Applying a whole systems approach to improve the health behaviours of Royal Naval personnel

Abstract

The Royal Navy (RN) is not immune to the global obesity epidemic. This poses
considerable health, economic and occupational risks, and in due course will impact on operational capability; thus counteracting action needs to be taken. Due to the complex and multifaceted determinants of obesity, recent government guidance directs that obesity should be tackled at a community level using a whole systems approach (WSA). This thesis presents a programme of research that aimed to evaluate whether a WSA could be taken to create a healthier environment onboard a RN ship, which facilitates RN personnel to adopt or maintain prudent health behaviours, and whether such an approach could reduce the prevalence of obesity amongst personnel. Six studies were undertaken to confirm the need for, inform the development and implementation of, and to rigorously evaluate a healthy lifestyle intervention. The studies confirmed that there was a need for a healthy lifestyle intervention. A cross-sectional study of 600 RN personnel indicated that 29% were classified as being at any risk of obesity related ill health. Furthermore,
personnel were typically consuming unhealthy diets and 13% of personnel were not being active enough to stay healthy. Moreover, a cross-sectional study undertaken onboard eight RN vessels indicated that although the physical activity environment supported healthy choices, the nutrition environment did not. The studies suggested that the intervention should take a multi-component, multi-level WSA. The evaluation of the intervention highlighted that a WSA can be applied to successfully improve the healthiness of the nutrition and physical activity environment onboard a RN ship. Strong leadership buy-in across all levels of the system, community involvement and sufficient financial support and resource were essential components contributing to intervention feasibility and sustainability. The research provides originality and presents recommendations to support the future delivery of WSA in a military context. The recommendations are also relevant to other non-military institutional settings.

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