Lifestyle and environmental assessment tools in relation to adiposity for military populations
Shams-White, Marissa.
2018
-
Abstract: In 2011,
an estimated 63.6% of all US military were overweight or obese, which is comparable to
the rate observed in the civilian population. Not only are major chronic diseases and
healthcare costs associated with obesity, but in military personnel obesity is also
linked to musculoskeletal injuries and heat-related illness in hot climate conditions.
Furthermore, overweight and ... read moreobesity jeopardize job security: military personnel may not
be retained because of their inability to meet fitness standards, which include weight.
Thus, obesity can endanger military careers, affect operational readiness and put the
long-term welfare of the military and national security at risk. Accurate measurements
of adiposity are thus a priority need for military personnel. Additionally, though
optimal nutrition is known to serve an important role in the health and physical
readiness of military personnel, how well the diets of military personnel adhere to the
current nutritional recommendations set forth by the 2015-2020 Dietary Guidelines for
Americans (DGA) remains unclear. The main objective of this dissertation research is to
evaluate lifestyle and environmental assessment tools currently used by US military
researchers and to propose evidence-based improvements to strengthen them. First, at the
individual level and in the context of the military's goals, we determined the level of
agreement between several anthropometric measures of adiposity and explored whether a
combination of measures would be more valid for screening overweight and obesity than
body mass index (BMI) alone. We found that BMI combined with circumference-based
equation (CBE) measures of body fat was the best combination to categorize
overweight/obesity in our study sample. BMI+CBE had the relatively highest sensitivity
and lowest false discovery rate, as well as a moderate level of agreement with
bioelectrical impedance analysis, which we used as the criterion measure. This
combination was notably stronger in females. Second, we aimed to strengthen the 5-item
Healthy Eating Score (HES-5) that is currently part of the military's Global Assessment
Tool to improve its correlation with the 2015 Healthy Eating Index (2015-HEI), a current
measure of dietary adherence to the DGA. By doing so, our goal was to provide an
improved nutrition assessment tool for future military studies when collecting detailed
dietary data is impractical. We examined the addition of items to assess breakfast
frequency, post-exercise recovery fueling snack frequency (RFsnack), and sugar-sweetened
beverage (SSB) consumption. We found that the addition of SSBs (8oz/serv) and RFsnack
significantly improved the correlation between the HES-5 and the HEI-2015. Their
inclusion in the HES-5 could improve the validity of this field measure. Lastly, at the
environmental level, we examined perspectives on the implementation and utility of the
Creating Active Communities and Healthy Environments Toolkit, a new Toolkit from the
Army Public Health Center developed to assess the health-promoting attributes of the
built environment on military installations. Participants identified the need for (1)
detailed manuals to improve Toolkit and Action Plan Guide functionality; (2)
leadership's enforcement of policies and their prioritization of health-promoting
improvements to the built environment; and (3) consideration of finances in Action Plan
Guide recommendations. Our findings suggest the opportunity for substantial impact on
military obesity research: they elucidate methods to more accurately measure and address
obesity and dietary trends, which represents an important step in the further
development of health promoting policies and messages related to food environments in
military settings.
Thesis (Ph.D.)--Tufts University, 2018.
Submitted to the Dept. of Nutritional Epidemiology.
Advisor: Aviva Must.
Committee: Ken Chui, Patricia Deuster, and Nicola McKeown.
Keywords: Nutrition, Statistics, and Military studies.read less - ID:
- kk91fz47r
- Component ID:
- tufts:25077
- To Cite:
- TARC Citation Guide EndNote
