Running head: MILITARY NUTRITION ENVIRONMENT ASSESSMENT 1

Military Nutrition Environment Assessment (m-NEAT)

Ginny K. Vance

Grand Canyon University – HLT 665

December 17, 2018

Military Nutrition Environment Assessment

An environmental assessment was conducted examining the nutritional environment on

Camp Foster, Okinawa, Japan. The Military Nutrition Environment Assessment Tool (m-NEAT)

is an instrument used to measure how well local establishments support healthy eating within the

community. With an overall m-NEAT score of 32% and eight out of ten components scoring

below 50%, establishments on Camp Foster are not supportive of a healthy eating landscape.

Further evaluation is recommended regarding the nutritional environment on Camp Foster and to

implement appropriate initiatives, supporting the health of the local military community.

Keywords: nutrition, military, food environment, m-NEAT

Background

Food environments have been shown to influence an individual’s eating habits and

weight (Penney, Brown, Maguire, Kuhn, & Monsivais, 2015). Obesity affects approximately 93

million Americans, contributing to an array of individual and public health concerns (CDC,
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2018). Furthermore, there is a clear association between obesity and chronic disease, such as

type two diabetes and cardiovascular disease (CDC, 2018).

In a recent study analysis, a combined increase of overweight and obesity was seen

among the U.S. military population (Reyes-Guzman, Bray, Forman-Hoffman, & Williams,

2015). Specifically, a rise in obesity, individuals with a body mass index above 30 kg/m2

increased from 5% to 12.7% (Reyes-Guzman, Bray, Forman-Hoffman, & Williams, 2015).

Proper nutrition and overall health are fundamental to the service members’ goal of mission

readiness. However, when the local food environment does not support this vision, a military

community may expect to see a rise in poor nutritional health, increasing the risk of obesity and

chronic disease. The purpose of this report is to identify the nutritional status on Camp Foster

and provide recommendations with attainable modifications, for the nutritional environment in

the community.

Methods

The assessment period was conducted from November 2018 to December 2018. Points of

contact were notified concerning the m-NEAT appraisal prior to the site assessment, when

applicable. The m-NEAT focused on ten components; community, fitness center, fast food

restaurants, sit-down restaurants, lodging snack shop, commissary, convenience stores, vending

machines, worksites, and dining facilities (DFAC). All sites within the components were

assessed during an onsite visitation and menu review.

Each component was evaluated using worksheets assisting the surveyors in the data

collection process. The detailed instructions allowed for the collection of objective data,

eliminating the possibility of entering subjective information. The data collected from the

worksheets were entered into the m-NEAT Excel spreadsheet scoring tool. The components were
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scored using a series of standard questions specific to each category. The collective scores

generated a final score for Camp Foster’s overall nutritional environment.

Results

A total of twenty sites, within ten categories, were evaluated during the m-NEAT

assessment. The scoring classifications are as follows: fully supportive (90%-100%), mostly

supportive (75%-89%), partially supportive (60%-75%), and not supportive (0%-59%). For

2018, the overall m-NEAT score for Camp Foster was 32% compared to 49% in 2017. Data

shows a significant decline when compared to scores between 2014 and 2016, which ranged

between 75% and 81%. Despite the majority of sites having a “not supportive” score for 2018,

two sites, the Commissary and DFAC (Permanent Party), did receive a “partially supportive”

score. However, improvements are recommended for all sites.

Component Score
Community (1 site) 17%
Fitness Center (1 site) 43%
Fast Food Restaurants (3 sites) 45%
Sit-down Restaurants (2 sites) 52%
Lodging Snack Shops (1 site) 4%
Commissary (1 site) 74%
Convenience Stores (3 sites) 22%
Vending Machines- Non-Refrigerated
(4 sites) 0%
Vending Machines-Refrigerated Beverage
and/or food (4 sites) 10%
Worksites (2 sites) 20%
DFAC Facilities (2 sites) 68%
Overall Score 32%

Table A. Results

Recommendations
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Upon completion of the assessment, the surveying team identified effective strategies to

eliminate barriers preventing optimal nutritional health of the environment. A local action plan

was completed to prioritize the recommendations, considering factors such as cost, time, support,

and importance, to calculate the priority ranking. Additionally, the courses of action were

selected according to the site specific m-NEAT score, practicality of implementation, and target

population.

