Development of an Internet/Population-Based Weight Management Program for the U.S. Army

Abstract

A significant number of Army soldiers are sufficiently overweight to exceed the maximum weight allowances defined by the Army weight control program (AR600-9). Also, the body weights of a substantial number of soldiers approach the maximum weight allowances. These soldiers should not gain additional weight if they are to meet Army weight allowances. The conventional approach to this overweight problem is assigning soldiers to remedial physical training and mandatory referral for nutrition counseling by a health care provider. An alternative to this conventional approach is to target the entire population of soldiers (population-based intervention) to promote weight loss in overweight soldiers and weight gain prevention in soldiers who are approaching overweight status. To accomplish this objective, the Healthy Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H.) program was developed. This article describes the rationale for developing the program, the components of the program, and the utilization promotion strategies of the program. The H.E.A.L.T.H. program includes two primary components: (1) a Web site tailored to the standards established in Field Manual 21-20, Physical Fitness Training, Army physical fitness test, and AR600-9, the army weight control program, and (2) a health promotion program designed to promote awareness of the H.E.A.L.T.H. Web site and to facilitate use of the Web site by soldiers and their family members. The Web site is equipped with personalized planning tools and progress tracking over time related to fitness, caloric intake, and lifestyle behavior change goals. The health promotion program includes media advertisements and “ground roots” efforts to facilitate use by soldiers.

Introduction

Since the early 1980s, scientists have observed a slow, but progressive increase in the prevalence of overweight, as defined by a body mass index (BMI) of 25–29.9 kg/m², and obesity (BMI ≥ 30 kg/m²) in adult U.S. citizens.^1,2 This increased prevalence of overweight and obesity has been observed in all gender and ethnic subgroups. By 2004, 32.2% of adults were obese.² It is well established that overweight and obesity are associated with a number of comorbid medical conditions, e.g., type 2 diabetes, hypertension, cardiovascular disease, and hyperlipidemia.³ Of particular concern to the Department of Defense (DoD), overweight and obesity can degrade combat readiness, increase injury and health risk, and increase attrition, leading to premature discharge from military service.⁴ Further, overweight and obesity may impact the ability to recruit, as the rising prevalence of obesity in children impacts the military eligibility of the pool of recruit-age Americans.

Soldiers must meet body fat standards, as defined by Army Regulation (AR) 600-9, the army weight control program.⁵ Age- and gender-specific weight-for-height allowances are used as the primary screening tool to identify soldiers who are overweight. If a soldier exceeds his/her specific screening weight-for-height allowance, or if the commander or supervisor determines that the soldier does not appear fit,⁴ circumference measurements are taken. If the person fails to meet the percent body fat standard, the soldier is referred to the Army weight control program (AWCP).⁵ Soldiers who fail to meet the percent body fat (AR600-9)⁵ and fitness standards [Field Manual 21-20, Physical Fitness Training, Army physical fitness test (APFT)]⁶ are the primary targets of the intervention described in this article. These soldiers are encouraged to lose body weight, body fat, and/or improve fitness. Soldiers with body weights and/or fatness that approach the maximum weight allowances and/or percent body fat standards as defined by AR600-9⁵ are also targets of the intervention and are encouraged to maintain current body weight and fatness levels.

Rationale

Military personnel are subject to the same environmental factors that have resulted in an increasing prevalence of overweight and obesity that plague the rest of Americans. However, soldiers are required to maintain fitness and fatness standards that are not required for civilians in order to be ready for combat. The military is aware of the overweight affection of military personnel and its adverse effect on combat readiness. In 2003, the Committee on Military Nutrition Research reviewed the need for interventions to address this problem.⁴ The committee was asked to identify the most effective interventions for weight loss and maintenance, with a particular focus on those most effective for nonobese military individuals. One recommendation of the committee was to develop and test Internet-based weight management programs designed specifically for the military. The committee recommended an Internet-based intervention that was “portable” so that soldiers could access and use the program wherever they were deployed. They concluded that testing of such programs should emphasize overall effectiveness and utilization.⁴ The Internet/environmental intervention, called Healthy Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H.), as well as the system designed to assess Web site data and utilization rates described in this article, was developed in response to this recommendation.

