Weight-Loss and Maintenance Strategies

The most important component of an effective weight-management program must be the prevention of unwanted weight gain from excess body fat. The military is in a unique position to address prevention from the first day of an individual’s military career. Because the military population is selected from a pool of individuals who meet specific criteria for body mass index (BMI) and percent body fat, the primary goal should be to foster an environment that promotes maintenance of a healthy body weight and body composition throughout an individual’s military career. There is significant evidence that losing excess body fat is difficult for most individuals and the risk of regaining lost weight is high. From the first day of initial entry training, an understanding of the fundamental causes of excess weight gain must be communicated to each individual, along with a strategy for maintaining a healthy body weight as a way of life.

PHYSICAL ACTIVITY

Increased physical activity is an essential component of a comprehensive weight-reduction strategy for overweight adults who are otherwise healthy. One of the best predictors of success in the long-term management of overweight and obesity is the ability to develop and sustain an exercise program (Jakicic et al., 1995, 1999; Klem et al., 1997; McGuire et al., 1998, 1999; Schoeller et al., 1997). The availability of exercise facilities at military bases can reinforce exercise and fitness programs that are necessary to meet the services’ physical readiness needs generally, and for weight management specifically. For a given individual, the intensity, duration, frequency, and type of physical activity will depend on existing medical conditions, degree of previous activity, physical limitations, and individual preferences. Referral for additional professional evaluation may be appropriate, especially for individuals with more than one of the above extenuating factors. The benefits of physical activity (see Table 4-1) are significant and occur even in the absence of weight loss (Blair, 1993; Kesaniemi et al., 2001). It has been shown that one of the benefits, an increase in high-density lipoproteins, can be achieved with a threshold level of aerobic exercise of 10 to 11 hours per month.

Self-Monitoring and Feedback

Self-monitoring of dietary intake and physical activity, which enables the individual to develop a sense of accountability, is one of the cornerstones of behavioral treatment. Patients are asked to keep a daily food diary in which they record what and how much they have eaten, when and where the food was consumed, and the context in which the food was consumed (e.g., what else they were doing at the time, what they were feeling, and who else was there). Additionally, patients may be asked to keep a record of their daily physical activities. Self-monitoring of food intake is often associated with a relatively immediate reduction in food intake and consequent weight loss (Blundell, 2000; Goris et al., 2000).