Community

The community has the potential to increase this score by utilizing media outlets to

promote nutritional health in the environment. It is warranted to publicize in the local military

magazine and newspaper about relatable nutritional health topics. Collaborating quarterly with

the local AFN radio station to advertise about public health services and applicable nutritional

health tips, presents the opportunity to reach a broader audience. The community would benefit

from encouragement of promotion activity initiated from other community establishments such

as schools, chapels, and shopping centers, to activate community gardens and farmers markets.

Fitness Center

During the site assessment, it was observed that the fitness center did not have any

nutritional health promotion materials posted within the main entrance or surrounding area. It is

recommended for the fitness center to increase nutritional health promotion within the facility by

posting flyers and information on the television marquees. Good nutrition and physical activity

are essential components of an individual’s overall health (Healthy People, 2018). The Life Juice

Café does not provide nutritional information for the consumer at the point of purchase. It is

advised that Camp Foster require all food establishments to provide nutritional content for all
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menu items offered. Setting a base wide standard to include nutritional information would be

beneficial for the community.

It is recommended that the energy drink vending machine located next to the field house

be removed, as it encourages less than ideal nutritional choices. Currently, the vending machine

offers five different varieties of energy drinks sizing between 16 ounces and 24 ounces. The 16

ounce can contains 50 grams of sugar and the 24 ounce can contains 75 grams of sugar. The

nutritional content of each item in the vending machine confirms having a vending machine near

a fitness center promotes the consumption of unhealthy beverages during physical training. The

base sponsored vending machine, located adjacent to the energy drink stocked vending machine,

currently contains two types of energy drinks, in addition to five sodas, five coffees, four teas,

and four types of flavored or plain water. Collectively, 70% of drinks in the vending machines

are above 40 kilocalories per beverage.

Fast Food and Sit Down Restaurants

Camp Foster has several fast food chain restaurants, in addition to others operated by

Marine Corps Community Services (MCCS). It is advised to work with MCCS to increase the

availability of affordable healthy food options. Nutritional information for all menu items must

be visible and available to patrons. Labeling at the point of purchase can encourage the

consumption of healthier food items (Liberato, Bailie, and Brimblecombe, 2014).

The lack of affordable healthy food options provides little opportunity for individuals to

make nutritious meal choices and is a frequent financial barrier to healthy eating. When healthy

food items are priced similarly to the price of the less healthy version, the goal is for the

consumer to be more likely to choose the healthier version. Rather than focusing on popular diet

trends, such as “Keto Diet” to promote the notion of good nutrition, the focus should be on
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labeling meals as “healthy food item” or “healthy option” and by following the Dietary

Guidelines for Americans.

Lodging Snack Shop

The lodging snack shop offers a variety of frozen snacks and meals, however, there were

no healthy options identified. An additional refrigerated section with food items provided by the

neighboring sit-down restaurant offers a variety of snacks and drinks. A minimal number of

these items were available at the time of the site assessment. It is recommended for more of a

variety be added to the selections and healthier versions of the food items be stocked and readily

available.

Commissary

During the site visit to the commissary it was observed that the overall design was

conducive to healthy shopping, but could benefit from some suggested improvements. The main

entrance was lined with a collection of stacked soda cases, bins of candy and other non-nutritious

food items. It is recommended that these items be relocated to the designated shelved location

within the isles. The area immediately following the main entrance could also be dedicated to

health promotion. The space would be an ideal location where healthy recipes can be shared,

current health promotion materials advertised, and facilitation from a dietitian could be

incorporated. The use of more robust signage and display will increase education for patrons and

improve the recognition of these promotion tools during shopping.

Although the commissary does have a nutrition guide program in place, it is

recommended that the program increase promotion by advertising more highly visible materials

such as events, literature, and posters. It is also recommended that the commissary participate in
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a health promotion program, aimed towards shopping the store perimeter, as a great tool to

promote consumption of healthy and nutritious food items. It was observed that the checkout

counters do not offer healthy food items and recommends the commissary to add baskets at

check out for fruits and vegetables, to increase consumption.

