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Commentary-Creating a Healthy Ship

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Commentary-Creating a Healthy Ship Commentary 5 Creating a Healthy Ship L Morrow, C Abrams, A Shaw Abstract In 2015 HMS DUNCAN was chosen as the intervention ship for an Institute of Naval Medicine (INM)-led project entitled Sec- ond Sea Lord (2SL)’s Feeding the Fleet Initiative. During her nine-month maiden deployment on Operation KIPION, a healthy lifestyle intervention was initiated, encompassing executive health, catering services, medical services and physical training. The key enabler of the success of the intervention was the formation of an effective Unit Health Committee. This article presents the lessons identified and provides useful examples from the intervention, which aimed to create a healthy lifestyle culture on board a deployed ship. Morrow L et al. J R Nav Med Serv 2017;103(1):5–9 Introduction work was endorsed by the Second Sea Lord (2SL) and brand- The prevalence of obesity in the United Kingdom (UK) is at ed as 2SL’s Feeding the Fleet Initiative. a concerning and increasing level, rising from 15% in 1993 to 26% in 2014.1 With the UK reporting one of the lowest The environment aboard a warship provides an ideal oppor- physical activity levels worldwide and poor dietary habits, tunity to monitor and improve the health behaviours (eating, measures are being taken nationally to tackle this crisis.2 physical activity, alcohol and smoking) of RN personnel, Worryingly, this societal trend appears to be replicated with- especially over the duration of a deployment. Moreover, if in the Royal Navy (RN). Two recent studies have been un- a culture of healthy living can be created within an environ- dertaken investigating the prevalence of RN personnel at risk ment that is conducive to prudent health behaviours, person- of obesity-related diseases. These studies utilise the National al goals for weight loss and the achievement of a healthy Institute of Health and Care Excellence (NICE) classification lifestyle are more likely to be realised. system, which combines body mass index (BMI) and waist circumference measurements. The first study, undertaken in Members of the Royal Naval Medical Service (RNMS) have 2012, reported that 30% of participants were classified as at a key role to play in health promotion and reducing the health risk.3 Furthermore, the initial results relating to the healthy burden of imprudent behaviours within the RN. Commonly lifestyle initiative discussed in this article concluded that within a unit or ship the medical team will be required to take from a population of 285 RN personnel, 32% of male and the lead on health promotion within the Unit Health Commit- 43% of female participants were classified as at risk. 4 These tee (UHC). This article, which has a medical focus, will pres- findings are not unique to the RN; in 2011, in a sample of UK ent the lessons identified from the implementation of a healthy Armed Forces personnel, 23% of male and 37% of female lifestyle intervention, which aimed to create a healthy lifestyle participants were classified as being at risk of obesity-related culture aboard a deployed ship. The article will provide exam- diseases.5 ples from the intervention and will discuss the importance of the UHC, and the requirement for whole ship and specialisa- The health and economic implications of obesity to the UK tion cooperation within the UHC. Armed Forces are considerable. In the RN a high BMI has been associated with being medically downgraded as unfit for Executive health duty,6 and the development of self-reported back problems, A key element of the success of the healthy ship initiative was musculoskeletal disorders and high blood pressure.7 It is es- the UHC. The UHC is a team of representatives, who formally sential that UK military personnel are ready and fit to deploy. meet and plan activities to promote good health and wellbe- For this reason, these statistics prompted Navy Command ing for their unit focused on the nine executive health topics Logistics and Infrastructure to task the Institute of Naval Med- (Table 1). It is a mandatory executive function and ideally all icine (INM) to undertake a programme of work to: improve the members of the medical team should be included and play an healthiness of the provision of food aboard RN ships; improve active role in it.8 Additionally the Senior Medical Branch Rat- the healthy lifestyle education provided to Service personnel ing or Medical Officer (MO) may be asked to lead on certain aboard RN ships; implement and evaluate a healthy lifestyle tasks, such as Unit Health Promotion boards. Collaboration intervention aboard a RN ship; and, improve the nutrition ed- between all departments was key and the UHC provided the ucation delivered to RN chefs during training and throughout ideal opportunity for intervention ideas to be discussed and their military careers. In November 2014, the programme of ensured that relevant stakeholders were working towards the 6 Journal of the