WASHINGTON, DC—Just like the rest of the nation, the military health system must also deal with issues of overweight and obesity. It is estimated that more than 40% of the MHS population is overweight and about 25% are obese. “Nationwide this has been a growing problem and one of ever greater concern. We know that it has been a growing problem for us,” said Dr Jack Smith, MD, DoD acting deputy assistant secretary for Clinical & Program Policy.

The medical expense associated with obesity is costly to DoD’s health care system. “Our estimates for our Tricare prime population are that obesity attributable costs are approximately $1 billion dollars a year. For our total population that runs up to about $2 billion dollars every year, taking into account the impact of diabetes and other health related problems related to obesity,” said Dr Smith.

The fact that military families and servicemembers deal with weight issues is not surprising to Dr Smith, who noted that the military is a “microcosm of the US.” “Our American diet is too heavy in sugar and fats. People who are very busy—and certainly most of our active duty families qualify as too busy— are prone to indulge in fast food and to perhaps grab things on the run that are not the healthiest choices,” he said.

Getting Fit

For active duty members, fitness is a condition of employment. There are standards for accession, and twice a year fitness exams are conducted by the Services. “With active duty members fitness is a condition of employment…” Dr Smith said. “When people have exceeding the standards for body fat, each of the Services have programs to assist them with that to reduce their weight by going into mandatory fitness programs.”

The military is also tackling the problem by working with the Defense Commissary Agency and the Services to help families read food labels and make healthier food choices. For example, in order to help commissary shoppers make informed decisions while shopping there are “shelf talker” mini signs that contain dietary tips based on the new “Dietary Guidelines for Americans.”

Tricare’s website also provides educational programs to help military families lose weight at tricare.mil/getfit. The website addresses childhood obesity, which is a particular concern to the nation and DoD since overweight children and adolescents are more likely to have risk factors associated with cardiovascular disease such as high blood pressure, high cholesterol and Type 2 diabetes. “We estimate that about 1/3 of [DoD] children may fall into the obesity category and about 19% of adolescents. We are concerned about that as a trend,” said Dr. Smith.

Doctor Smith said that Tricare also initiated a demonstration pilot that ran from 2006 to 2008 that focused on assisting beneficiaries to lose weight through an internet-based program called “Healthy Eating and Active Living in Tricare Households.” Officials wanted to determine whether a web-based intervention is effective and whetherTricare would want to offer it as a potential benefit. So far, no decision has been made on the future of the intervention. “We noted in the people who were participants that the average weight loss was about 9 pounds after 6 months…We know that interventions of this sort can be beneficial. Certainly, the risk of injury, the risk of developing diabetes and other weight related-illnesses are decreased when people shed those pounds. We considered it to be a successful demonstration,” said Dr Smith.

Physicians play a role in helping patients with their weight, Dr Smith said. “Physicians ought to be assessing the patient’s weight in terms of body mass index. It is recommended that they give counseling and guidance concerning weight reduction, if the patient is falling into an unhealthy category—either the overweight or the obese category.”

The VA/DoD Clinical Practice Guidelines on the management of obesity and overweight outlines evidence-based recommendations in the screening and treatment of obesity and overweight for practitioners throughout the DoD and VA Health Care systems.

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