FALLS CHURCH, Virginia –
Think you might need to lose a little weight?
You're not alone.
Even in the military, where maintaining physical fitness remains a job requirement and a key component of military readiness, thousands of service members struggle with weight.
But physical fitness is more than just a set of scores measuring your body-mass index, run times, or how many push-ups you can do. Optimizing your physical fitness starts with a combination of good diet, healthy lifestyle and exercise serving as the foundation for increased strength, flexibility, balance, and endurance.
Yet keeping a healthy body weight is correlated with all those components and is essential for long term health, fitness and personal readiness.
Pro Tip: Avoid Fad Diets
Among the first things that professional dieticians and nutritionists are likely to tell you is to avoid "fad diets", like Keto, intermittent fasting, Paleo and others.
Many people attempt these diets as quick-fixes, but these diets may not be healthy or effective for long-term weight loss. For some people, these diets can fuel frustration because people try them and then revert to their old eating habits, gaining even more than their initial starting weight.
Fad diets can be severely restrictive; they're not something patients can maintain long term, said Air Force Lt. Col. Tracy Snyder, the nutrition consultant to the Air Force Surgeon General at the Air Force Medical Readiness Agency, in Falls Church, Virginia.
Severely restricting a specific food group could be problematic.
"Once their diet goes back to baseline, they quickly regain any weight or body fat that they lost and potentially get into a negative cycle of weight loss, weight gain, weight loss, weight gain, from one extreme to the next," Snyder said. "That's how we end up with yo-yo dieting."
In addition to not being healthy, that cycle fuels frustration and makes patients feel like they can't achieve their goals and their efforts are pointless.
Consuming a balanced diet rich in nutrients can "help prevent stress fractures and other anomalies that prevent military personnel from being ready for duty," said Army 1st Lt. Cara Adams, a registered dietitian and the chief of outpatient nutrition at General Leonard Wood Army Community Hospital in Missouri.
Good nutrition goes beyond just calories and protein, she pointed out. "Our bodies were created to absorb and use nutrients from whole foods."
She suggested service members "start with the basics" by simply taking an honest look at what they eat and drink every single day. "Are you setting your body and your health up for success by consuming a variety of whole foods?" she asked.
Whole foods are foods that are not heavily processed or refined, like fruits, vegetables, nuts and seeds, beans and legumes, whole grains, meat, fish, and eggs.
"Unfortunately, our current food environment seems at odds with healthy eating," she said. "The evolutionary discrepancy between our brain's desire for calorie-dense foods to ensure survival and the ultra-processed food, sedentary living, and stressful lifestyle of today's culture creates the perfect storm for constant cravings, weight gain, and poor health."
Moreover, many fitness-oriented service members are focused more on cure-all dietary supplements rather than their core diet.
A good rule is to avoid any "diet" that is not truly stainable, Adams advised.
Many want quick fixes to weight loss. “They want to go vegan or vegetarian simply to lose weight, yet chicken and fish are their favorite foods. I remind patients that they do not have to completely eliminate any of their favorite foods to achieve their health goals. In fact, I encourage them not to."
The most important goal is a healthy diet and regular physical activity.
"It can help reduce the risk of heart disease, stroke, and certain cancers, as well as strengthen bone, muscles, and joints," Adams said.
Regular exercise and proper nutrition "have been shown to improve levels of happiness, increase energy levels, and increase your chances of living longer. It can also improve sleeping habits and sleep quality and help you build a stronger immune system," she said.
Changing Bad Habits
Dietitian Leah Roberts said she tries to "reframe" her patients' triggers for bad nutrition that can contribute to weight gain. Roberts is a licensed dietitian and certified diabetes care and education specialist at the Army's Kimbrough Ambulatory Care Center at Fort Meade, Maryland.
Her primary recommendation is that overweight service members should cook their meals at home or eat at their installation's dining facility where there are freshly cooked hot meals and other healthy foods available three times a day.
Avoid meal delivery services, Roberts suggested. During the COVID-19 pandemic "we've created a new culture of fast food and delivery service" that leads to unhealthy eating, she said.
Too much work and after-work or after-school activities frequently lead to settling for comfort foods or convenience foods because there just doesn't seem to be time to shop for healthy foods, Roberts said.
Her second recommendation is to "avoid sodas, juices and sweet tea.” They are full of sugar and empty calories.
Tip number three on Roberts" list: "Have a plan."
"People struggle the most about how to have food that is nutritious, easy to have on hand, and easy to prepare during busy weeknight schedules," she said..
Her most important component, she said, is to encourage small goals that are modifiable but consistent.
For instance, she makes her patients' first goal to lose 5% of their body weight. "I deal with people who weigh 220 or 230 pounds. When they calculate how many pounds to lose to get to that first goal, they say, 'I can do this.'"
Psychological Aspects of Weight Loss
Nutrition is a key component to maintaining a healthy body weight. But experts say it’s a mistake to fixate solely on your diet.
There are a host of mental and psychological factors that impact weight, and getting those aspects of your lifestyle and fitness program on track can make all the difference in your long-term success.
Dr. Natasha Schvey, assistant professor of medical and clinical psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, says the best approach to improving your health is one that takes into account both mind and body.
