Its a Matter of National Security

US Obesity rates is now a matter of National Defense. Smaller pool of potential recruits. Not to mention the growing number of current members who are not "fit to fight" any more (e.g. weight creep, poor nutritional habits, inactivity, injuries).





More Military-Aged Americans Are Too Fat to Fight
Released: 10/15/2010 7:05 AM EDT
Source: Cornell University


Newswise — At a time when American military forces are stretched thin overseas, a growing number of potential recruits are too fat to enlist, according to an analysis by Cornell University researchers.

In the past half-century, the number of women of military age who exceed the U.S. Army’s enlistment standards for weight-to-height ratio and body fat percentage has more than tripled. For military-age men, the figure has more than doubled.

As of 2007-08, 5.7 million American men and 16.5 million women of military age were ineligible for duty because they were overweight or obese, according to John Cawley, Cornell associate professor of policy analysis and management, and a Cornell economics doctoral student Catherine Maclean.

The findings, published in September by the National Bureau of Economic Research in a working paper titled, “Unfit for Service: The Implications of Rising Obesity for U.S. Military Recruitment,” are cause for alarm for the four U.S. military branches, which together must attract more than 180,000 new service members each year.

“Almost one in four applicants to the military are rejected for being overweight or obese – it’s the most common reason for medical disqualification,” Cawley said. “It is well-known that the military is struggling to recruit and retain soldiers. Having a smaller pool of men and women who are fit enough to serve adds to the strain and creates even more problems for national defense.”

The study follows a similar report last spring by retired generals and admirals. But Cawley and Maclean chart the climbing obesity rates over a much longer period, using data from the National Health and Nutrition Examination Surveys spanning 1959-2008. Moreover, the Cornell study estimates the number of civilians who meet the body fat requirements of each military branch, which had not been tracked previously.

“It’s another example of the underappreciated public consequences of obesity,” Cawley said. “We tend to think of obesity as a personal, individual health problem. But the fact that U.S. military leaders view it as a threat to national security and military readiness shows its far-reaching impact.”

The paper is available online: http://www.nber.org/papers/w16408

Body Composition Feb 2010

So I need to lose 7-8 lbs of fat and not gain any more muscle. Or just keep doing what I'm doing and be healthy no matter what the bioelectrical impedance machine says.

Dietitian Humor

I think this is very fitting after a long discussion with someone that has been working out in CrossFit with me these past two months. She continues to focus on the scale and says sees herself in the mirror as being too big. But she is only 16% body fat. She looks great! Our short statures and strong muscles make us both appear bigger than models in magazines. I learned long ago that since I didn't have tall slender parents I'll never look like that 0.001% of the population (and I don't know how to airbrush my pictures).

We talked about perceptions of beauty through the past century, pop culture influences on women, and what men really find sexy (muscles and curves are still top of the list for most men I poll). Then I explained it in terms of health. 16% body fat for a woman is inside of the "athletic" range. I think she is starting to see that the mirror is lying to her (she is NOT fat) and that the scale is not the best judgement for her health (her strength and how her clothing fits is a better indicator).

Nutrition for the Athlete

Adapted from the Health & Lifestyle lecture I have been providing at Joint Base Balad, Iraq during my deployment with the 332d Expeditionary Medical Group.


The first priority for athletes is meeting energy requirements. Energy balance is key to maintaining lean tissue mass, immune and reproductive function, and optimum athletic performance.

To have calories in = calories out means you will have a balance effect on the scale. If you have more energy coming in then going out then your weight will start increasing. If you have less energy coming in and more energy going out then you will have a wt loss.

With limited energy intake the body will then use fat and lean body tissue for fuel. Not maintaining enough energy for fuel compromises the benefits of training.

You will most likely not achieve your best physical performance while restricting calories. (Keep in mind that it is certainly possible for an over-fat, way out of shape individual to both lose weight and improve their physical performance at the same time) However, for a normal weight, relatively “in-shape” individual…caloric restriction will be detrimental to performance.

