DoD fights battle of the bulge

Thursday - 4/17/2014, 12:44pm EDT

Listen to our full interview with Capt. Kim Elenberg from this week's Agency of the Month radio show.

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By Lauren Larson
Federal News Radio

To increase readiness and improve the health of the entire Defense workforce, the Defense Health Agency is looking for the best programs and promising practices within each of the services to be applied department-wide. The programs aren't limited to the workforce though; achieving a healthier DoD means reaching out to families and the retired as well.

"One of the things that we recognize is that there are tremendous primary prevention initiatives going on, both through the Military Health System and at the installations and within the units," Capt. Kim Elenberg, program manager for Population Health, Health Promotion and Disease Prevention, told Federal News Radio on this week's Agency of the Month radio program.

Operation Live Well is the umbrella program under which these health initiatives are coordinated and evaluated. An advisory board made up of representatives of key stakeholders oversees the mission. DHA did an assessment of the state of military health and launched three phases of Operation Live Well: education, analysis and implementation.

Courtesy of DHA

The initiatives identified are demonstrated through the Healthy Base Initiative. Each installation implements a common framework, but the actions vary to target the specific needs of the community, Elenberg said. Submarine life presents very different health challenges than an air base, for example. A crew living underwater for three months will need food that won't spoil and they'll need to know how to exercise quietly in tight spaces. After the demonstration period, the programs are then evaluated for effectiveness.

The enemy: smoking, alcohol and obesity

As DHA started looking at the military's disease burden and contributing factors, obesity and tobacco stood out. Elenberg calls them low-hanging fruit that can be taken on in a short time with great impact. They also align well with the goals of the National Prevention Strategy. DHA decided to focus its efforts on physical activity, nutrition and sleep as part of its fight against obesity and tobacco. As DHA planned the framework, it looked to the Centers for Disease Control and Prevention's Healthy Communities Program as an example, as well as some state and county health associations.

Tobacco rises to the top as perhaps the biggest preventable health challenge, according to Elenberg. She said the Military Health System incurs nearly $54 million per year in expenses related to absenteeism, smoke breaks and other smoking-related loses. Overall, with related health care costs, she said total costs related to tobacco usage reach $1.6 billion annually.

"If you have somebody who's trained in a specific skill and they work hard to learn that skill, we want to make sure that what we're doing is offering them the support they need to have a healthy lifestyle," said Elenberg. "That the healthy choice is the easy choice so they can meet their readiness requirements and we can maintain the value of our investment."

Alcohol is another enemy for DoD. Not only does it contribute to obesity, it can cost a service member his or her career if they are cited for driving under the influence, said Elenberg. Through a program called "That Guy," young service members are learning to stop and think about the choices they are making and the potential consequences of those decisions. From opting for a designated driver to considering the image one portrays to the opposite sex while intoxicated, Elenberg says they are working hard to keep "That Guy" fresh with ongoing efforts to revitalize the campaign.

Winning strategies

As they searched for the best programs from each service, Elenberg said, a number stood out to her.

In Yokota, Japan, they've implemented recess before lunch for children in military families. They are seeing greater appetites, less food waste, higher milk consumption and improved behavior in the classroom, according to Elenberg. It isn't a cost issue, it's a timing issue, she said. They have also implemented a 5- 2-1-0 program. That's five fruits and vegetables a day, two hours or less of screen time, one hour or more of physical activity and zero sweetened beverages. Elenberg said this program really pulled the community together, the children became excited about fruits and vegetables, and they had lower Body Mass Indexes, in turn.

Another initiative Elenberg speaks highly of is patient-centered medical homes. Here, service members can find support for medical care, for primary prevention and for care coordination. The homes care for a group of individuals as a team and work hand-in-hand with the Army's Wellness Centers.

"I really think this is the future of moving from a system of health care to a system of health; that partnership between the patient-centered medical home and the wellness center," Elenberg said.

At the wellness centers, the care is focused more on prevention. They train and educate on weight loss and proper exercise. Someone at risk for diabetes, for example, can receive a breath test that will determine metabolic rate. From that test, they can calculate how many calories an individual needs to burn each day and how much that calorie quota changes with exercise. The test is followed up with classes to educate on how to read nutrition labels and select healthy foods.

Health for generations

The Army is also working on a pre-retiree weight management pilot to be demonstrated during the Healthy Base Initiative. On active duty, an individual might be burning more calories, Elenberg said. But, after retirement, she said people really struggle with weight.

"They are a group of individuals we need to look at and help them understand how they remain part of this bigger family, and how our social determinants and behavior choices impact the greater mission," Elenberg said. "Each one of us, all members of this big family, have to understand the personal accountability we have and the choices we make and how those choices impact the greater mission. We need to understand it throughout our career and throughout retirement."

Healthy initiatives have to go from cradle to grave, Elenberg said. "We need to start with the children… because they are our greatest pool of recruits. We need to incorporate a culture of health and wellness from the time people walk into the recruiting office through their basic training and all their schooling throughout their careers, including the schooling they get prior to retirement."