The U.S. military spends $1.24 billion each year to address obesity in the ranks, but Defense Department policies have been slow to adopt weight management treatments, including therapies and medications such as Wegovy or Zepbound, to address a major readiness concern, according to new research.
Obesity is the main reason potential recruits are disqualified from serving -- preventing an estimated 52,000 from joining last year -- and is a leading cause of separation from duty, with roughly 101,000 troops leaving from 2018 to 2022 for weight-related reasons, according to a paper published Wednesday by the American Security Project think tank.
During a forum to discuss the research and obesity's impact on military readiness, health experts said the Pentagon has access to new treatment options to help service members effectively manage their weight but has been slow to address the issue.
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"There are service-specific policies that are in place that are old and outdated and confusing, that talk about how you can't necessarily treat people with medications for anorexic purposes," said Dr. Richele Corrado, director of Walter Reed's Internal Medicine Comprehensive Weight Management Program. "A lot of people are fearful of the repercussions of treating people."
Last year, the American Security Project, a Washington, D.C.-based think tank founded in 2006 by then-Sens. John Kerry, D-Mass., and Chuck Hagel, R-Neb., the secretaries of state and defense under President Barack Obama, respectively, noted that nearly seven in 10 active-duty personnel were either overweight or obese based on body mass index, a measure of weight versus height.
Project analysts said this year that roughly 22% of the active-duty force was medically considered obese, meaning a body mass index of 30 or higher.
While body mass index as a measure of fitness has long been considered controversial because it does not take into consideration athletic builds or accurately measure the fitness of some women or minorities, it remains a key component for the services to assess body composition standards.
The researchers suggested that appearance-based standards be replaced with health standards and weight management should be classified as a medical concern, paving the way for treatment in the military medical system.
Instead of "fat-shaming," the analysts added, the DoD should "institutionalize a system-wide process for obesity referrals, screenings, and diagnoses," and when a service member is medically found to be obese, they should be "discreetly referred to a health care provider who has received specialized training in obesity identification and management."
Not only would this improve troops' health, protecting them from developing chronic obesity-related diseases such as diabetes, high blood pressure and liver disease, it would help preserve readiness and could save the Defense Department not only the billions it is spending on medical care but up to $99 million per year in lost productivity, according to the group.
"These conditions lead to prolonged time spent out of service, reduced ability to meet the physical demands of service, and rising attrition rates across the services. With both recruitment and retention on the decline, maintaining fit and capable personnel is critical to ensure a force structure sufficient to combat rising global threats," the researchers wrote.
Corrado said that few physicians are trained to care for overweight and obese patients, and she is trying to convince the Defense Health Agency to support treatment for service members either at the weight management clinic at Walter Reed or to establish similar clinics to tackle the problem across the force.
In terms of treatment, many are now available, added Tracy Zvenyach, director of policy strategy and alliances at the Obesity Action Coalition.
"Society needs to catch up with the science," Zvenyach said. "Qualified and trained health care professionals should be offering evidence-based interventions and treatments, and that can look like anything across the spectrum of nutrition counseling, intensive behavioral therapies, FDA-approved medications, or metabolic and bariatric surgery."
A recent study found that just 0.44% of active-duty troops who qualify to take GLP-1 weight-loss medications, such as Wegovy, are prescribed them.
Stuart Piltch, president of Risk Strategies Consulting and a specialist in insurance and health care, said he understands why the military has been slow to embrace the medications, given the impact they may have on the musculoskeletal system and strength, and the logistical burden given that they need to be refrigerated.
But, he said, treatment to decrease obesity in the U.S. services needs to embrace "whole health."
"I think it's education first, but also changing these policies that make people think that they can't take them," Piltch said.
The change would require the Defense Department and the services to define obesity as a disease so it can be treated, according to the report.
"Without this written classification and its associated protections, service members face bias and discrimination for 'exceeding weight standards,' becoming ineligible for promotion, educational privileges, deployment or disability compensation," the report states.
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