Low-energy intakes can result in loss of muscle mass, menstrual dysfunction, loss or failure to gain bone density, and increased risk of fatigue, injury, and illness.

To help optimize training and prevent illness, athletes should consume a daily diet rich in nutrient-dense carbohydrates and high-quality protein in order to provide adequate energy for muscular activity and maintenance of optimal immune system functions.

Carbohydrates are the body’s main source of energy. The body converts Carbs you eat into glucose. Glycogen is the main storage form of glucose and it is stored primarily in muscle and liver.

Continuous exercise uses up the body’s glycogen stores. It is important to ensure adequate Carb intake pre, during, and post intense physical activity. Repetitive training/competition reduces glycogen storage leading to impaired performance.
Athletes (and very active military members) need adequate Carb intake to keep glycogen stores high, therefore allowing for optimal physical performance.

Approximate protein intake guidelines are based on the type of athlete. Requirements include the need to repair exercise-induced microdamage to muscle fibers, use of small amounts of protein as an energy source during exercise, and the need for additional protein to support gains in lean tissue mass. However, repeated research has shown that protein intake in excess of 2 g/kg simply results in the excess amino acids being converted to fat and stored appropriately.

Turns out that most Americans (even non-athletes) easily achieve these protein intakes as part of their regular diet, therefore it is rare that an athlete would need to deliberately add a protein supplement to their diet. Except when people are limiting their total caloric intake for weight loss.

For optimal benefit, spread protein evenly throughout the day.

Fat is important in the diets of athletes as it provides energy, fat-soluble vitamins, and essential fatty acids. Additionally, there is no scientific basis on which to recommend high-fat diets to athletes. There are no ergogenic effects from fat intake (i.e. eating more will not improve athletic performance, but not eating enought total calories may hurt your progress). Be sure to limit saturated fats since that is the type of fat that can raise blood cholesterol.



How much energy do you need? Even when you are trying to lose weight, there is a minimal amount of calories you need to prevent loss of muscle mass. You need to support your Resting Metabolic Rate (RMR).



Once you calculate what your body needs to support stable weight at your activity level, you can reduce the intake, increase the activity, or best - combination of both, to help promote weight loss. But never eat less than your RMR if you want to keep your metabolically active muscles - see "Maximizing Metabolism" Lecture (coming soon).

Want to gain weight (muscle)? You have to support the proper exercise (higher resistence, fewer repetitions to fatigue) with adequate rest for repair and building. And you need enough extra CALORIES (not extra protein). Remember the protein needs even when in anabolic mode (muscle building) are maximum 2 g/kg (or ~1 g/lb body weight).

Look at your hands; your two hands are a good representation of the total amount of protein you can use in a day for support of muscle building. Magazines advertising protein powders and bars and supplements are owned by the companies selling these products. High protein diets tend to increase blood acidity, phosphorus load (thus pulling calcium out of your bones and then it is lost in your urine), and nitrogen released when protein is used for energy (fortunately healthy kidneys can remove the excess nitrogen from our blood).

To get extra calories between meals try dried fruit & nuts, peanut butter sandwich, high fiber snack bars.




Hydration (Fluid) is very important. And being deployed in the desert (Iraq) makes it a prime concern even if you are not exercising. Water is the best rehydration for most people. Electrolyte-replacement Sport drinks (i.e. Gatorde or Powerade) are useful when your workout is over 60 min or you are drinking a lot of water and not eating (don't want to dilute the sodium in your blood).

Water helps cool your body. When you are active your body heats up. Sweating brings water to the surface of your skin where evaporation pulls this heat away from your body. If you don't have enough water to sweat, or you cover up all your skin so you sweat but it cannot evaporate, you will overheat. If your body temperature gets too hot, you are "cooking" yourself into a severe illness.

Some ways to tell if you are drinking enough. Weigh yourself before and after your workout. Drink at least 2 cups of water for every pound lost. Check your urine; if it's darker than pale yellow straw you need to be drinking more. Here in Iraq I've been drinking about 4L per day.



