By: Maria McConville, MS, RDN, with expert input from Dr. Richele Corrado, DO, MPH, FACP
Along with the rest of America, the military faces challenges with Service Member obesity. The numbers are also rising alarmingly according to DoD Health of the Force Reports from 2018–2022. The percent of active-duty Service Members counted as obese in 2002 was 8%. In 2022, it was 22%—that’s almost 3 times as much in just 20 years!
Obesity is a chronic, progressive disease where excess body fat contributes to health problems affecting metabolism, physical function, and overall well-being. Obesity is not a moral failing—it is a complex disease. It’s not just about appearance; obesity is a serious medical condition that requires proper diagnosis and treatment to lower the risk of developing other health problems and improve overall health. The disease of obesity is influenced by genetic, environmental, and behavioral factors. Recognizing obesity as a disease is crucial to destigmatize and effectively manage it, because it can lead to serious health consequences, including cardiovascular diseases, diabetes, musculoskeletal disorders, and more than 200 other diseases.
It would be great to have a magic bullet to solve obesity, but there’s no one-size-fits-all approach. Effective treatment often requires a comprehensive, individualized approach. The pillars of obesity treatment are lifestyle modifications, including changes to your diet, exercise, sleep, and stress management.
Change Your Diet
To lose excess fat tissue, you need to consume less calories than you burn—what’s known as “calorie deficit.” There’s no special diet. The goal for fat loss is to build sustainable, healthy habits while maintaining a reduced-calorie diet that satisfies you and doesn’t leave you hungry. This can be a challenge. Strategies for weight loss include:
- Eat more nutrient-dense foods full of protein and fiber that suppress hunger.
- Limit empty-calorie foods and drinks (like crackers, candy, chips, and sodas) that spike your blood sugar and don’t leave you feeling full or satisfied.
- Eat smaller portions than you ate in the past.
- Limit fried and fast foods.
Exercise for Weight Loss
Exercise alone is not an effective strategy for fat loss, but it is very important for your metabolic, physical, and mental health. Try to build physical activity into your daily routine, even if it’s just 10 minutes here and five minutes there. Something is better than nothing. The key is to move more and do what you like so you can keep it up. As you lose weight, it’s important to maintain muscle mass and function, and you can achieve that with just a couple of days a week of resistance or strength training.
Sleep, Behavior, and Stress
Getting enough restful sleep can help you control body fat. When you’re well rested, the hormones that control appetite are at optimal levels. Restful sleep helps you optimize performance. Changes you can make to get better sleep include:
- Create a bedtime routine.
- Avoid caffeine after mid-afternoon.
- Limit tobacco use close to bedtime.
- Avoid alcohol within 4 hours of bedtime.
- Avoid long or late naps.
- Stop stimulating activities within one hour of bedtime.
- Avoid screen exposure (computer, tablet, and phone) close to bedtime.
High stress levels can be a major obstacle to your fat-loss goals. Recognizing and managing your stress levels can help reduce emotional eating as well as regulate hunger hormones and stress hormones like cortisol. Stress modifications include: making stress your ally, practicing deep breathing, meditation, and reaching out to others to strengthen connections and spiritual wellness.
Remember: Perfection doesn’t exist. Don’t beat yourself up if things don’t go as planned. Get back to your goals tomorrow, and make sure they’re realistic for you. Sustainability is key.
Medical Options Available to Service Members
Lifestyle changes alone may not be enough to achieve and sustain fat loss despite your best efforts, because obesity-associated brain and hormonal dysfunctions can impair your metabolism and increase your appetite. Your healthcare provider may recommend obesity medications, medical devices, and/or bariatric procedures as part of a comprehensive approach to treat your obesity.
Obesity medications (OMs) have been available since the 1950s, but new drug classes are now transforming obesity treatment, achieving total body weight loss of 15% or more. These medications should be prescribed by a knowledgeable medical provider, along with guidance on how to manage side effects and incorporate lifestyle modifications for optimal results. OMs can be either daily oral pills or subcutaneous injections administered daily or weekly.
While OMs offer promising treatment options, barriers to their use include high costs, inconsistent insurance coverage, supply shortages, and a shortage of healthcare providers experienced in prescribing and managing these therapies.
TRICARE has covered obesity medications for eligible individuals since 2018, but prior authorization for coverage is required. Some weight-loss medications (such as compounded OMs tailored to the needs of an individual) are not FDA-approved, which means their safety and effectiveness are uncertain. As a result, TRICARE covers only FDA-approved obesity medications, so beneficiaries can access safe, proven treatments without resorting to potentially unsafe alternatives.
Policies across the various DoD Service branches regarding the use of OMs for active-duty Service Members vary greatly and leave room for interpretation. Future guidance from DoD and individual Services is needed to clarify this important issue.
If you're interested in finding out more about Service Member obesity, you can find information in the Army’s DoD Health of the Force Reports. To explore obesity treatment options, including OMs, speak with your healthcare provider. While more detailed guidance is still pending, your provider can help determine the best course of care for your individual needs. Also, please consult Operation Supplement Safety (OPSS.org) for articles on some obesity medications, including semaglutide and phentermine.
While obesity medications might help with weight loss, the only way to keep weight off is through changes in diet and behavior as part of your commitment to lifelong healthy habits.
Resources:
What is a Healthy Weight-Loss Eating Plan?
How Your Body Burns Fat and Carbs During Exercise
Sleep Readiness to Optimize Your Performance and Military Wellness
Strategic Habits for Better Nutrition
Maria McConville, of the Henry M. Jackson Foundation, is a Senior Nutrition Health Educator for the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences (USU).
Disclosure: *The opinions and assertions expressed herein are those of the authors and do not reflect the official policy or position of USU or DoD. The contents of this publication are the sole responsibility of the author and do not necessarily reflect the views, opinions, or policies of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The author has no financial interests or relationships to disclose.