Clinic-Based vs Internet/Population-Based Approaches

Since the mid-1970s, many studies of pharmacological, behavioral, dietary, and exercise interventions for obese adults⁷ and children⁸ have reported successful weight loss induction but poor maintenance of weight loss. Clinic-based interventions that target changes in eating habits, nutrition, and exercise can lead to substantial reductions in body weight, but weight loss is generally maintained only if regular contact with a lifestyle counselor is continued over an extended time period. Use of the Internet to provide a “home study course” is one approach that could be used to overcome some of these obstacles. Many soldiers have Internet access at work and/or at home, which makes this approach viable for application with soldiers who are overweight. Overweight status in the military can affect promotions, participation in professional military or civilian schooling, assignment of command positions, and even separation from the service. Soldiers attempting to lose weight, or prevent weight gain, may prefer to do so anonymously via the Internet to avoid social stigmatization. Indeed, among soldiers enrolled in the AWCP, 29% (28% of males and 36% of females) reported that they would like, but did not have, access to an Internet-based program to facilitate their weight loss efforts.⁹

Use of an Environmental Approach

In recent years, seven published papers have described studies that tested the use of the Internet as a means of delivering weight management programs for adults and children. Overall, these studies reported that the Internet can be used to induce small weight losses and that this approach has potential for use as a weight gain prevention strategy.¹⁰ A primary problem that has plagued the Internet approach for treatment delivery has been sustained utilization of the program over time. The problem of sustaining usage of Internet-based approaches can be addressed by combining the Internet approach with environmental approaches that promote the utilization of the Internet program for long-term weight management.¹⁰

Why Develop an Internet Program for the Military?

The Army has attempted to address the problem of overweight and obesity. The AWCP is an Army regulation program designed to assist soldiers at losing body weight/fat. Military personnel who fail to meet percent body fat standards are placed on the AWCP for remediation.

Also of considerable concern are the methods used by soldiers to reduce body weight when they are in danger of not meeting weight and/or fat allowances. One study found that soldiers enrolled in the AWCP reported the use of numerous strategies to control body weight, and some of these methods might be harmful to their health. For example, 46% of a sample of soldiers enrolled in the AWCP reported using sauna/rubber suits to reduce body weight, and 21% reported the use of laxatives.⁹

In 2005, Tsai and Wadden¹¹ reviewed the efficacy of existing commercial Internet-based programs for weight management. Based on our own review and that of Tsai and Wadden,¹¹ we concluded that no existing online resources met the specific weight management needs of the military. Thus, the H.E.A.L.T.H. Web site combines features of traditional lifestyle modification tools, as well as technological interactive components, all of which are tailored for use in military populations. The material on the H.E.A.L.T.H. Web site was designed to be compatible with the AWCP, and soldiers enrolled in the AWCP are encouraged to utilize the H.E.A.L.T.H. Web site as a tool to aid them in reaching their weight management goals.

Description of the H.E.A.L.T.H. Intervention

The mission statement of the H.E.A.L.T.H. program is “to empower soldiers in healthy and safe lifestyle change to sustain healthy weight and performance on a year-round basis.” This mission was founded on the concept that soldiers should strive to be fit and healthy year round, versus engaging in unhealthy behaviors (e.g., fasting, using laxatives) as a means of achieving weight/fat standards one to two times per year during mandatory weigh-ins. Additionally, to be prepared for combat, soldiers must be fit and healthy all of the time.

The H.E.A.L.T.H. Web site was designed specifically to aid military personnel in achieving healthy nutrition, physical fitness, and healthy management of body weight, as well as being prepared physically for combat. Soldiers can use the Web site to obtain general information on nutrition, fitness, and maintenance of a healthy lifestyle or they can create an “account” that allows them to use the Web site interactively to track their progress and develop a more personalized diet and exercise plan unique to their individual needs and goals. Family members (civilians) of soldiers are also encouraged to utilize the Web site to support the soldiers in weight management efforts or their own efforts at weight management. Civilians may also set up an account on the Web site. Use of the Web site is completely anonymous (the research team cannot identify an individual user of the Web site), regardless of whether a user creates an account.

