Dissemination of the Look AHEAD Intensive Lifestyle Intervention in the United States Military: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study, "Fit Blue," was to compare a translation of the Look AHEAD (Action for Heath in Diabetes) intensive lifestyle intervention with a self-paced version of the same intervention among active duty military personnel. METHODS: Active duty military personnel (N = 248; 49% male, 34% racial minority) with overweight or obesity were randomized to 12-month distance-based (i.e., phone and email) parallel programs, counselor-initiated (CI) condition or self-paced (SP) condition, from 2014 to 2016. Trained lay interventionists were retired military personnel or had extensive familiarity with the military. RESULTS: The CI condition had greater weight loss at 4 months (CI: mean ± SD = -3.2 ± 3.4 kg; SP: -0.6 ± 2.9 kg; P < 0.0001) and at 12 months (CI: mean ± SD = -1.9 ± 4.1 kg; SP: -0.1 ± 3.8 kg; P < 0.001). Participants in the CI condition also had a greater percent weight loss at both 4 months (CI: 3.5% ± 3.8, SP: 0.6% ± 3.1; P < 0.0001) and 12 months (CI: 2.1% ± 4.7, SP: 0.0% ± 4.0; P < 0.001). In addition, a greater proportion of CI participants lost 5% or more at 4 months (CI: 29.8%, SP: 10.5%; P < 0.001) and at 12 months (CI: 29.5%, SP: 15.6%; P < 0.05). CONCLUSIONS: The CI behavioral weight loss intervention translated from Look AHEAD was well received and is a promising approach for managing weight in an active duty military population.

Dissemination of the Look AHEAD intensive lifestyle intervention in the United States Air Force: study rationale, design and methods.

BACKGROUND: Despite an increase in overweight and obesity similar to the civilian population, there have been few randomized controlled trials examining behavioral weight management interventions in the military settings. PURPOSE: This paper describes the design, intervention development and analysis plan of the Fit Blue study, a randomized controlled behavioral weight loss trial taking place in the United States Air Force. DESIGN: This study compares two adapted versions of the efficacious Look AHEAD Intensive Lifestyle Intervention (ILI), a counselor-initiated condition and a self-paced condition. Also described are the unique steps required when conducting military-based health promotion research and adaptations made to the Look AHEAD intervention to accommodate the military environment. CONCLUSIONS: To our knowledge, this is the first translation of the Look AHEAD ILI in the military setting and one of the first translations of the ILI in general. If successful, this intervention could be disseminated to the entire U.S. Military as this project is designed to overcome the barriers and utilize the facilitators for weight loss that are unique to a military population. Programs validated in military populations can have a major public health impact given that with 1.4 million active duty personnel, the Department of Defense is the nation's largest employer. However, while this intervention is designed for a military population and there are unique aspects of the military that may enhance weight loss interventions, the diversity of the study population should help inform obesity efforts in both civilian and military settings.

Staphylococcus aureus and other skin and soft tissue infections among basic military trainees, Lackland Air Force Base, Texas, 2008-2012.

Military training environments have been identified as high-risk settings for acquisition of skin and soft tissue infections (SSTIs), including those caused by methicillin-resistant Staphylococcus aureus (MRSA). Among the 148,355 basic military trainees at Lackland Air Force Base, Texas, between 1 October 2008 and 30 September 2012, there were 289 SSTIs, including 48 cases of culture-confirmed MRSA and 48 cases of possible MRSA-defined as SSTIs treated with both incision and drainage and MRSA drug coverage (i.e., trimethoprim-sulfamethoxazole, clindamycin, a tetracycline, or linezolid). The period prevalence rates of all SSTIs and MRSA SSTIs increased annually since fiscal year 2010. Of the 87 SSTIs cultured during the surveillance period, 74 were positive: MRSA (n=48); methicillin-sensitive Staphylococcus aureus (n=24); Haemophilus parainfluenzae (n=1); and viridans Streptococcus (n=1). Among MRSA positive cultures, three were resistant to clindamycin, one to tetracycline, and one to both clindamycin and tetracycline; none was resistant to trimethoprim-sulfamethoxazole. An algorithmic clinical approach and heightened public health measures may reduce rates of future SSTIs among basic trainees at Lackland Air Force Base.