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Health Services Research & Development

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HSR&D Citation Abstract

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Bookwalter DB, Porter B, Jacobson IG, Kong SY, Littman AJ, Rull RP, Boyko EJ. Healthy behaviors and incidence of overweight and obesity in military veterans. Annals of epidemiology. 2019 Nov 1; 39:26-32.e1.
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Abstract: PURPOSE: Research suggests that U.S. veterans have a higher obesity prevalence than nonveterans and that weight gain is high after military discharge. Few studies have assessed the joint effects of health behaviors on obesity risk. METHODS: We prospectively assessed the incidence of overweight and obesity in relation to multiple behaviors among U.S. veterans, with follow-up beginning 2-3 years after military discharge. Self-reported physical activity, sedentary time, fast-food intake, sleep duration, smoking status, and alcohol use were categorized as "healthy" based on recommendations or prior literature. Multivariable Cox models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for overweight/obesity (body mass index [BMI] = 25 kg/m) and obesity (BMI = 30 kg/m) in relation to healthy behaviors. RESULTS: Among 11,025 participants with baseline BMI of 18.5-24.9 kg/m, those reporting at least five of six healthy behaviors had 36% lower overweight/obesity risk compared with those reporting 0 or one healthy behavior (RR, 0.64; 95% CI, 0.54-0.74). Among 17,583 participants with baseline BMI of 25.0-29.9 kg/m, obesity risk was 38% lower for those with at least five of six relative to 0 or one healthy behavior (RR, 0.62; 95% CI, 0.54-0.72). CONCLUSIONS: Self-reporting multiple healthy behaviors was associated with reduced overweight/obesity rates. Further research is warranted to determine whether interventions targeting several health behaviors may be more effective in reducing obesity among military veterans than interventions targeting one behavior.

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