Features and Structure of the Web Site

The H.E.A.L.T.H. Web site is designed with several basic structural features: (1) the Web site operates off of a “guided” and interactive design (i.e., interactive tools and questions), such that it guides the user down a path based on the choices they make in self-reporting data; the opposite of this type of design would be an educational design in which the user would be a passive receiver of information, (2) the Web site utilizes limited outside resources (e.g., external Web site links) to keep the user focused on what the intervention Web site offers, (3) the Web site content (e.g., information, graphics) is dynamic, always being updated and refreshed so that users do not become apathetic to the content, and (4) the Web site contains algorithms that provide individualized feedback and personalized plans for weight loss or weight maintenance based on the entered self-report data by the soldiers or civilians. Table 1 describes the algorithms used for establishing a user account, if the user chooses to do so.

Table 1.

Web Site Algorithms

Case 1	If the user decides not to set up an account, then they have access to many educational features on the site, including nutrition, fitness, and general health information.
Case 2	If a soldier chooses to form an account on the Web site, upon initial registration on the Web site, the soldier is prompted to report height, weight, age, and level of physical activity. The soldier has the option to report body fat and/or circumference measurements as well. From this self-reported assessment, a prescription is formulated from algorithms to determine the soldier's need for weight loss or weight maintenance based on AR600-9.
Case 3	If data entered into the Web site suggest that the soldier is in the range of allowable weight and fat (if entered), then the soldier will be directed toward a weight maintenance plan on the site.
Case 4	If data entered into the Web site suggest that the soldier is approaching his/her screening table weight (within 5% as suggested by AR600-9) and/or body fat standard, then the Web site will guide the person into a moderate weight loss plan to achieve the desired range or weight maintenance (the person will be able to choose their plan based on their desired weight loss pattern, e.g., 1 pound per week, 1.5 pounds per week, 2 pounds per week).
Case 5	If data entered into the Web site suggest that the soldier exceeds his/her screening table weight and/or body fat standard, then the Web site will guide the person into a weight loss plan to achieve the desired range at a 1 pound, 1.5 pounds, or 2 pounds per week rate of loss (the person can choose). However, depending on the weight of the person, the Web site may only offer/prescribe the 1-, 1.5-, or 2-pound plan or some combination of the three.
Case 6	If data entered into the Web site suggest that the soldier is substantially below his/her screening table weight (unhealthy weight) and/or body fat standard, then the Web site will suggest that the person consult with their doctor.
Case 7	The Web site may also be utilized effectively by civilians (family members of soldiers). These algorithms are based on body mass index instead of military weight for height allowances. Civilians can create similar weight management plans as described earlier based on self-reported height, weight, and fitness information entered into the Web site.

Interactive Tools

Table 2 identifies featured pages/tools of the H.E.A.L.T.H. Web site and a description of each page. The “my Weight” page of the Web site provides a summary with a graphic illustration (Figure 1) of the soldier's current weight as it relates to military allowances and maximum recommended weight (defined as 5% below screening table weight) in order to stay within military recommendations, as well as calories needed to maintain current weight or lose weight. The weight loss regimen is determined by the amount in which the soldier exceeds his/her screening table weight and/or body fat standard. Once a calorie level is established for weight loss or weight maintenance, an individual is guided through interactive self-report activities to create individualized nutrition and fitness plans appropriate for their goals.

Table 2.

Features of the H.E.A.L.T.H.

