Prevention and intervention against obesity and overweight in the military: a systematic review.

Background: Overweight and obesity have a negative impact on health and have a detrimental effect on the operational readiness of soldiers. Different prevention and intervention measures against obesity include diet, physical activity, education, coaching or medication or a combination of several aspects have been investigated. This review systematically assesses the effectiveness of lifestyle, dietary, educational, and pharmacological interventions on weight, body composition, and military readiness in active-duty personnel.

Methods: We carried out a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted in various electronic databases from 2000 to July 2024. The search strategy combined three concepts: military population, outcome terms, interventions or programs. For the review, 21 articles met the inclusion criteria (total n = 1696). Where possible, the effect size (ES) was calculated.

Results: In studies that only examined exercise, minor effects were reported, e.g. a reduction in weight (-0.5 kg), Body Mass Index (BMI) (-0.3 kg/m²), waist circumference (-0.1 cm) and body fat percentage (-1.1%) without relevant statistical ES. Studies with nutritional programs reported low to moderate ES. Combined programs including dietary and exercise countermeasures showed to be more effective than programs based on diet or exercise alone. Combined programs with exercise and educational methods showed a moderate to large effect size (ES 0.6-1.3) for weight reduction. Pharmacological treatment for reducing fat intake resulted in a larger effect sizes for weight loss. The greatest efficacy (ES > 1.0) was observed for a combined intervention program consisting of lifestyle changing components based on individually tailored cognitive behavioral therapies, psychoeducation, exercise and nutritional interventions.

Conclusions: Effective countermeasure for reducing body weight found in this study were combined interventions, like education on lifestyle changes, dietary habits and promotion of physical activity in military personnel, as well as by ketogenic dietary interventions combined with physical activity and followed by pharmacological intervention approaches. Combined interventions appear promising in some studies, but future evaluations may focus on combinations of physical activity and exercise with new pharmaceutical approaches like Semaglutide or Bimagrumab medication in the long term for military personnel due to probable favorable body composition adaptations and military readiness.