Transform one, transform many: Lifestyle and Performance Medicine leaves lasting impact Published May 28, 2024 By Maristela Romero Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- U.S. Air Force medical personnel are integrating lifestyle intervention into practice and transforming their patients’ lives since the Air Force Medical Service endorsed lifestyle and performance medicine in 2021. Balancing the six tenets of lifestyle and performance medicine - nutrition, physical activity, stress management, restorative sleep, social connection, and avoidance of risky substances can be a challenge for individuals without additional support, but the Department of the Air Force has a working group committed to the field. Col. Mary Anne Kiel, chair of the Air Force Lifestyle and Performance Medicine Working Group, explained that many service members experience difficulties getting started and overcoming the mental barriers of sustaining new habits. However, with more specialists in the Lifestyle and Performance Medicine field and through the use of measures of accountability and support systems, practitioners are helping service members overcome these challenges resulting in successful, long-term health benefits for many Airmen and Guardians under their care. “Having that initial sense of what needs to be done or what can be done then finding the motivation to do it is a big deal,” said Kiel. “Continued engagement and frequent touchpoints are critical. Having practitioners share with patients the belief that something is possible and that we’re here to support them is one big area that we use in lifestyle medicine.” In the Department of the Air Force’s Lifestyle and Performance Medicine Working Group, practitioners have found that positive reinforcement, through a variety of digital tracking tools and peer-based approaches, is meaningful and effective in engaging patients. “Sometimes it just takes one person to demonstrate a positive change. That is such a motivator for the other people in their circle,” Kiel said. Through the years, Airmen who participated in case studies measuring the impact of lifestyle and performance medicine shared how their experience in improving their health has changed their approach to maintaining a balanced lifestyle for themselves and for their families. On the mend: Reaping the benefits of lifestyle change U.S. Air Force Lt. Col. Angela Maass, 88th Medical group Emergency Services Flight commander, Wright-Patterson Air Force Base, Ohio, shares photos exhibiting her fitness transformation from 2019 to 2022. Maass changed her lifestyle with the guidance of a Lifestyle and Performance Medicine practitioner. During her journey, she observed improvements in her approach toward fitness and dietary choices, which positively impacted her overall health and optimized her readiness. (Courtesy illustration from U.S. Air Force Lt. Col. Angela Maass) (This image was cropped to emphasize the subject) Photo Details / Download Hi-Res In 2019, Lt. Col. Angela Maass, Emergency Services Flight commander, Wright-Patterson Air Force Base, Ohio, felt concerned with her ability to sustain her Air Force career. Maass said her weight and health impacted all aspects of her life, noting that she experienced consistent fatigue, body and joint aches, headaches, brain fog, eczema, and high levels of stress. “As a military officer, I need to present an image of professionalism, and walk the walk,” said Maass. “I was presenting an image that I was out of control.” She made an appointment with a lifestyle and performance medicine provider in which they discussed stress relieving techniques, sleep patterns, and exercise. She also received a plant-based diet prescription and access to tools and resources that left her with a sense of hope and purpose. Within four weeks she felt like a different person. “I was exercising consistently because now I had the energy to do it. I was happier and felt in control,” she said. And within six months, Maass lost 55 pounds, lowered her cholesterol level, normalized her blood sugar levels to where she was no longer prediabetic, permanently resolved her eczema, and after years of infertility and enduring nine pregnancy losses, became pregnant at the age of 42. “My obstetrician said the lifestyle change I made reset my body,” Maass said. “It’s crazy how you know you don’t feel well, but you don’t realize how bad you feel until you have the good to compare it to. That is the motivator for keeping the changes up, not to mention the positive health impacts these changes had on my family.” A lifelong fitness journey as a commitment to self, community, and loved ones U.S. Air Force Master Sgt. Janquil Jackson, senior enlisted leader, Air Force Medical Service Office of Diversity and Inclusion, poses for a photo at the Defense Health Headquarters in Falls Church, Virginia, March 26, 2024. Jackson incorporated Lifestyle and Performance Medicine practices into her everyday life and has embraced and shared