Feature	Description
“my Weight”	Upon initial registration, a self-reported assessment of height, weight, age, and level of physical activity is entered, a summary is produced of the soldier's current weight as it relates to military weight allowances (maximum recommended weight), as well as calories needed to maintain current weight or lose weight. A similar summary is provided to civilians based on BMI. For soldiers and civilians (soldiers' family members), an estimate of the number of calories necessary to lose weight at a healthy and safe rate (1-2 pounds per week) and a personalized weight management program, including nutrition and physical fitness planning, are individualized based on the information provided by the user.
Jumpstart	The Jumpstart program is designed to orient a user to the website program. It also contains educational articles relating to nutrition and fitness relevant to soldiers and civilians. Quizzes test the user's knowledge of the information in the articles, and a certificate of completion is available for printing when the user achieves a passing score that may be utilized to demonstrate adherence to the program if brought to supervisors.
“my Meal Plan”	This interactive tool allows soldiers and civilians to plan meals based on their weight maintenance/weight loss needs. Predesigned menus are available for user convenience. The user also has the option of either entering foods eaten throughout the day or planning meals for the following days.
“my Workout Plan”	Soldiers and civilians are prescribed a workout plan based on their current level of physical activity. These exercise prescriptions are based on the American College of Sports Medicine (ACSM) guidelines.14 The user can adjust the plan to accommodate their personal schedule, as allowed by the program (e.g., options to switch days or change exercises) within the guidelines of the ACSM.14
Lifestyle modification goals	The lifestyle modification goals assist soldiers and family members in identifying and discontinuing unhealthy eating and exercise habits. Topics such as exercise/food monitoring and behavioral contracting are embedded throughout the site. Users are prompted every 7 days to update their goals.
“my H.E.A.L.T.H.”	The “my H.E.A.L.T.H.” page displays a daily summary of the meal plan selected or created by the user, the fitness prescription, and lifestyle modification goals. Prompts were added to remind the user to update weight, body fat, food, and physical activity information, as well as lifestyle modification goals every 7 to 30 days, depending on the information needed.
“my Calendar”	This page provides a month-at-a-glance comprehensive view of meals planned, cardio and strength exercises, and lifestyle modification goals scheduled for the month. Illustrative icons allow the user to track adherence to their nutrition, fitness, and lifestyle goals.
APFT tracker	An APFT tracking tool allows the soldier to track and manage APFT scores. The soldier is able to use this tool to calculate APFT scores and to store historical data from APFT tests. This feature is only available to soldiers.
Family section	In this section, articles are available to educate the user on the most up-to-date information regarding nutrition, fitness, lifestyle modification, and time management as it relates to the family.

Figure 1.

“my Weight” Internet screen capture.

Nutrition

The “my Meal Plan” feature (see Figure 2) provides a predesigned or a “flipbook menu” created to aid the user in food selection. This menu tool contains meals, each of which has been precalculated to contain the number of calories required to enable the user to achieve the recommended total daily caloric intake. Users are able to “flip” to selections of menus for each meal if they prefer a selection other than what is initially provided in the plan and the calorie content is preserved by the program supplying other choices with the same caloric content. These plans also include suggestions for vegetarian diets, healthful fast food options, and meal replacements if an individual prefers to replace meals with convenient shakes and snack bars.

Figure 2.

“my Meal Plan” Internet screen capture.

The user also has the option of not using the preestablished meals and can create a personalized plan from a blank menu. A user can enter foods eaten throughout the day (self-monitoring), plan meals for upcoming days, or use both options. All foods incorporated into the menu tool are acquired from the U.S. Department of Agriculture database and/or restaurant menus.

Physical Fitness

All soldiers, whether active or reserve, must meet requirements for physical performance, defined by the APFT.⁶ These standards apply to all soldiers by Department of Defense Directive 1308.3 and Department of Defense Instruction (DoDI) 1308.3.¹² The current Army policy requires that all personnel, including the active Army, Army National Guard, and Army Reserve, take the APFT at regular intervals.¹³ Active-duty soldiers perform the APFT two times per year, whereas reservists perform the APFT annually. When a soldier fails the APFT, they are usually enrolled in a remedial physical training program. Soldiers who fail the APFT repeatedly may be either barred from reenlistment or processed for separation from the service. Tools on the Web site, including an APFT calculator (see Figure 3), aid soldiers in tracking APFT scores over time and calculating scores in real time as they prepare for the test.

