Obesity: Growing Problem for DOD

by J.J. Thomas, MPH

Note: This post represents the view of the author and is not endorsed by the Department of Defense.

Contrary to the common argument of “if I can do my job, why do weight standards matter,” a mounting body of literature suggests that rising rates of obesity in America can hurt our Department of Defense. If approximately 7 in 10 American youths are ineligible for military service, obesity is one of the prime factors that would prevent accession into the armed forces [1]. Of the youth population ineligible for service, 31% are ineligible due to obesity [6]. Obesity was even cited in a recent interview by Secretary of Defense Mattis as one of the factors affecting military service qualification [2]. How exactly obesity plays a negative role within our Navy still requires greater study to fully comprehend future challenges. Nonetheless, we can still posit that obesity hurts our labor pool, increases injury prevalence in boot camp, increases long-term chronic disease cost to the DOD and VA systems, and creates challenges to readiness. 

Labor Pool Shrinking 

A shrinking labor pool for the Department of Defense is a commonly cited issue related to the increasing prevalence of obesity in youth. According to a study in the Journal of Public Health Management and Practice, we draw recruits heavily from the southern states that also have the highest prevalence of obesity in youth [5]. This creates a unique challenge for labor analysts: are body weight composition waivers required or will the armed forces have to waive other conditions to reach recruitment goals? 

Injuries to Recruits 

Initial military training for many is some of the first experiences for greater intensity workouts. In a 2012 Military Medicine journal article, researchers found that those with low fitness levels were associated with increased risk of injury during recruit training [4]. Higher levels of body fat were a major factor along with lower aerobic ability. In 2005 dollars, each Army recruit to be discharged during initial training cost the DOD $54,500 per instance. Furthermore, in a study of 5000 Finnish troops in 5 different 1000-person cohorts, the risks of musculoskeletal injury not only increased with age but also with overweight body mass index values [3]. 

Short Term Costs to Readiness 

According to literature posted by the Centers for Disease Control and Prevention, the effects of obesity can be felt in our current armed forces [6]. Per annum, the Department of Defense loses over 650k workdays in obesity related conditions. This concern has become more prevalent as rates of obesity have grown 61% between the years 2002-2011. The cost per year to the DOD is estimated to be $1.5 billion in the CDC literature [6] and $1.1 billion in other studies [7, 8]. Monetary value does not seem to fully cover the costs completely because those active duty members who show signs of obesity are less likely to be ready to deploy and the loss of manpower may be hard to fully quantify [6,7]. 

Long Term Costs to Our System 

First and foremost, the cost of obesity is a human cost [9]. Being obese is inherently unhealthy with increased risk for various chronic diseases to include coronary heart disease, stroke, sleep apnea, hypertension, type II diabetes, depression, osteoarthritis, and some cancers. Beyond the human cost, there is a monetary cost to society. The annual cost in 2008 dollars to the entire United States healthcare system is estimated to have been $147 billion, up from $78.5 billion in 1998 [10]. The Military Health System and the VA Health System are not shielded from these costs and need to incorporate this phenomenon in future spending models. 

Final Thoughts 

The obesity epidemic in the United States has a real impact on the future of the Department of Defense [11]. When considering the available literature, the trends are not promising in maintaining a strong labor pool, a fit and ready force, or long term sustainable chronic disease mitigation. There are real impacts to our national security and society as the rates of obesity rise. Considering that many service members have family members that were in the armed forces, we may have to look at our dependents to see what our next generation may look like. Putting together an accurate model of what the future holds for our labor pool is important for our national security, especially regarding the obesity epidemic. 

References 

1. Military Readiness. (2018). Congressional Digest, 97(4), 31. 

2. Wolfgang, B. (2018, May 24). James Mattis says number of Americans qualified for military service continues to drop. Retrieved from https://www.washingtontimes.com/news/2018/may/24/james-mattis-warns-number-americans-qualified-mili/ 

3. Pihlajamaki, H.K., Parviainen, M.C., Kautiainen, H., & Kiviranta, I. (2017). Incidence and risk factors of exercise-related knee disorders in young adult men. BMC Musculoskeletal Disorders, 181-7. doi:10.1186/s12891-017-1701-3 

4. Molloy, J.M., Feltwell, D.N., Scott, S.J., & Niebuhr, D.W. (2012). Physical training injuries and interventions for military recruits. Military Medicine, 177(5), 553-558. 

5. Bornstein, D. B., Grieve, G. L., Clennin, M. N., Mclain, A. C., Whitsel, L. P., Beets, M. W., Sarzynski, M. A. (2018). Which US States Pose the Greatest Threats to Military Readiness and Public Health? Public Health Policy Implications for a Cross-sectional Investigation of Cardiorespiratory Fitness, Body Mass Index, and Injuries Among US Army Recruits. Journal of Public Health Management and Practice,1. doi:10.1097/phh.0000000000000778 

6. CDC: Unfit to serve. (2017, May). Retrieved from https://www.cdc.gov/physicalactivity/downloads/unfit-to-serve.pdf 

7. Nadolsky, K.Z. (2018). Rational for Utilization of Obesity Pharmacotherapy in the Active Duty Population. Military Medicine, 183(3/4), 45-50. Doi:10.193/milmed/usx074 

8. Dall, T.M., Zhang Y., Chen, Y.J., et al. (2007). Cost associated with being over- weight and with obesity, high alcohol consumption, and tobacco use within the military health system’s TRICARE prime-enrolled population. American Journal of Health Promotion, 22(2): 120–39. 

9. Overweight & Obesity. (2018, March 05). Retrieved from https://www.cdc.gov/obesity/adult/causes.html 

10. Finkelstein, E.A., Trogdon,J.G., Cohen, J.W., & Dietz, W. (2009). Annual medical spending attributable to obesity: payer and service specific estimates. Health Affairs. Doi: 10.1377/hlthaff.28.5.w822. 

11. Cawley, J., & Maclean, J. C. (2010, September). Unfit for Service: The Implications of Rising Obesity for U.S. Military Recruitment. Retrieved from http://www.nber.org/papers/w16408.pdf