Convenience Stores

A health promotion program was in place in all convenience stores aimed at promoting

healthy choices, but the program was not maintained and the stickers indicating healthy choices

did not always align accurately with the intended food item. It is recommended to train staff and

appropriately maintain the promotion program for proper placement of stickers. Additionally,

health promotion materials should be more pronounced, advertised, and located in observable

areas to promote consumption of the healthier food choices. In addition to healthy option

promotions, it is recommended the convenience stores refrain from supporting “buy one-get one

deals” and “free with purchase deals” that included non-nutritious options.

During the site assessment it was observed that products were offered in a language other

than English and were being sold without translation or nutritional information. It is

recommended that all food items have label and nutritional information available in English on

site and posted near the products for patrons to be able to make informed choices. Furthermore,

one convenience store had more healthy items and a larger variety of available options compared

to the other two stores on Camp Foster. The surveyors advise the convenience store chain to

standardize all items and products offered in all convenience stores, to improve consistency of

healthy food options base wide.

Dining Facilities
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On site evaluations were completed for two dining facilities. Each site provided menu

availability in person and online, including nutritional information for every food item,

ingredients available, and health promotion programs in place. The Go-For-Green health

promotion program is offered, although in one location it was located in a low light area with

little foot traffic. To increase effectiveness, it is recommended that both facilities relocate health

promotion materials to areas where they would be more visible.

Areas for improvement for both locations were identified, specifically for food offerings

and variety. It is recommended both locations consider offering more than one soup and one of

the options be low sodium. More nutritious cereals should also be offered, focusing on folate,

sodium, whole grain, and sugar content. It is recommended both locations offer at least two

100% juice options and limit the sugary sweetened beverages. Suggestions to have all food items

labeled with nutritional information in English on site and posted near the products offered will

assist patrons to make informed choices.

Vending Machines

Observations showed all 204 vending machines located on Camp Foster need

improvement with food and beverage offerings. It is suggested to incorporate a more nutritious

variety base wide. Substitutions should promote healthy drinking and eating, as well as include

health promotion labeling and identification. It is also recommended that nutrition information,

in English, be made available at the point of sale to better support the local nutrition

environment.

Worksites

It was observed the worksites do not have well communicated written policies promoting

healthy food and beverages, vending machines, or sanitation policies. Recommendations in the
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workplace include improved communication about policies, posting policies in a visible area,

and training staff about the identified guidelines. It is also recommended to have healthy food

and beverage promotion literature posted and advertised in the worksite common areas.

Conclusion

The m-NEAT assessment highlights the need to improve Camp Foster’s nutritional

environment. Nutrition should be entwined with the military service member and is an essential

component to promote mission readiness as the military requires an optimal level of overall

health. The main population on Camp Foster consists of newly enlisted marines and sailors,

between the ages of 18-24 years old. When driving restrictions and lower pay are already in

place, lack of access to healthy food options increases. With a poor nutritional environment and

other influential barriers, the risk of not reaching optimal mission readiness is high. Changing the

local food landscape to reflect the needs of the military is vital. The goal of the recommendations

is to successfully modify the nutrition environment, ultimately improving health outcomes of our

local military population.

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References

Centers for Disease Control and Prevention (CDC). (2018). Adult obesity facts. Retrieved from

https://www.cdc.gov/obesity/data/adult.html

Healthy People. (2018). Nutrition, physical activity, and obesity. Retrieved from

https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition-

Physical-Activity-and-Obesity

Liberato, S.C., Bailie, R., & Brimblecombe, J. (2014). Nutrition interventions at point-of-sale to

encourage healthier food purchasing: a systematic review. Retrieved from

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-919

Penney, T.L., Brown, H.E., Maguire, E.R., Kuhn, I., & Monsivais, P. (2015). Local food

environment interventions to improve healthy food choice in adults: a systematic review

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and realist synthesis protocol. BMJ Open, 5(007161), 1-6. Retrieved from

https://bmjopen.bmj.com/content/bmjopen/5/4/e007161.full.pdf

Reyes-Guzman, C., Bray, R.M., Forman-Hoffman, V.J., & Williams, J. (2014). Overweight and

obesity trends among active duty military personnel: a 13-year perspective. American

Journal of Preventative Medicine, 48(2). Retrieved from

https://www.researchgate.net/publication/268695894_Overweight_and_Obesity_Trends_