Figure 3.

APFT calculator Internet screen capture.

In addition to specifically preparing for the APFT, fitness is important for the soldiers' health and combat readiness. As noted in DoDI 1308.3, “It is DoD policy that physical fitness is essential to combat readiness and is an important part of the general health and well-being for armed forces personnel.”¹² Thus, the goal of the H.E.A.L.T.H. fitness plan is to aid the soldier in overall fitness (e.g., cardiovascular, strength training) based on the self-reported fitness level of the individual. The user is provided with a personalized workout plan on the “my workout plan” page (see Figure 4). This plan is provided utilizing the recommendations from the American College of Sports Medicine (ACSM).¹⁴ The user can view photographs and instructions of each exercise prescribed in the workout plan (see Figure 5) and can print them. Specific exercises are shown for each body area (e.g., arms, legs) each day.

Figure 4.

“my Workout Plan” Internet screen capture.

Figure 5.

“my Workout Plan” exercise Internet screen capture.

Behavior/Lifestyle Modification

An important component of the H.E.A.L.T.H. intervention is lifestyle modification. In 2003, the Institute of Medicine recommended the development of programs to reinforce the concept of nutrition and activity as part of daily military life. In this component of H.E.A.L.T.H., the user chooses lifestyle goals that focus on stimulus control, self-monitoring, and achieving other weight management goals (see Figure 6). These lifestyle modification goals assist soldiers and family members in identifying and discontinuing unhealthy eating and exercise habits.

Figure 6.

Lifestyle goals Internet screen capture.

Performance Tracking

The “my H.E.A.L.T.H.” page (see Figure 7) provides a daily summary of personal meals, fitness, and lifestyle data of a user. This personalized “dashboard” provides an at-a-glance summary of a meal plan selected or created by the user, the fitness prescription, and lifestyle modification goals, as well as weight data and caloric intake over time. Prompts are presented to remind the user to update weight, body fat, food intake and/or meal planning, and fitness plans, as well as lifestyle modification goals every 7 to 30 days, depending on the information needed. For example, users are prompted to enter weight information on a weekly basis and are prompted to update fitness plans every 28 days.

Figure 7.

“my H.E.A.L.T.H.” Internet screen capture.

The “my Calendar” page (see Figure 8) provides a month-at-a-glance comprehensive view of meals planned, cardiovascular and strength exercises, and lifestyle modification goals scheduled for the month. This feature also includes illustrative icons that allow the user to view and track adherence to their nutrition, fitness, and lifestyle goals.

Figure 8.

“my Calendar” Internet screen capture.

Family Members/Civilians

Including family members fosters additional support for the soldier to lead a healthy lifestyle. The family section of the Web site can be utilized by spouses or family members of the soldier. Family members (civilians) who want to set up their own weight management program on the site may do so by setting up a user account. If a civilian sets up an account on the site, the individualized programs for nutrition and fitness will be determined by BMI rather than by military weight and/or fat allowances.

Data Collection

For a comprehensive view of the data fields collected by the H.E.A.L.T.H. Web site, see Table 3. The H.E.A.L.T.H. Web site captures three types of user data, including (1) demographic, (2) utilization, and (3) user satisfaction. Basic demographic items of the users (e.g., gender, education level), as well as self-reported weight, fatness, fitness, nutrition, and adherence, are collected. There are also fields of data that are specific to soldiers (e.g., military rank). Utilization data include items such as date and time of use of the Web site and type of browser the person was using (e.g., Internet Explorer), as well as navigation paths of the users. From these data, the most frequented pages, as well as the most frequent users, can be determined. Changes in body weight, fitness, and fatness can be monitored over periods of time. Satisfaction with the Web site is evaluated anonymously when users complete online surveys voluntarily. For an example of a user satisfaction survey utilized on the Web site, see Figure 9.

Table 3.

