivation "the royal route to obesity." According to the National Sleep Foundation, Dr. Van Cauter's research shows that people who don't sleep enough have physiologic abnormalities that may increase appetite and calorie intake.
Lack of sleep may increase levels of ghrelin (the appetite increaser), and reduce levels of leptin (the appetite decreaser).
The Veteran's Administration (VA) Response
In January 2006 the VA has implemented MOVE!, a program designed to help combat the problem of veteran obesity. Their goals included:
- annually screen every veteran who receives care at VA facilities for obesity
- refer veterans to weight management services
- make different treatment options available that fit the needs and preferences of veterans
The VA's Move! program has had limited success. In 2014, the VA received a lot of media attention for the number of veterans who had to wait for a month or more for treatment. A year later, the waiting lists had grown over 50%.
According to the Lancet, an online health journal on diabetes and endocrinology for health professionals, participation in the Move! program is associated with weight loss, but the rate of participation was low. According to US Medicine, problems within VA facilities prevented the successful care of veterans. Different VA facilities had different implementation issues, including:
- not offering all of the services for veterans
- slow implementation of the program
- lack of support among senior management
- poor attitude among service-line chiefs, with attitudes ranging from passive acceptance to skepticism
Weight Loss Strategies for Veterans
Veterans can take advantage of the Move! program offered at their local VA facility. To do that, follow these steps laid out on move.va.gov:
- Let your VA primary care team know that you want to get involved.
- Complete the MOVE!11 Getting Started Questionnaire at your local VA or online.
- Print and review your MOVE!11 Getting Started Questionnaire report with your health care team who will help you set some initial goals, such as how much total weight you want to lose, how much you want to lose each week, and your plans for increasing activity and decreasing calories. This report will also recommend MOVE! handouts specific to your needs.
- With your team's guidance, choose from the MOVE! Options of Care available at your facility.
However, if they're put on a waiting list, or if for any reason they're not able to access the full program, we offer some tips to help veterans stay healthy.
Practice Mindful Eating
Melanie Greenberg, PhD, a clinical psychologist in Mill Valley, CA who specializes in mindfulness and eating disorders, says that mindfulness can help improve memory and reduces stress, depression, and blood pressure.
She defines mindfulness as “the practice of being in the moment and deliberately noticing every sensory experience, while also separating direct experience, thoughts and feelings from judgments about them.”
To help fix the bad habit of fast eating that many veterans have developed, which can lead to excess calorie consumption, veterans have to slow down. Some mindful eating guidelines from Harvard Health Publications can help with this, which include:
- Slow down and ask yourself why you're eating. Is it because you're hungry, or is it because you're anxious, bored, or stressed? If it's not due to hunger, you can take a walk, exercise, or do something productive.
- Cut your food into smaller bites.
- Set your kitchen timer to 20 minutes, and take that time to eat a normal-sized meal.
- Eat in silence, thinking about what it took to produce that meal, from the sun’s rays to the farmer to the grocer to the cook.
Additional tips include:
- Create a peaceful environment where you eat. Dr. Greenberg recommends setting the table with flowers, as well as avoiding distracting sounds and visuals.
- Turn off the TV, laptop, and stay off of your cell phone during mealtime. One study found that eating in front of the TV can cause you to eat 10% more calories during your meal, and 25% more calories later in the day.
- Pay attention to the tastes and textures of your food. If you're eating with others, you don't have to be silent, but slow down, adding periods of silence to your eating.
- Put your fork down between bites, helping you to slow down and appreciate the food.
- Be grateful for your food.
- Accept what you're feeling. Dr. Greenberg says that mindfulness isn’t about hiding from how you feel, it's about noticing and accepting those emotions. By allowing them to come over you without fighting them, you may realize that ultimately they do pass on their own, and that your emotions don’t have to rule you.
Address PTSD and Insomnia
Take advantage of the VA's services if possible, or the services of a trained professional. The National Center for PTSD offers several resources for those suffering from PTSD. Visit ptsd.va.gov for more information.
Helpguide.org has several self-help tips, which include:
- Get moving- aim for 30 minutes of exercise per day.
- Regulate your nervous system with mindful breathing, using certain sensory stimulations to calm you down (such as a song or a smell that helps your relax), and practice reconnecting to painful experiences without becoming overwhelmed by them.
- Connect with someone who cares for you that you can talk about your life with.
- Avoid alcohol and drugs, eat a good diet, and get enough sleep.
Reduce Sedentary Time
As there's extensive research regarding the dangers of being sedentary for long periods of time, make it a habit to break up sedentary periods with some kind of movement every 20 minutes. Check out 24 ways to add more movement to your day.
Many do this by utilizing an adjustable sit to stand desk, and/or treadmill desk.
In addition, the CDC recommends 150 minutes per week of moderate exercise (such as walking), and 75 minutes per week of vigorous exercise (where you're breathing hard).
Other Weight Loss Tips for Veterans
- Reduce or even better, eliminate sugary drinks. Instead drink vegetable juice, milk, or water. 100% fruit juice is healthier than juice with added sugar, but limit yourself to 12 ounces per day.
- Experiment with different ways to make foods that you currently eat healthier. A google search or search on Pinterest can give you options that may be even tastier and healthier than what you’re currently consuming. Instead of potato chips, try peppers, celery, or other vegetables with hummus.
- Eat a diet with balanced macronutrients (energy from fat, carbohydrates, and protein.)
- Get in the habit of reading labels. It will take time, but you’ll need to replace some of your current selections with healthier options. If you’re looking for a new way to make a recipe, you can search for paleo options, which are usually low in sugar.
- Avoid artificial sweeteners.
- Don’t eat out as much, and when you do, snack before dinner. "Ruining your appetite" will help you consume fewer calories when eating out, which is often less healthy food than what you will get by preparing food yourself.
- Avoid trans-fat and partially hydrogenated fats. These are found in:
- Most commercially-baked foods including chips, candy, microwave popcorn, cookies, crackers, cakes, muffins, pie crusts, pizza doughs, and many breads.
- Many fried foods, especially fast foods, including french fries, fish sticks, chicken nuggets, and hard taco shells. Some restaurants have switched to non-hydrogenated oil, but many have not.
- Cake mix and pancake mix
- Packaged snack foods (crackers, microwave popcorn, chips, candy)
- Solid fats (stick margarine, vegetable shortening)
- Biscuits and frozen-biscuit sandwiches
- Non-dairy creamer
- Creamy frozen drinks as well as some brands of chocolate milk
- Focus instead on good fats, such as avocados, olives, olive oil, nuts such as almonds, peanuts, macadamia nuts, hazelnuts, pecans, cashews, and walnuts; fatty fish such as salmon, tuna, mackerel, herring, trout, sardines, or sablefish; brussels sprouts, kale, spinach; sunflower, sesame, pumpkin seed, and flaxseed. Use to-go boxes when eating out.
- Instead of frying, roast, grill, or saute meats and vegetables.
- Don’t skip breakfast.
- Pay attention to portions. Smaller portions often result in fewer calories consumed.
- Eat together as a family whenever possible.
- When eating in, serve food on a plate, and don’t keep the serving dishes on the table, which encourage higher consumption.
- When snacking, to reduce the number of calories ingested, don’t eat straight out of the package.
- Keep unhealthy snacking foods out of sight and in harder to reach places, and healthy snacks out in the open.