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For Libraries. Larger Image. For example, they described chronic back, foot, knee, and shoulder pain from injuries that occurred during their service that interfered with physical activity. While they acknowledged poor eating and medications as causes of weight gain, they most often attributed weight gain to pain and inability to exercise rather than poor food choices Individuals who had successfully lost weight usually spoke of doing so by increasing walking, joining a gym, or obtaining exercise equipment.
A lack of daily structure and inadequate life skills were other reasons why participants found it difficult to maintain their weight and fitness levels. In the military, they were required to pass physical tests and experienced structured exercise regiments. Some had been required to wake up early every morning to exercise, and this imposed structure was difficult to maintain after discharge In contrast, their current lives were often unstructured especially if they were disabled, retired, or unemployed If they worked, they struggled to incorporate physical activity into their lives.
While in the military, they had less autonomy and their basic needs were met When they were discharged, they often found themselves unprepared to make their own health choices Finally, some of the participants expressed frustration that they did not get enough support when they were discharged. Some felt that given the service they gave to their country, the VHA should provide gym memberships and other resources e. This second major theme was defined as factors that support the initiation, integration, and continuation of healthy behaviors.
Participants described previous successful and unsuccessful weight loss experiences. As described above, most of their attempts had a strong physical activity component usually walking, jogging, or swimming. They spoke about different ways they tried to change their diet including eating regular meals or pre-packaged meals, limiting food variety, decreasing portions, and juicing. As is common in many populations struggling with obesity, study participants discussed lack of motivation as a barrier to lifestyle change and weight loss [ 43 ].
For this reason, their belief that it was important to maintain a healthy weight often did not translate into ability to sustain healthy behaviors For example, several participants described starting programs for weight management, but losing motivation to continue. For those who had it, support from family and friends was an important facilitator. One female participant spoke about her brother and friends as being important for supporting her rock climbing. However, others spoke of living alone and being unwilling or unable to cook for themselves.
Barriers to losing weight included high levels of stress and personal issues, often due to their military service, which made them want to eat more than they should Participants also indicated that personal finances and lack of time prevented them from eating healthy and exercising. Aging and health-related barriers also contributed to weight gain. These included chronic diseases and the need to take medications that caused weight gain, such as insulin for diabetes or steroids for asthma or arthritis. This was especially true among older participants. We specifically asked participants questions about goal setting as a potential method to help them lose weight.
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In general, most found goal setting useful and were able to distinguish between a goal and a plan Some had received lessons from the MOVE! Many set behavior change and weight loss goals, while others wanted to improve their physical appearance.
Weight Management: State of the Science and Opportunities for Military Programs
Others mentioned non-health or weight-related goals such as getting rich, retiring early, and enjoying new experiences. Some were diligent about writing down and charting their goals However, others felt that setting goals could be discouraging if they failed to achieve them. One participant had a particularly negative view of goal setting These participants spoke about how technology enhances their ability to track their goals , provides constant feedback which some said was particularly appealing to Veterans , and gives information about their health without relying on a doctor.
However, a few participants in each group were suspicious of technology and had concerns about privacy, security, and misinformation Still, others expressed not feeling comfortable using technology in general unless assisted. Participants spoke about local resources that helped them to lose weight, including low cost public gyms and parks near where they lived. They also spoke about the local food environment as contributing to their difficulty losing weight and making healthy choices.
For instance, they cited an over-abundance of food at work and social functions They frequented unhealthy restaurants and complained that even the VHA hospital cafeteria served unhealthy food. They thought that food advertising also contributed to poor eating habits Overall, participants had mixed views about the care and counseling they received at the VHA.
While some complained about access and continuity of care, others had very positive experiences and were impressed by the quality of care they received.
When asked about weight management counseling, they reported receiving advice from nurses, doctors, and dietitians, but experienced variability in the quality of counseling. Participants also varied in whom they preferred to deliver the advice. Some felt that doctors should be the ones giving the advice, and some preferred advice from the nurses. Some had received individual counseling by a dietitian, whom they often only saw one time unless they were enrolled in MOVE!.
Participants were much more likely to be satisfied with weight management counseling and advice from any healthcare professional if it was individualized and tailored to them e. This concept emerged in every group, but more frequently in female groups. Some participants did not go to MOVE! Cost of travel was an issue for others.
Those who had not heard about the program suggested it could be advertised better. Yet, many did not go because it did not offer a structured physical activity component Many felt that they already knew what to eat and believed that discussing their diet and health behaviors in a group would not increase their motivation to change. Those who had attended MOVE! Some initially lost weight, but gained it back after the program ended. While Veterans share many of the barriers to weight loss that impact all populations e.
In the military, the lack of autonomy and the highly structured environment may prevent Veterans from learning how to make proper lifestyle choices once they leave service. One study demonstrated similar findings about the role of military service [ 48 ]. In interviews with 64 Veterans about their eating behaviors during military service, they found soldiers experienced varying levels of control over food choices and periods of food insecurity while in service that contributed to overeating when they were discharged.
They also found high carbohydrate and high fat diets during service contributed to unhealthy habits after service. Indeed, other researchers have documented weight gain after discharge from military service in Veterans from the United States [ 49 ] and Belgium [ 50 ]. A systematic review found that military deployment impacted body weight and a variety of other health behaviors including excessive drinking and smoking [ 51 ].
Several participants in our study believed physical activity was more important than diet for weight loss, even though evidence shows dietary changes drive weight loss more than physical activity [ 52 ]. While this belief may be due to lack of knowledge about the importance of diet for weight loss, many of our participants had seen dietitians or had attended the MOVE! This finding that many Veterans seem to believe physical activity is central to weight loss has implications for the delivery of lifestyle interventions in this population.
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For example, adding more physical activity components with accommodations and extra support for Veterans with injury or chronic pain to existing health interventions may increase acceptability to Veterans and encourage them to adopt healthier diets as well. This is supported by cross-sectional studies showing a positive correlation between physical activity and dietary quality [ 53 — 55 ].
Further, even if Veterans do not lose weight with physical activity, it has several health benefits including improved mood [ 56 ] and decreased risk of cardiovascular and all-cause mortality [ 57 ]. On an individual level, we found that barriers to weight management included high levels of emotional and financial stress, issues thought to be common in Veterans [ 58 , 59 ]. Indeed, psychosocial and financial stress are associated with weight gain over time in other populations [ 60 ], and this supports using stress management strategies and MOVE!
Most of the participants spoke favorably about goal setting as a strategy for behavior change and weight loss, although they may need more support e.