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| ORIGINAL ARTICLE |
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| Year : 2018 | Volume
: 20
| Issue : 2 | Page : 132-134 |
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Dietary changes adopted by overweight candidates desirous of joining armed forces: A food frequency questionnaire-based study
Shrajana Singh, Anil S Menon, Narendra Kotwal
Department of Endocrinology, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| Date of Submission | 07-Mar-2018 |
| Date of Acceptance | 16-Aug-2018 |
| Date of Web Publication | 10-Jan-2019 |
Correspondence Address:
Brig Anil S Menon
Department of Endocrinology, Command Hospital (CC), Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_13_18
Background: Young male adults wishing to join armed forces have to comply with age-matched height and weight standards. Aim: This study aimed to examine the dietary changes adopted by young male adults declared overweight at initial medical examination. Settings and Designs: This was a cross-sectional observational study of candidates reporting for Appeal Medical Board (AMB). Materials and Methods: Nutrient information was collected using a 24-h semiquantitative food frequency questionnaire for food intake both before being declared unfit and before appearing for AMB. Calorie intake and macronutrient consumption were calculated using the Indian Council of Medical Research charts. Statistical Analysis: Microsoft Excel 2016 was used to analyze sample frequencies, percentage, mean (± standard deviation), and median (range), and paired t-test was used for comparing pre- and postdata. Results: Twenty-five male candidates participated in this study. They had reduced weight by a mean of 6.5 ± 2.7 kg by reducing caloric intake from 2884 ± 587.8 kcal to 1624.4 ± 327 kcal. The daily intake of carbohydrates was reduced from 510.2 ± 120.7 to 284.2 ± 67.0 g and fats from 60.46 ± 14.06 to 20.3 ± 3.0 g, whereas protein intake was increased from 64.4 ± 10.7 to 74.6 ± 11.8 g. The candidates had switched to a diet containing fruit, vegetable salad, mung dal, and oatmeal. Amount of calories expended by exercise was approximately 350 kcal/day. Majority had sourced the Internet for information. Conclusions: Young male adults being made unfit for overweight during initial medical examination reduce weight by adopting a low-fat diet. Keywords: Low-fat diet, overweight, weight loss
How to cite this article:
Singh S, Menon AS, Kotwal N. Dietary changes adopted by overweight candidates desirous of joining armed forces: A food frequency questionnaire-based study. J Mar Med Soc 2018;20:132-4 |
| Introduction | |  |
In India, the prevalence of obesity is increasing. According to the National Family Health Study 4 (2015–16), the prevalence of overweight and obesity in India was 18.9% among men aged 15–54 years, which is double of that reported in the National Family Health Study 3 (2005–2006).[1],[2]
Armed forces world over have age-appropriate height and weight standards for selecting candidates for military training. The premise is proper body weight supports good health, physical readiness, and appropriate military appearance.[3]
In India, graduate students selected to join armed forces as officers have to appear before a Special Medical Board (SMB). Those declared “unfit for overweight” are given an option to appear before an Appeal Medical Board (AMB) within the stipulated period, i.e., 42 days from the date of SMB.[4] It has been observed that many candidates declared overweight at SMB successfully manage to reduce weight appropriate for their height and age when they appear for AMB. They represent a cohort of individuals who have successfully lost weight in a short period. The aim of this study was to examine the dietary changes adopted by young male adults after being declared “unfit for overweight.”
| Materials and Methods | | |
We conducted a cross-sectional observational study of “unfit for overweight” candidates reporting to a tertiary care hospital for AMB. Using universal sampling, all male candidates reporting for AMB during the period July to December 2016 were recruited. The researchers and the participants were blinded to the outcome of AMB. Informed consent was taken from the candidates and the Institutional Ethical Committee approved the study. Demographic details, age, and prior weight were obtained from the referral documents. Height and current weight were measured using a stadiometer and electronic weighing scale. Nutrient information was calculated using a 24-h semiquantitative food frequency and food recall questionnaire listing the details of morning tea, breakfast, midmorning snack, lunch, evening tea, dinner, and bedtime snack both prior to SMB and post SMB. Food groups consumed were determined, and the calorific value was calculated using the macronutrient values for Indian foods published by the Indian Council of Medical Research (ICMR).[5] We assessed the composition of macronutrients (carbohydrate, fat, and protein) and their proportional shares (percentage) of total calories consumed were calculated. Source of food (home cooked/mess/canteen), frequency of outings for food (daily/alternate day/weekly), and use of food supplements were recorded. Frequency and type of exercise both before being declared unfit and at the time of appearing for the AMB were recorded. Candidates were deemed to have a sedentary lifestyle if they performed <30 min of physical activity per day. We also documented the source of information for making dietary changes, e.g., dietician/trainer/friend or Internet. No hematologic and biochemical investigations or body composition analysis was performed on the candidates.