Data Fields Collected

Demographic data
Data fields	Soldier	Civilian
Log-in ID	X	X
Gender	X	X
Date of birth	X	X
Country of birth and country where raised	X	X
Race	X	X
Army/civilian	X	X
Education level	X	X
Smoking	X	X
Family obesity	X	X
TV viewing	X	X
Computer hours	X	X
Military job assignment and rank	X
Time in military (years and months)	X
Weight when joined military	X
Diet attempts since joining	X
Push-up score	X
Sit-up score	X
Run score	X
Total APFT score	X
On weight control program	X
Height	X	X
Weight	X	X
Activity level	X	X
BMI	X	X
Basal metabolic rate	X	X
Total energy expenditure	X	X
Neck, abdomen, hips, forearm, and waist circumferences	X
Percent body fat	X

Nutrition and fitness data
Meal information
1. Food name	X	X
2. Food amount	X	X
3. Was food consumed	X	X
4. Date	X	X
Exercise information
1. Exercise	X	X
2. Sets	X	X
3. Reps	X	X
4. Weight	X	X
5. Date	X	X
6. Exercise completed	X	X
Lifestyle information
Currently stored in database	X	X

Utilization data
The following information is collected on each page visited
1. URL of page	X	X
2. Referrer page (i.e., from where they came)	X	X
3. IP number	X	X
4. Type of browser (IE, Firefox, Opera, etc.)	X	X
5. Date and time (accurate to milliseconds)	X	X

Figure 9.

User satisfaction survey.

Environmental

There is a consensus that the environment (e.g., availability of foods in vending machines, fast food restaurants) and technical advances promote sedentary activity (e.g., watching television or playing video games) and determine considerable variance in food selections, food intake, and levels of physical activity.^15–17 These environmental factors are relevant for both civilian and military populations.

In 2000, an expert panel¹⁸ concluded that effective environmental interventions will require action at many different levels (e.g. in many behavioral settings), with multiple enablers (e.g. environmental prompts, military leaders) of behavior change. In this context, the Internet-based component of the H.E.A.L.T.H. intervention aims to modify nutrition and fitness habits and beliefs, while the environmental health promotion program of the H.E.A.L.T.H. intervention targets the social and work context of the soldiers' behavior. Environmental targets in the military environment include the unit and command system, local health care facilities, nutrition care, recreational centers, fitness centers, the media, and other information services. The environmental and Internet-based interventions are thus closely linked. The Internet-based intervention can be seen as a key component of an environmental intervention that promotes utilization of the H.E.A.L.T.H. Web site. The health promotion component includes advertisement of the Web site in health-related venues (e.g., health care facilities), while the internet intervention, in turn, publicizes those same local resources on the Web site (as one aspect of the “customized” Web site).

Using this combined environmental/Internet-based approach, the H.E.A.L.T.H. intervention can be viewed as having functional components for primary (universal) prevention, secondary (selected) prevention, and tertiary treatment. Primary (universal) prevention targets the entire population, secondary (selected) prevention targets soldiers who are gaining weight and are on a trajectory to become unfit or overweight, and tertiary treatment targets soldiers who are noncompliant with AR600-9, i.e., exceed the body fat standard. These soldiers will be encouraged by the Internet-based program to use the intervention in combination with existing medical and nutrition care resources and services in their local area.

Environmental Promotion/Prompting Plan

Awareness

The environmental promotion program was developed to reach soldiers as well as soldiers' family members (civilians). This program was designed for the purpose of creating awareness in the environment of the Internet program. The strategy includes various venues to reach perspective users and to retain registered users. Briefings to various audiences, including key military personnel (command structure), business owners and fitness facility personnel (specialty briefings), new soldiers arriving on post (newcomer briefings), spouses (family readiness group), and soldiers in the AWCP (nutrition care briefings) are held on a weekly to monthly basis. A strategic organization plan for these briefings has been developed and followed to accommodate a wide variety of audiences and individuals (Figure 10). In accordance with this plan, appropriate briefing materials have been developed to tailor the needs of each audience. Further, this plan may be tailored to active duty and reserve populations.