“I actually think it’s more important to focus on addressing some of the other possible targets of weight management rather than weight loss specifically – things like physical activity, addressing disordered eating attitudes and behaviors, such as crash dieting, reducing body dissatisfaction, and trying to improve ‘intuitive eating,’ which is essentially re-learning to eat according to your internal hunger and fullness cues,” said Schvey.
There is often the misconception that weight loss is a reflection of willpower or discipline – basically, that you can’t lose weight because you don’t want to or you’re not trying hard enough.
“It’s really important to realize that significant weight loss is very, very difficult to maintain psychologically and physiologically,” she said. “Even the best treatments aren’t particularly effective in the long run. That being said, even small amounts of weight loss can be accompanied by tangible and important health gains and benefits.”
She recommended that people “reframe the approach.”
Individuals often adopt weight management plans or programs with an “all or nothing” attitude.
“Rather than thinking, ‘I’m on a diet,’ or, ‘I’m off a diet,’ or, ‘I’m going to start a diet on this particular day’ – instead try to adopt approaches that are more sustainable in the long-term,” Schvey explained. “Also remember that weight is something that is largely controlled by factors that may not be within our control like genetics.”
“There are obvious physical components to this, but weight can be a very fickle friend or foe,” said Schvey.
Time to Get Professional Help?
If you've struggled unsuccessfully to lose weight in the past, it might be time to try getting some professional help.
A trained nutritionist can help you reach your goals by designing a personalized plan based on your health status, your individual needs, and your lifestyle.
When it comes to obesity, for example, a registered dietitian understands "it's a disease, just like any other disease," said Snyder, the Air Force nutrition consultant.
Additionally, registered dietitians are "educated in helping individuals tweak their normal dietary intake and give them options they might not be familiar with that can help them decrease their overall caloric intake," said Robert Goldberg, a registered dietitian certified in diabetes care and education at the Walter Reed National Military Medical Center in Bethesda, Maryland.
Tools of the Trade
Dietitians and nutritionists can help you to modify habits in a healthy, achievable way. And depending on each patient's goals, professionals can provide different types of support and education.
"Some patients are interested in learning how to read food labels. Some are interested in creating mutually agreeable dietary goals that they can try on a day-to-day basis. Some are interested in obtaining meal plans. Some want custom meal plans, and some just need accountability and regular feedback from a professional on how they are eating," Goldberg said.
Embarking on a weight loss journey with professional guidance also means looking at your current habits and understanding where you want to be and why, Snyder said.
"When beginning treatment with a patient, one of the first things I take into consideration is where the individual is currently in their weight loss journey, their individual motivation and other factors that may or may not impact their ability to make changes," she said. "Sometimes that’s not even a nutrition-related problem."
To remain in check, Goldberg recommends service members see a registered dietitian to assess their current dietary intake and habits, eating a diet consistent with the plate model, and exercising between 150-300 minutes per week.
What TRICARE Can Do For You
Keeping a healthy weight can be challenging, but it’s worth the effort. And with the right support, it’s possible. Whether you’re active duty, retiree, or a family member, you can work with a health care provider. They can help you understand your weight and its impact on your health, and get you started toward diet and exercise goals to help you reach and maintain a healthy weight.
“Not only can carrying extra body weight impact your mobility and joint health,” said Air Force Lt. Col. Heidi Clark, chief of the Nutritional Medicine Clinical Support Service at the Defense Health Agency. “Being overweight or obese puts you at risk for serious health conditions, like diabetes, heart disease, sleep apnea, lower back pain, depression, and fatigue.”
Here are some of the services TRICARE covers and tips to help you with weight management:
Treatment for Obesity
If you meet specific conditions, TRICARE covers intensive, multicomponent behavioral interventions for obesity. These services promote sustained weight loss (12 to 26 sessions in a year). A TRICARE-authorized provider, like a physician or a registered dietitian who’s working under the supervision of a physician, must provide these weight loss services for TRICARE to cover them.
To qualify for these services, you must be:
- An adult with a Body Mass Index (BMI) of 30 kg/m2 or higher
- A child or adolescent with a BMI value greater than the 95th percentile
Services include, but aren’t limited to:
- Behavioral management activities like setting weight-loss goals
- Guidance regarding physical activity and dietary changes
- Strategies to maintain lifestyle changes
- Addressing your personal barriers to change
- Teaching you self-monitoring behaviors to track your weight loss progress
TRICARE also covers surgical obesity treatment for non-active duty service members. This includes gastric bypass surgery and other surgeries for weight loss. But you must meet certain conditions for TRICARE to cover. You can go to the Bariatric Surgery page on TRICARE.mil to see the list of covered services. And you can find the medical conditions which may make weight loss surgery medically appropriate for you.
Seeing a Registered Dietitian or Nutritionist
TRICARE covers medically necessary services and supplies from registered dietitians and nutritionists. They must have a license from the state where you get the care. They must also be working under the supervision of a physician. Here are some examples of conditions that may benefit from medical nutrition therapy (also medical nutrition counseling) sessions provided by a registered dietitian or nutritionist: Obesity, elevated blood lipids/high cholesterol, diabetes, anemia, irritable bowel syndrome, and eating disorders.
For more on what TRICARE can cover, visit the TRICARE.mil to review coverage of weight management services available to beneficiaries.