By Annette M. Boyle
WASHINGTON — Even as nearly 1 in 3 young adults, ages 17 to 24, fail to qualify for military service solely because of their weight, the DoD has increased enforcement of body fat measures for active-duty personnel and eliminated waivers for overweight recruits.
While all branches met their accession goals for active duty enlistments in 2013, the new standards for recruits and for retention could create challenges.
“Obesity is the leading disqualifier for military service today,” says retired Rear Adm. Casey W. Coane, former executive director of the Association of the United States Navy and a member of Mission: Readiness. “We’ve always had potential recruits who were disqualified because of color blindness or diseases, but the increase in obesity is really troubling.”
The current combination of a slow economy and a reduction in force have kept interest in enlistment up and recruitment demands down, but that could change quickly. As the economy improves, fewer young people may seek to join the military, making achieving recruiting goals more challenging.
“Right now we have the best quality forces I’ve seen in my lifetime. Maybe in the future, we won’t be able to field an all-volunteer force like we have today. That would be a mistake for the country,” Coane said.
About 30% of today’s potential recruits exceed the Pentagon’s body fat standards, according to Jonathan Woodson, MD, assistant Secretary of Defense for Health Affairs and TRICARE Management Activity director.
“Obesity is a preventable problem which, if combated, can help prevent disease and ease the burden on our overall Military Health System,” Woodson said in 2012, when announcing a DoD campaign to improve nutrition for servicemembers. The DoD spends $1.4 billion each year on medical care for active-duty personnel with obesity-related issues, such as diabetes, heart disease and osteoarthritis.
During Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF), the DoD gave exemptions to physically fit recruits with higher body mass indices than previously accepted in order to meet recruitment goals. In 2008, about 7% of new recruits received waivers for excess body fat. Even with the relaxed standard, between 2006 and 2011, 62,000 potential recruits failed their entrance physical solely because of excess weight.
Many new warriors who enlisted with higher body fat had difficulty meeting and maintaining physical fitness. The services released about 1,200 first-term enlistees each year before their contracts expire because of weight related issues, Woodson said, costing the DoD about $75,000 per person or $90 million annually to retrain replacements.
Those retained continued to contribute to higher costs. Overweight recruits who enlisted during OIF/OEF were 47% more likely to suffer a musculoskeletal injury and many had to repeat boot camp, according to a study in the journal Occupational Medicine. 1
A recent study of various Army exercise and conditioning programs in a light infantry brigade combat team with 1,393 soldiers found that 61% were overweight or obese. Overweight men (BMI of 26-29) had nearly twice the risk of injury compared with those with a BMI of 25 or less, while obese men (BMI of 30+) had nearly three times the risk of injury. Further, the researchers found that those soldiers with lower physical fitness test results also had higher average BMIs, indicating an adverse effect on aerobic and strength performance. 2
To address the problems associated with increased body fat, the Army recently revamped the Army Body Composition Program (formerly the Army Weight Control Program). In explaining the changes, the regulation notes that “Individuals with desirable body fat percentages generally exhibit increased muscular strength and endurance, are less likely to sustain injury from weight-bearing activity and are more likely to perform at an optimal level.”
Under the new policy, commanders have three working days to “flag” a soldier who fails to meet standards and two additional days to notify and enroll the soldier in the Army Body Composition Program (ABCP). The soldier must develop a Soldier Action Plan within two weeks and meet with a dietician or health care provider within 30 days.
To stay in the Army, a soldier must show weight loss of 3 to 8 pounds or one percent reduction in body fat per month. Soldiers who fail to meet the requisite weight loss goals three times will be discharged. While in the ABCP, soldiers are not promotable, cannot be assigned to command, command sergeant major or first sergeant positions and cannot attend military schools or most training programs.
Certain groups of soldiers are exempted, including pregnant and postpartum soldiers, those who have sustained major limb loss, soldiers who have had hospitalizations of 30 or more days and a few others.
New recruits have six months to achieve the body fat standard for their age and sex. Men may enlist with body fat of 24% but must drop to a 20% body fat standard to stay in if they are ages 17 to 20 or 22% for those ages 21 to 27.
Women cannot exceed 30% body fat at enlistment. The body fat standard for women ages 17-20 in the Army is 30%. For those 21-27, it rises to 32%. Until July, men could enlist with 26% body fat and women with 32% body fat.
The DoD establishes the circumference-based tape method as the standard method of determining body fat. For men, neck and waist measurements are used, while, for women, both of those measurements plus the hip circumference are used in the calculations.
Unlike the other branches, the Air Force has used the abdominal circumference (AC) measurement alone to assess body composition. Because the measurement is part of the physical fitness test, the Air Force is not required to have a separate weight management program.
As of October 1, airmen who fail the AC measurement component of the physical fitness assessment but pass the other three components of the physical fitness assessment (pushup, situp and 1.5-mile run) have been be measured using the BMI taping standards. “If the Airman meets the DoD BMI standard, they pass the PFT,” said Air Force Chief of Staff Gen. Mark A. Welsh III in announcing the change. The DoD sets the maximum BMI at 25.
Welsh noted that only 0.03 percent of airmen have failed the AC portion of the fitness test and passed the other three parts with a score of 75 or more since 2010.
While the DoD struggles to control obesity within the ranks, Mission: Readiness and other groups urge attention to the nutrition and physical fitness of the children who will be tomorrow’s recruiting pool.
“At Mission: Readiness, we see obesity as a significant national security issue,” Coane told U.S. Medicine. To address it, the organization, which includes more than 400 retired admirals and generals, has actively lobbied Congress to increase the nutritional quality of school lunches, reduce the availability of high-calorie snacks and drinks in school vending machines and increase physical education requirements for schools.
Their long-term approach likely will be necessary. The current numbers of American youth disqualified from service because of excess weight concerns Coane and other retired military leaders, but the future figures could be significantly worse.
According to research by John Cawley and Johanna Catherine MacLean of Cornell University, “The need for effective obesity prevention is urgent, as our estimates indicate that just an additional 1% gain in weight and percent body fat would disqualify an additional 671,000 men and 1.01 million women from military service.” 3
1 Cowan, D.N., Bedno, S.A., Urban, N., Yi, B., & Niebuhr, D.W. (2011). Musculoskeletal Injuries Among Overweight Army Trainees: Incidence and Health Care Utilization. Occupational Medicine, 61(4), 247-252.
2 Grier T, Canham-Chervak M, et al. Extreme Conditioning Programs and Injury Risk in a U.S. Army Brigade Combat Team. The United States Army Medical Department Journal: The Foundation of a System for Health: Army Medicine’s performance Triad. October-December 2013.
3 Cawley J, Maclean JC. Unfit for Service: Implications of Rising Obesity Rates for U.S. Military Recruitment.” Institute for the Study of Labor. IZA DP 5822. June 2011.