her fitness knowledge with many others since 2017. (U.S. Air Force photo by Megan Hearst) Photo Details / Download Hi-Res Master Sgt. Janquil Jackson, AFMS Office of Diversity & Inclusion senior enlisted leader, had a wake-up call when she was diagnosed in 2014 as prediabetic and pre-hypertensive at the age of 28. She had already lost family members due to complications from diabetes. “I decided to take charge of my health, and over the years, I’ve seen some incredible changes,” Jackson said. She met with a fitness coach to start her journey and to adjust her diet. After two years, she lost 67 pounds and remains determined to maintain her healthier lifestyle. By 2017, Jackson explored other aspects of fitness from bodybuilding to powerlifting and even worked with children with special needs through adaptive sports. She became a fitness trainer and successfully coached other military members through weight loss programs. Jackson’s fitness journey was so impressive that she was invited to an American Forces Network Okinawa radio station to share her story with its audience of 60,000 listeners. Now, a decade after starting her journey, Jackson began learning about the benefits of whole food, plant-based nutrition at her doctor’s recommendation. This type of diet is predominantly made up of unprocessed fruits, vegetables, and whole grains that protect against overconsumption of nutrients that lead to obesity and chronic diseases for all stages of life, according to the American College of Lifestyle Medicine. “At the age of 38, I have already accomplished so much in my life. As a personal fitness trainer, Lifestyle & Performance Medicine Enlisted Champion, and a health and wellness advocate, I have gained valuable knowledge and experience in my field. My dedication to my wellbeing has had a tremendously positive impact on my life, both physically and mentally. This experience has made me not only healthier, but also wiser and happier. I know that with determination and a commitment to wellbeing, positive changes are possible, and I’m thankful for everything that has turned my health around for the quality of life I desired.” Optimizing health and performance through nutrition Maj. Gen. Thad Bibb, 18th Air Force commander, does push-ups with the 92nd Civil Engineering Squadron during their morning physical training, on Fairchild Air Force Base, Washington, May 21, 2021. Throughout the base visit, the 18th Air Force command team met with the Airmen who fly, maintain and support the world’s largest air refueling fleet. (U.S. Air Force photo by Airman 1st Class Kiaundra Miller) Photo Details / Download Hi-Res Kiel said that case studies confirm that Airmen and Guardians who have committed to the behavioral changes adopting the program’s approach to nutrition and incorporating the other pillars have experienced holistic improvements which routinely exceed their expectations. “People come to us so surprised about some of the success they end up having,” said Kiel. With nutritional counseling from Dr. Regan Stiegmann, lifestyle and performance medicine practitioner and former Air Force flight surgeon – Lt. Col. Christopher Cherry and Maj. Grant Scholl, 70th Flying Training Squadron operations manager, led a conscious effort to make incremental changes to their daily diets. As a result, both Cherry and Scholl experienced improvements in their cholesterol levels, prediabetic indicators, sleep quality, and mental cognition. “I’m not saying everyone needs to cut out all animal products and processed foods, but in my experience, the more closely I’ve adhered to a whole food, plant-based diet, the better I’ve felt,” Cherry shared. Scholl takes pride in making healthy dietary and fitness choices but found he had fallen short for his prediabetic indicators after receiving his lab results. With a few minor changes to his diet, his health metrics normalized within three months. “No fads or crazy diets. Just keep it simple, whole foods, plant-based!” he emphasized. Future directions of lifestyle and performance medicine The Air Force Medical Service hosted its first Lifestyle and Performance Medicine Summit in February for medical leaders to champion the benefits of the medical approach and to discuss how its practice can be standardized for Airmen and Guardians in partnership with the Defense Health Agency. “As a nation how can we make ourselves even more health-minded and have the resources we need to be able to adopt health changes,” Kiel said. “And it’s true that our kids are the next generation of potential military recruits. How can we make ourselves a more effective workforce and improve our longevity? Those are aspirational goals. But I think it’s certainly within our ability.” Lifestyle and performance medicine’s evidence-based success continues to garner support among medical personnel who recognize that its comprehensive and patient-forward approach aligns with the Department of the Air Force’s efforts to present a ready and fit force.