Data were analyzed using the Microsoft Excel (2016) using simple frequencies, percentage, mean (± standard deviation), and median (range). Paired t-test was used to compare changes in body mass index (BMI) and intake of calories, carbohydrate, fat, and protein.
| Results | | |
Twenty-five male candidates participated in the study. The average age was 21.76 years (range 18–26 y). The candidates had reported for AMB 37.4 ± 2.3 days (range 33–41 days) after SMB and achieved weight loss of 6.5 ± 2.7 kg (range 4–12 kg). BMI, caloric intake, and consumption of macronutrients both before being declared unfit and at the time of AMB are depicted in [Table 1]. The candidates had reduced the daily caloric intake by 1259.6 ± 469.29 kcal. They had reduced the consumption of carbohydrates and fats and increased the consumption of proteins significantly. The consumption of fat, as a percentage of total caloric intake, was reduced to below 20% [Figure 1]. | Table 1: Body mass index, energy, and macronutrient intake of candidates
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Dietary preference
All the candidates hailed from North India and consumed three major meals with fried snacks with or without glass of milk prior to SMB. After being declared unfit, the candidates had stopped the consumption of food cooked in oil. The dietary preferences for reducing weight varied between candidates, but few common features could be observed. The major meals would consist of fruit salad, vegetable salad, oatmeal with or without egg white, mung dal, and chapatti (roti, flattened wheat bread). The candidates consumed raw cucumber, cabbage, and tomato. Commonly eaten fruits were papaya, citrus, and pomegranate. Mung dal (Vigna radiate, split green gram) was consumed in different forms (soaked/sprouts/chilla [pancake]/khichdi [cooked with little rice]).
Change in dietary habits
Prior to SMB, the primary source of food in majority (14/25) was mess/canteen; the rest ate home-cooked food. Outing for food (daily/alternate day) was reported by 84% (21/25) and snacking between meals was reported by 76% (19/25). After being declared overweight, candidates had switched to home-cooked food (25/25) and had stopped outings for food (21/25). None of the candidates reported taking food supplements or medication for weight loss. Seventy-six percent (19/25) of candidates reported a sedentary lifestyle sans any form of exercise prior to initial medical examination. After being declared unfit, majority (24/25) of the candidates had started jogging daily at speeds varying from 5 to 8 mph for 60 min.
Source of information
Forty-eight percent of candidates had sourced the Internet for advice on rapid weight loss, while others had taken guidance from friends (28%), dietician (16%), and gym trainers (8%). None of the candidates had enrolled in a weight loss clinic or consulted a physician. The candidates reported craving for food (13/25) and weakness (2/25) and uniformly mentioned lack of taste in the food they consumed.
| Discussion | | |
We studied the lifestyle changes made by a group of young male adults who were declared “unfit for overweight” at initial medical examination prior to joining armed forces. The candidates were college graduates with sedentary habits. Prior to SMB, the average daily caloric consumption of the candidates was 2884 ± 587.58 kcal (approximately 48 kcal/kg/day; reference weight of 60 kg). ICMR has deemed energy requirements of Indians performing sedentary activity to be 39 kcal/kg/day (2320 kcal/day for a man with body weight of 60 kg).[6] The mean daily intake of fats of 60.46 ± 14.06 g was nearly two and half times the recommended intake by ICMR (25 g).