For more information:
sportsmedicine.about.com/Sports_Nutrition.htm
www.dietitian.com/sportnut.html
Food and Nutrition Information Center (USDA)
Nancy Clark, MS RD “Sports Nutrition Guidebook”

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Starting to Say Goodbye

The NCOIC is the first to leave. His replacement and one of the new airmen arrived late last week. We've given gifts to our food service workers and their supervisors.

Today dawned beautiful and relatively cool (only 80 degrees). But soon another dust storm rolled in. That halts the convoys (no fresh produce) and our mail (no box from home). But, more importantly, it makes it difficult for the medical choppers to fly. So some folks get stuck at the Combat Surgical Hospitals (CSH) and have to wait there before we can move them forward to Germany.

The Medevac Unit here is known as "Dustoff". 2-641 AVN moved their operations to the helipad next to the hospital a few months ago. I helped them get things set up for on-call personnel to have their meals at the hospital DFAC (since they cannot be more than 10 min away from the choppers). As thanks their command chief presented me with one of the Commander's coins.
















Last Friday we hosted the final results of the second round for "Fit-2-Fight" (our weight lost competition). This time around we put emphasis on fitness and body composition rather than just weight. My team got 2nd place (average 5% fat loss amongst the four of us).



The hospital Commander called me up in front of the participants and presented me with his coin to thank me for all the work I have done at the hospital this year. He cited the remodel of the DFAC, bringing in some new food/beverage items; the Halal meal contract so our Iraqi patients would eat more (helps in wound healing and decreased length of stay), and the Medical Nutrition Therapy (clinical care, nutrition support, diet education).

Before & After

Stay tuned for numbers (lbs, fat & inches) TBD next week.

Edit 23 June 09:
Jan: 155#, unkn waist, est 34% body fat
May: 145#, 30" waist, calculated 29% body fat
Now: 140#, 28" waist, calculated 25% body fat

CrossFit

Our instructors are Vanessa and Jim (this picture is from his blog).

"Ouch" is all I can say today (after two classes). I thought it would be my low back but it's my lower calf muscles that are killing me today. My goal is to do at least 4 classes a week for the next 6 weeks.

CrossFit is a system of workouts that emphasize "functional" fitness & strength training. Monday we did "Angie" (100 pushups, 100 situps, 100 pullups and 100 squats). Yesterday was "Punisher" (7 rounds of Deadlift, KettleBell Swings, Wall Ball Shots, Box Jumps). The picture above was taken after the class. I'm not sure why we are all smiling - must be because we finished.

This morning I was walking like an old lady. Once I managed continuous movement for about 10 min the muscles loosened up enough that most of the pain went away. But then I sat at my desk to do some work and got sore again. Hopefully tomorrow morning I'll be able to walk around H6 again (I'm not holding out to be able to jog again until this weekend).

My other goal? To do a real pull-up (at least 2 of them).

Headlines: More servicemembers fighting battle of bulge

By Sandra Jontz, Stars and Stripes
European edition, Wednesday, February 11, 2009

The percentage of active-duty troops who are overweight or obese has more than doubled since the start of the Iraq war in 2003, according to a recently released Pentagon study, with stress and return from deployments as the top reasons for weight gain.

For the study, military health officials reviewed servicemembers’ outpatient records from 1998 to 2008, using the Body Mass Index scale to determine which troops were overweight or obese.

For the first four years of the study, the number and percentage of overweight troops remained relatively stable, even dipping slightly in 2001. Since that time, however, the number of overweight troops has ballooned from about 25,000 in 2001 to nearly 70,000 in 2008, according to the review, contained in the January edition of the Defense Department’s Medical Surveillance Monthly Report.

"In the past decade among active military members in general, the percent of military members who experience medical encounters for overweight/obesity has steadily increased," according to the report’s editorial comment section. "Since 2003, rates of increase have generally accelerated."

