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Defining Total Fitness for the 21 st Century , Bethesda MD, 6-9 Dec 2009. Nutritional Fitness for Military Personnel. Scott J. Montain, Ph.D. U.S. Army Research Institute of Environmental Medicine CAPT Mark B. Stephens, M.D. Uniformed Services University of the Health Sciences.

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Nutritional fitness for military personnel

Defining Total Fitness for the 21st Century , Bethesda MD, 6-9 Dec 2009

Nutritional Fitness for Military Personnel

Scott J. Montain, Ph.D.

U.S. Army Research Institute of Environmental Medicine

CAPT Mark B. Stephens, M.D.

Uniformed Services University of the Health Sciences

Consequences of poor nutrition
Consequences of Poor Nutrition

  • Mission Degradation

    • Reduced physical and cognitive performance

    • Impaired immune function

    • Increased injury susceptibility

  • Increased Health Care Costs

    • Disability

    • Cancer

    • Heart Disease

    • Diabetes

Nutrition is FHP Enabler

The nutritional fitness domain
The Nutritional Fitness Domain

Nutritional Fitness

Specific Nutritional


Dietary Quality



Dietary quality
Dietary Quality

Providing the “right” stuff

  • Nutritional value

    • Raw ingredients

    • Impact of food preparation

  • Acceptability

  • Variety

  • Physical Factors

    • Dining hall hours

    • Necessity for utensils or food preparation

Specific nutrient requirements ensure individual needs are met
Specific Nutrient RequirementsEnsure individual needs are met

  • Dietary needs are not one-size-fits-all

    • Nutrient requirements BM dependent

    • Gender-specific nutritional requirements

    • Energy and fluid needs vary

  • Available food must be sufficient to meet these individual requirements

Healthy choices picking the right stuff
Healthy Choicespicking the “right” stuff

Current dietary practices are suboptimal
Current Dietary Practices are Suboptimal

  • Overconsumption of energy

  • Reliance on processed foods

  • Inadequate fruits and vegetables

  • Inadequate whole grain and dairy

  • Over reliance on Dietary Supplements ?

Nutritional fitness for military personnel

Challenge #1

Operational Rations

Public / Private Dining

Group Rations

Individual Rations

Garrison Dining



Meal, Ready to Eat

Meal, Cold Weather/LRP

UGR–B: Canned & Dehydrated Foods

UGR-H&S: Heat and serve ration

UGR-A: Heat & Serve+ Fresh, Perishable foods

It s not nutrition until it s eaten col dave schnakenberg
“It’s not nutrition until it’s eaten” - COL Dave Schnakenberg

Challenge #2

  • Nutrient Factors

    • Macronutrients

    • Micronutrients

    • Bioactive Components

  • Non-Nutrient Factors

    • Food associated

    • Individual associated

    • Environmental

Nutritional Value



Food Preferences



Health Is not often the chief motive for young men to change eating behavior –

(vigor, appearance, performance)

Meiselman & MacFie, 1996

Assessing nutritional fitness
Assessing Nutritional Fitness

  • Tools

    • Survey and Diary

    • Direct Observation

    • Assessment of Physiological Markers

  • Standards

    • Military Recommended Dietary Intake (MRDI)

    • Food Group Recommendations (e.g., Healthy People 2010)

Measuring success metrics
Measuring Success: Metrics

  • Healthy People 2010

    • Eat at least 2 servings of fruit per day. Target: 75%

    • “ “ 3 servings of vegetables per day. Target: 50%

    • 3 servings of whole grain products/day. Target: 50%

    • Consume less than 30% of calories from fat. Target: 75%

    • Increase # worksites that offer nutrition or wt. mgmt. classes or counseling. Target: 85%

Promoting healthy eating behavior civilian cafeteria research
Promoting Healthy Eating Behavior -Civilian Cafeteria Research

Nutrient Content Manipulation of ad lib diet

  • Jayhawk Observed Eating Trial (Donnelly et al., Obesity. 2008)

    • 305 sedentary normal & overweight men & women, reduced fat diets

      • Only effective in weight loss when energy intake was reduced

        Ad lib food choice can be manipulated

  • Harvard SPH Cafeteria Study (Michels, et al., J Am CollNutr. 2008)

    • Educational displays

    • Price subsidies for “healthy” selections

Why are french fries & hotdogs cheaper than salad?

Promoting healthy eating behavior civilian cafeteria research1
Promoting Healthy Eating Behavior -Civilian Cafeteria Research

NIH-funded Cafeteria Study (Lowe, et. al., unpublished ongoing project)

  • Detailed food labeling

  • Greater number “healthy” selections

  • Price subsidies for reduced energy density items

    Yale NSLP Study (Schwartz, Int. J. Behav. Nutr. Phys. Act. 2007)

  • Verbal prompts by servers encourage fruit selection

    ”Sargent Choice” at Boston University

  • Logo label “healthy” food choices throughout DFACs

Promoting healthy eating behavior fort bragg dfac intervention on going
Promoting Healthy Eating Behavior -Fort Bragg DFAC Intervention (on-going)

  • Intervention

    • Dietary Guidelines for Americans 2005

    • Presentation, placement, nutrition labeling, education

  • Measurements

    • Ad lib food selections & intake, demographics & satisfaction ratings

    • Digital photography to assess quantity/quality of food selected.

    • Outcomes

      • Primary - % kilocalories intake from fat

      • Secondary - % carbohydrate and protein intake, food selection, fruit & vegetable servings, total kilocalories food intake.

To achieve nutritional fitness
To Achieve Nutritional Fitness:

  • Ensure High quality foods are available for consumption

    • Healthy cooking oils

  • Meet nutritional requirements of diverse military work force

    • IOM DRIs, FSR

  • Identify strategies for healthy eating

    • Education, Incentives, Dietetic Consultants