Royal Naval Medical Service 2017; 103(1) same goal. For example, one of the key areas of change was participants to contemplate and prepare for potential lifestyle improving the healthiness of the food; the attendance of the changes. A competitive element was included by calculating Logistics Department at a management level and a chef repre- the scores departmentally on a monthly basis and awarding a sentative were essential. prize for the highest departmental relative waist reduction and weight loss. It was probably as a result of peer encouragement (1) Fitness. and a mid-deployment recruitment drive that participant num- (2) Nutrition. bers increased significantly over the course of deployment to a (3) Alcohol Consumption and Substance Misuse. final number of 70 participants. One of the aspects which ap- (4) Smoking Cessation. peared to be successful was that the ‘weigh-ins’ were available (5) Mental Health. to everyone in all categories, not just those at risk, therefore (6) Sexual Health. perhaps reducing prejudice compared to a traditional weight- (7) Maternity Health. loss clinic. (8) Oral Health. (9) Injury Prevention Practicalities At the initial attendance, individual SMART (specific, meas- Table 1: Executive health topics. ureable, achievable, realistic and timely) goals were set along with motivation and potential barriers to weight loss; these A UHC is required to meet at least three times a year, but for factors were reviewed as required at subsequent clinic attend- the successful delivery of the intervention, HMS DUNCAN’s ances. Participants were weighed and had their waist circum- UHC met monthly to allow the previous month’s programme ference measured and recorded on a regular basis (weekly, to be reviewed alongside feedback from the ship’s company. fortnightly or monthly). Results were discussed with the par- Changes were then made for the upcoming month and to fu- ticipants and if relevant, participants were shown their risk ac- ture intervention activities. cording to the NICE obesity risk classification. An opportun- istic discussion then took place between the participant, MO In order to increase the impact of the UHC messages on inter- and Unit PTI about the previous time period in relation to their vention activities and events, representatives from each mess results. The benefit of having both the MO and Unit PTI avail- (wardroom, senior rates and junior rates) were recruited to the able meant that the discussion could be tailored depending UHC. These Healthy Lifestyle Representatives were able to on whether difficulties or barriers were related to nutrition or provide direct feedback on intervention activities from and to physical activity. For those participants who required further their messes. This was particularly useful for gathering feed- support, helpful advice sheets were distributed from the De- back on menu changes and ideas to promote involvement. fence Nutrition Advisory Service (DNAS). Participants were Engaging members of the ship’s company who would not oth- given a copy of their results with any improvement points and erwise be involved helped to create buy-in and provided role a generic message, including a fact of the week and informa- models for the intervention activities. tion to sign up to other intervention activities, to reinforce their weight loss success. Medical department One of the key deliverables of the healthy lifestyle interven- Behaviour change workshops were trialled to prepare partic- tion for the Medical Department was a weight management ipants for their mid-deployment leave period and for the end clinic, which was run in the sickbay in collaboration with of the deployment. These workshops aimed to provide partici- the Unit Physical Training Instructor (PTI). INM supported pants with ideas and strategies to enable them to maintain their this activity by providing additional guidance and behaviour new body weight and behavioural changes when they returned change resources. Whilst time consuming, the weight man- home. These workshops were most beneficial for participants agement clinic delivered statistically significant reductions in struggling to maintain their weight loss or physical fitness, weight, waist circumference and BMI measurements. 49 per- and used ideas from the Nutrition Practitioner Handbook and 9 sonnel participated for the entirety of the deployment, report- DNAS factsheets. ing a reduction from 45% pre-deployment to 29% at the end of the deployment in those classified at risk of obesity-related It was essential that accurate height, weight and waist cir- diseases. cumference measurements were obtained in order to measure changes over time. Waist circumference was measured ac- Running a weight management clinic cording to the NICE guidelines (at the mid-point between the This drop-in clinic was held in the sickbay ward area and was highest point of the iliac crest and the lowest rib) using a metal ® conducted by the MO and the Unit PTI at the same time every Lufkin . week, covering both watches.
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