Figure 10.

Strategic organization plan for environmental promotion briefings.

A demonstration of the Web site is held at “mass events,” including sporting events, health fairs, and in general congregational areas (e.g., restaurants, shopping malls, post exchanges) where promotional items displaying the H.E.A.L.T.H. logo and URL are distributed to potential users. A link to the H.E.A.L.T.H. Web site is included in various electronic newsletters, on home pages of various military facility Web sites, and military intranet events. For an illustration of some of the activities on the promotion plan, see Table 4.

Table 4.

Description of Promotion Strategies

Promotion	Description
Links	Link to H.E.A.L.T.H. Web site placed on various Web sites/home pages of health programs, units, intranet
	Link placed on e-newsletters
Television	:30 announcement on cable channels, seen in post housing and offices that have cable access
Welcome packets	Provides information about Web site to newly arriving soldiers
Fliers	Full-page, full-color flier
	Gives basic description of Web site; includes URL and access code
Posters	Full-color posters
	Gives basic description of Web site; includes URL and access code
Banners	Ad placed on 36 × 84-inch vinyl banners
H.E.A.L.T.H. Link newsletter	Electronic newsletter featuring current nutrition and fitness information, a featured exercise, recipes, and upcoming additions/adaptations to the Web site
Local magazines	Campaign-specific, one-half page full-color ad in local military magazines/publications
Briefings	Oral overview of Web site
Voice on hold	Recording while on hold in local hospitals and public offices
Business cards	3.5 × 2-inch business cards with URL and code
Coasters	12,000 3.5 × 3.5-inch coasters placed in local businesses and restaurants
Promotional items	t-shirts, coffee mugs, water bottles, gym towels, mouse pads, pens
Shopping malls	Set up table in mall; demonstrate Web site using printed materials
Restaurant publicity	Set up table in restaurant; demonstrate Web site
Family readiness groups	Participate in family readiness group; assist spouses in gaining information necessary to support soldiers in weight management activities
Fitness events	e.g., Jingle Bell Jog, Army 10-Miler, Fitness Fest
Community events	e.g., Children's Fest, Operation Celebrate Freedom, Octoberfest, holiday tree lighting
Health events	Family health day, neighborhood health fairs

Utilization

1. Emails/newsletters (i.e., “H.E.A.L.T.H. Link”) are distributed on a quarterly basis to prompt soldiers to visit new features on the Web site (Figure 11).

2. “Hot Mails” featuring new additions to the site or new information for soldiers to utilize are sent to members of the command structure (e.g., command sergeant majors, staff sergeant majors, and first sergeants) once per month to encourage members of the command to recommend usage to soldiers.

3. “On-Web” prompting is conducted. When a user logs in, they are identified by their self-reported information and are prompted with individualized messages about weight, fitness, and nutrition, as well as user satisfaction questions. For example, if someone is an infrequent user, they are queried as to what might make them a more frequent user. Messages of encouragement are also provided as individuals meet or do not meet their self-reported goals and adherence plans.

Figure 11.

Example of newsletter prompt, “H.E.A.L.T.H. Link.”

Summary/Conclusions

Novel interventions are needed to increase health risk communication and to promote healthy body weight/fatness, physical performance, and combat readiness among military personnel. The H.E.A.L.T.H. intervention is a new, Internet/environment-based weight management tool developed specifically for use by active duty and reserve Army soldiers. H.E.A.L.T.H. combines an Internet-based intervention that promotes weight loss for soldiers who exceed weight allowances or approach maximal weight allowances and weight maintenance for soldiers who need to prevent weight gain with a health promotion program that is designed to motivate sustained utilization of the Internet-based intervention. Outcomes are being monitored using an online database utilization system. This pilot study is the first in a series of studies to address the need for a population-based weight management program for soldiers as recommended by the Institute of Medicine.⁴

Abbreviations

APFT

Army physical fitness test

AR

Army Regulation

AWCP

Army weight control program

BMI

body mass index

DoD

Department of Defense

DoDI

Department of Defense instruction