Advances in Lifestyle and Performance Medicine in the Military
A lifestyle medicine Story Project
Major Jeffrey Smith, Chief of Behavior Medicine, and Major Breanna Gawrys Associate Program Director, Family Medicine Residency, of David Grant USAF Medical Center share how they are implementing lifestyle & performance medicine approaches to optimize warfighter health in the U.S. Air Force and the impact implementing same has had for them and for those they train.
Poor health behaviors during and after military services, especially in areas of physical activity, nutrition, tobacco, and alcohol are the highest drivers of the significant health disparity within veteran populations1. In fact, although healthier upon entering military service, after they serve, separate, or retire, veterans are some of the unhealthiest Americans in this country.
The growing burden of unhealthy behaviors and subsequent chronic disease is a threat to military readiness, national security, and our Nation’s economy.
The annual cost of suboptimal lifestyle habits to the DOD are significant:
- Tobacco use: ~18. billion2
- Obesity-related health care costs: ~1.5 billion2
- Excessive alcohol consumption: ~1.1 billion3
Implementing lifestyle medicine is imperative to improving readiness and optimizing the performance of our Nation’s service members.
Major Jeffrey Smith, Chief of Behavior Medicine, David Grant USAF Medical Center:
“Lifestyle performance medicine became important to me when I commissioned in the United States Air Force, especially when I deployed to Afghanistan. My mission there was to convoy and fly around Afghanistan, provide behavioral consultation to soldiers, Sailors, Airmen, and Marines down range. A lot of the challenges that they endure involve sleep, stress, or nutrition, lack of social connectedness, separation from home. This is an opportunity we can promote lifestyle and performance medicine and arm our service members and inoculate them against the rigors of conflict.
The idea is that we sustain the mission by keeping them in the fight. We visited every Ford operating base within 30 days, and we registered a 99% return to duty rating. We sent one soldier home; everybody else was retained, was kept in the fight. It’s really important that we’re delivering it to the warfighter on their terms and in their environment.
October of 2009, I was in a convoy that was struck by an IED. I heard the .50 caliber machine gun going off, and I knew something was wrong. I looked over to the medic, and he said, “Get out of the truck, we need you.” And as I’m running down the road, we were taking AK-47 rounds by my head. As a behavioral health professional there to support, here I am in an active combat situation.
Little did I know that I was going to be coming across four killed in action: an Afghan Governor, a commander, and two police chiefs. It was pretty devastating to see that, but to see war firsthand and what it does to people, and I experienced it myself that day, I’ll never forget. It stuck with me to this day, but it’s also made me a better behavioral health professional, and especially when I’m promoting things like lifestyle medicine.
I think of service members as elite athletes, and the medical teams that surround them are part of that sports medicine team that gets them ready for war. In the military, there’s quite a bit of stigma with seeking help. We say the masculinity norm, being able to operate on days without sleep, is masculine; that’s strong. But lifestyle medicine goes beyond that. When we promote lifestyle and performance medicine, that performance piece is key. Service members appreciate that war-fighting instinct to become optimal in the way they do their job. Innovation is key to me, so when I arrived at Travis Air Force Base and heard about the lifestyle and performance medicine working group, I wanted to get involved.”
Major Breanna Gawrys Associate Program Director, Family Medicine Residency, David Grant USAF Medical Center:
“The lifestyle and performance medicine working group has been around for a couple of years now, and we’ve been expanding each year, working to do some initiatives through DHA and bringing them out to multiple military treatment facilities to help implement lifestyle and performance medicine.
What I did was capitalize on an opportunity where I embed myself and my expertise, assisting the aerial port, which is one of the largest aerial ports in the Pacific. It’s important to meet patients where they’re at with this because you can see there’s some people that are working night shifts all night, and they may not have access to healthy food, and so just telling them to eat fruits and vegetables, incorporate fiber into your diet is not really realistic, and we need to start at the ground level and really change what they have available to them and bring physicians and bring members of the team out to them because they’re not able to sometimes come to the hospital.”
Major Jeffrey Smith:
“I was able to acquire technology, which is a movement tracker and can track sleep, so I was able to issue those wearable technologies out to the unit. We were able to develop some intervention strategies, and we were able to mitigate fatigue levels, and sleep goes beyond just the impact of physical and mental health. This was also another avenue to get in behind those musculoskeletal injuries that a lot of the aerial reporters faced. So, they were interfacing with that technology and seeing benefits, not just the data but also how they felt, and then the word spread, and then more people wanted to participate. It’s a conversation piece, being able to go on their phone and see where their sleep is, and for the first time, they’re having contests on who can sleep better. You don’t get that type of thing in the military.
I’ve always found that I want to make an impact. I do all this training, and it’s nothing you can read in a book. You need to get out there and experience it for what it is. As part of my Behavioral Medicine Curriculum, all first-year interns are required to have a one-month rotation with us, so we have 12 residents. So I thought, given that I’ve been going out to the unit and providing lifestyle medicine intervention strategies, I thought it would be a good opportunity to incorporate the learning for the residents in that environment, so I started bringing residents out there with me to go out and see aerial porters in their natural environment, and it was deemed one of their favorite rotations in their first year.”
Major Breanna Gawrys:
“We’re really able to target people at the very beginning of their training and really have this as a focus of what they’re going to be discussing with their patients. I hope that they introduce this into their daily practice with patients, even if it’s just a quick 5-10 minutes where they’re talking about one of the pillars of Lifestyle medicine, and that this just becomes part of their ingrained daily conversations. I hope to see this go downrange to the deployed units as well, and I just hope to see a fundamental culture shift within the Air Force and within all of our armed services to put this first.”
Major Jeffrey Smith:
“This work, I think, is most important to me because of the experiences I observed growing up in my family, my father and grandfather, who served in Armed Forces. I watched them struggle with invisible wounds of war. That’s why I became a behavioral health professional, and so this is my opportunity to wear the uniform, serve, and promote lifestyle medicine for our warfighters and their families.
Unfortunately, given the rigors of the military service and what it does, it has a toll. We recruit the healthiest population to the armed services, but then they serve, separate, and retire, and we’ve found that veterans, when they’re cross-matched with their civilian counterparts, are among the unhealthiest population.
Lifestyle and performance medicine helps address this by focusing on those six pillars of nutrition, exercise, sleep, social connectedness, and really helps work with our population to fundamentally change the behaviors that are causing them to become some of the unhealthiest people. If we can get behind this and give them the care while they’re in the service, we might be able to better their life when they get out of service.”
1. Journal of Behavioral Medicine 2017
2. Center for Disease control and Prevention, 2022
3. Alcohol Research 2012