In 2003, the number of troops who were overweight/obese was about 1.75 percent of the active-duty population. Now, that number is 4.4 percent, or 68,786 troops. The biggest rate increase occurred between 2005 and 2007, when the percentage climbed from 2.9 percent to 4 percent.

Women made up the highest percentage of overweight active-duty personnel, with a rate of 7.2 percent of all servicemembers.

Other findings included:

Troops working in health care were the most likely to be overweight/obese, at 6.9 percent of the active-duty population of the field.
Air Force members had the highest percentage of troops who were overweight at 6.7 percent. Marines were the lowest with 1.2 percent.
The age group with the highest percentage of overweight troops were those above 40 at 6.6 percent. Not surprisingly, troops younger than 20 had the lowest percentage diagnosed as overweight/obese at 1.6 percent.
Medical personnel at the U.S. Navy hospital in Naples, Italy, say the report gives them an idea of where to focus their efforts in regard to the health of the military community, said Navy Lt. Kathleen Brennan, of the hospital’s Health Promotions program.

"[Overweight/obesity] issues are found throughout the military active duty and dependent population of [Naval Support Activity] Naples just by visually examining the community," she wrote in an e-mail. "However, we do not see as high of numbers of overweight and obesity as the non-military community."

Generally, the issue of overweight soldiers is a concern for the Army. But for troops and families in Europe, additional help is on the way.

In the coming weeks, "we are beginning a campaign to increase patient awareness of our wellness centers," said Phil Tegtmeier, a spokesman for European Regional Medical Command.

The Air Force in Europe was unable to reply to queries by deadline.

The DOD report concluded that the percentage of troops who are overweight/obese "is a significant military medical concern because it is associated with decreased military operational effectiveness, and both acute and chronic adverse health effects."

The result of the analysis suggests the military is significantly affected by weight problems similar to those facing young Americans, the report stated.

"‘Nutritional fitness’ should be a priority of military medical and line leaders at every level," it said.

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Somethings I've noticed around here (at Joint Base Balad, Iraq).
1. There is very poor portion control at the DFAC; they want to serve you big pieces, you can get double or more of anything, desserts are available every meal (and ice cream),and there is plenty of soda & Gatorade.
2. Everyone seems to get boxes of candy or can easily find some from various places around the base that get those "any service member" boxes and they put out the candy jar (the Command hallway at the hospital is a minefield of candy boxes).
3. Plenty of junk food is available at the BX and the Shoppette, and there are fast food joints (Burger King, Popeyes, Pizza Hut, Taco Bell, Cinnabon, Subway) in various places around the base. So far I've only been to the Subway.
4. Not as many Army guys are hoofing it on patrols in full gear anymore. Many of them sit around for a day or two between "missions" (which is ultimately safer for them). While some workout at the gym (and there are a large number of folks who have made working out a type of religion for themselves), there are probably an equal number who sit around the rec centers watching movies, playing video games, or just socializing.
5. The conflict in the Middle East really showed how much the Air Force needed to improve physical fitness to keep up with the other services and this helped change our PT testing policies a few years ago. Previously in the Air Force, you worked out on your own and did a bike VO2 max test once a year. Now we have upgraded to testing our fitness with a 1 1/2 mile run, pushups & situps, and waist circumference. But the Reserves do not typically participate in the squadron physical training sessions three or more times a week that the active duty folks have. And there are many non-active jobs in the Air Force. Many that require skill sets so important, there are probably more 'waivers' for decreased fitness or increased weight than in the other services (but some base commanders are really cutting down on these).

On the flight over here, when folks found out I was the dietitian, I can't tell you how many said they planned to lose weight during their deployment. Both the hospital and the H6 Gym are offering weight loss/wellness competitions. I can't run outside (the air sucks and I can't use my headphones outside) but I am using the elliptical at the gym and have improved my pushups/situps this past month. I think I've lost a few pounds since I got here (my goal will be 10#, but I wouldn't be upset if I came home 15# lighter).