Retrospective Secondary Analysis of Overweight/Obesity in Veterans Compared to Civilians Using Add Health Data

Introduction Despite U.S. military comprehensive fitness standards, service members (SMs) and veterans have similar rates of overweight or obesity [OV/OB] as civilians. This study assessed for differences in OV/OB as estimated growth curves in SMs and veterans compared to civilian peers from adolescence to middle adulthood. Materials and Methods The study was retrospective secondary analysis of the Add Health restricted-use dataset, with a final study sample of 6,465 individuals followed across 5 waves of data collected from 1994 to 2018. A generalized linear mixed model, which used a dichotomous military service grouping variable based on reported history of military service and tested relevant covariates and demographics, was estimated using maximum (pseudo) likelihood to assess for similarity between the body mass index (BMI) growth curves of the study sample’s SMs/veterans compared to civilians. Results BMI growth curves for the SM/veteran group differed from civilian group (γ = −1.01; P < .001). The growth curves began with different intercepts (i.e., the main effect of veteran status) but remained parallel, with veterans’ BMI remaining 1 kg/m2 lower than civilians’ BMI at all waves. Both growth curves were the same shape, approached OB by wave 5, and experienced large increases in BMI. The best fitted model contained a random intercept for participant; categorical treatment of time with a random slope; controlled for ethnicity (γ = 0.72), sex (γ = 0.66), general health status (γ ≥ 0.66), sleep (γ = −0.24), hazardous alcohol use (γ = −0.74), sugary beverage consumption (γ = −0.03); and used an autoregressive (1) specification to account for serial correlation. Conclusion Veterans’ growth curve had lower predicted BMIs at all waves; however, both the veterans’ and civilians’ growth curves approached OB by middle age. Findings indicated OV/OB are powerful factors affecting the newest generations of SMs and veterans. Elevated OV/OB rates create negative health consequences for individual people and the U.S. military. Further research is needed to examine OV/OB effects on human health, assess intervention effectiveness, and develop prevention strategies.