Weight loss can be achieved by reducing calorie intake or by increasing calorie expenditure. Weight loss diet can be divided into low-carbohydrate (LC) diet or low-fat (LF) diet. LC diets are those that advise carbohydrate intake to be reduced to 20–100 g/day, while proteins and fats provide additional calories. LF diets are those that restrict daily fat intake to <25%–35% of the total energy intake.[7],[8] The popular LF diet (Atkins) and LC diet (Weight Watchers, Ornish) cater to the European and North American population.[9] The candidates in our study had reduced daily caloric intake by 1259.6 ± 469.29 (approximately 21 kcal/kg/day; reference weight 60 kg) by bringing down the consumption of fat to <20% of the total calorie intake while maintaining carbohydrate intake at around 284.2 ± 67.0 g [Figure 1] and [Table 1].
We observed the consumption of mung dal and oatmeal with egg white as part of major meal by the candidates. Mung dal has 62% carbohydrates, including 16% dietary fiber, 23% protein, and <2% fat. Mung dal is a rich source of Vitamin B, low on calorie (347 kcal/100 gm), and affordable.[10] Oats are 66% carbohydrates including 11% dietary fiber, 7% fat, and 17% protein and provide 389 kcal/100 g and are rich in several essential nutrients.[11] The addition of egg white to oats increases the protein content.
A deficiency of 500 kcal/day achieves a weight loss of 1 lb (0.5 kg) per week.[7] The rapidity of weight loss in our candidates (0.5–2 kg/week) was contributed substantially by restricting calorie intake (1259.6 ± 469.29 kcal/day), while exercise (jogging 5–8 mph for 60 min) contributed to loss of approximately 350 kcal/day in the candidates.[12] It is said, “a calorie is a calorie” whether it is lost by dietary restriction or physical activity; it is, however, important to consider the body composition changes that occur with rapid weight loss. Individuals who lose weight by dietary restriction alone lose fat and lean body mass in the ratio of 70:30. Exercise on the other hand minimizes loss of lean body mass, helps in sustaining a reduction of weight, and improves cardiorespiratory fitness.[7]
The majority of candidates in the study sought guidance for weight loss from Internet. We searched on the Internet for Indian diet for weight loss. The most viewed blogs generally gave a 1200 kcal 7-day weight loss plan. We failed to find a free-to-download, week-wise diet plan catering to Indian users similar to what is available on the website of National Health Service, UK.[13]
The candidates in our study were motivated to meet the weight for height standards required for joining the armed forces. We found no study on the weight loss measures adopted by individuals motivated to join the armed forces.
The limitation of our study was small sample size, use of food recall questionnaire that is subject to recall bias, and lack of follow-up data regarding weight gain in the candidates. Reduction in lean mass occurs following crash dieting and is of relevance in these candidates, as they would be starting a grueling military training. A larger study with follow-up anthropometry and body composition analysis may answer these questions.
| Conclusion | | |
We studied a cohort of young male adults who after being declared overweight at SMB reduced weight by decreasing intake of fat and replacing routine meals with those containing mung dal, oat meal, raw vegetables, and fruit, thus achieving a significant reduction in total calorie intake. The individuals performed aerobic exercises daily for an hour. Majority of individuals sourced the Internet to seek information about weight loss.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | National Family Health Study. Findings from the National Family Health Study. India: National Family Health Study; 2005–2006. Available from: http://www.rchiips.org/nfhs/. [Last accessed on 2018 Apr 19]. |
| 3. | Naghii MR. The importance of body weight and weight management for military personnel. Mil Med 2006;171:550-5. |
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| 6. | National Institute of Nutrition, ICMR, Government of India. Nutrient Requirements and Recommended Dietary Allowances for Indians. A Report of the Expert Group of the Indian Council of Medical Research; 2010. |
| 7. | Dubnov-Raz G, Berry EM. The dietary treatment of obesity. Med Clin North Am 2011;95:939-52. |
| 8. | Avenell A, Sattar N, Lean M. ABC of obesity. Management: Part I – behaviour change, diet, and activity. BMJ 2006;333:740-3. |
| 9. | Freedman MR, King J, Kennedy E. Popular diets: A scientific review. Obes Res 2001;9 Suppl 1:1S-40S. |
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[Figure 1]
[Table 1]
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