Defense

Coalition urges DoD to tackle obesity epidemic

Citing low recruitment rates and readiness challenges, a coalition of health groups is urging the the Defense Department to do more about obesity.

Tom Temin@tteminWFED

May 2, 2024 2:47 pm

9 min read

Citing low recruitment rates and readiness challenges, a coalition of health groups is urging the the Defense Department to do more about obesity. They tell Defense Secretary Lloyd Austin that leadership needs system-wide recognition of what it calls an obesity epidemic. For the latest, the Federal Drive with Tom Temin spoke to the American Security Project’s Courtney Manning.

Interview Transcript:

Tom Temin And in this letter to Secretary Austin, you’re saying that obesity is an existential threat to the U.S. military. Since we last spoke it sounds like not much has changed, really.

Courtney Manning Unfortunately, things have only gotten worse. When we last spoke, the U.S. military’s armed active duty division was around 21% of service members having obesity. Now that number is at 22, possibly even 23%. So yeah, things haven’t gotten better.

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Tom Temin And this is both a problem for recruitment because too many of the people otherwise recruitable don’t meet the guidelines for weight and body composition. And then once people are in and they become obese or they acquire obesity, then it’s difficult for them to perform their duties in some cases.

Courtney Manning Right. So when we say 22%, that’s already shocking to some people. But other people say, well, 22% doesn’t seem existential. What becomes existential is seeing the downstream effects that obesity and the lack of treatment of obesity has on recruiting, retention and readiness. So beyond just the disease itself and how it impacts service members. We’re seeing a big effect on who is able to join our military, who is able to stay in our military. And then when those individuals leave service who they tell to sign up for or not sign up for the military based on their own experiences.

Tom Temin I guess 22% doesn’t sound bad if you go to Disneyland where it looks like 85%, but that’s the American population. But this letter to Secretary Austin, you’ve got a lot of signatories. So this is a seems to be a widespread concern among ethnically based or racially based health groups, and also just groups concerned with the issue as a public health problem.

Courtney Manning Yeah. So we have American veterans signed on. We’re the largest veterans service organization. And I’ve spoken with several members of the Military Coalition, which is a group of VSOs (Veterans Service Organizations) and MSOs (Military Service Organizations), about this issue. And it’s controversial for the reasons you might expect. Weight loss and gain is a deeply personal issue, and even though we have the science today to be able to identify and treat it a level we never have before, getting people to overcome those hurdles in believing that weight loss has to do mostly with willpower, that you just need to toughen up. The high prevalence of obesity in the military demonstrates that’s not always the case, because you can have the most regimented, strong mentally and physically individuals in our country, and they’re still struggling with this. So it’s really been encouraging to see how many organizations came back to us when we reached out to them and said, we’ve been saying this for so long, we really need to make some changes, because the way that civilians are able to access obesity identification and treatment right now far exceeds both in scope, scale and quality the care that our military service members are receiving. And that’s really unacceptable.

Tom Temin We’re speaking with Courtney Manning. She’s a research fellow at the American Security Project. And you have called on Austin and DoD, really to take several steps. Review them for us.

Courtney Manning So we have five main goals for the Department of Defense, some of which may already be happening internally. But we want to make sure that they are being public and coming to light, because a lot of these internal initiatives that the DoD might be running aren’t as public as I think we need to have them in order to gain momentum behind them and show our support for helping our service members reach greater health care access. So the first one is a full review of obesity identification and treatment guidelines within the Department of Defense. We need better statistics on treatment approvals, denials and appeals for existing treatment options from what we can find on our own side and with working with rare, the Walter Reed Army Institute of Research utilization of, for example, anti-obesity medications, which is just one treatment option, is 04 to .05 percent, which compared to that 22% number we were talking earlier, is only around 191 individuals across our entire 1.3 million person active duty. So that shows even though some of these treatment options have been approved since 2018, they’re not being utilized, they’re not being prescribed, they’re not being taken. And we want to find out why. And without data we can’t find out why. So that was a big one. Number two is that we need to recognize obesity is a chronic disease that can be treated while in service, similar to any other mental or physical health concern. We shouldn’t be kicking people out just because they don’t meet an arbitrary weight standard, and then not helping them return to a healthy weight. We need to keep as many people as we can, quite frankly. And if we do establish this as a chronic disease that deserves and requires treatment, we’re not able to just administratively separate individuals for obesity. And the numbers on that are really big. Number three is we need cost effective policies for obesity prevention. So looking at what kinds of obesity prevention initiatives and programs have been introduced in the civilian world we live, and looking at their efficacy and introducing them in the military.

Tom Temin The ways that obesity is treated, those are also evolving and modernizing, aren’t they? It’s not just if you run another five miles, as we all know, you can out eat exercise in 10s when you’re done. So there are much more sophisticated ways of dealing with weight loss nowadays, aren’t there?

Courtney Manning Oh, I’m not a physician. I can’t clinically recommend any specific treatment option. But only about 7% of individuals who are identified as having obesity in service ever get referred to a medical professional or a specialist, and even fewer of those around like 1 to 2% receive some form of treatment, which means that they may not even have the information that they need, or the access to the information they need to make lifestyle choices, which is the number one recommendation. But then, given that most people in their lives have tried a diet, have tried lifestyle choices when they recognize that they have a problem and they’re not able to access any of the further steps that we now have. I think there’s over 28 different treatment options for obesity. They’re very case by case, their individual basis, and you need to go to a doctor to access them. So without access to doctors this is a world closed off to our service members.

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Tom Temin All right. And there were a couple of other things that you’re calling on Austin and DoD to do.

Courtney Manning Yeah. We’d like to establish early intervention, not just for obesity, but for overweight as well, for all service members, because when we end up spending $1.8 million on a service member who has obesity over the course of their lifetime, meeting them at the point that maybe they’ve already been separated, they’ve already been struggling with this for many years. Maybe they have a comorbidity, like a heart disease, high prevalence of stroke or cardiac issues. We have liver disease, a much harder time treating them. And the Department of Defense spends more on treating obesity and its comorbidities than it does on pretty much any other health care problem that we see in service. And if we catch them early when they’re first starting to become overweight, or maybe they’re just on the cusp of having obesity, that’s when we can make the biggest impact in their life. For as little as $30, we can provide obesity treatments that stave off all of these horrible comorbidities that may not arise ten, 15 years later. Last thing we want is greater access to food and nutrition practitioners and obesity specialists, really. So having just that first meeting with the prescriber or someone who is able and qualified to assist, not in a uncredentialed, see my sister, she sells this great diet supplement, you’d love her. But an actual obesity specialist or a credentialed medical professional. If you’re super fit and it was a mistake and actually you’re buff and you’re healthy, that’s fantastic. That meeting shouldn’t take longer than 15 minutes. It’s an in and out process to get your blood pressure checked, to get a physical once over by a doctor, identify any potential health effects, and then let that person on their way. But usually if we are able to provide that specialized expertise, we can prevent some of these effects later on in a service members.

Tom Temin Life and the cost to the health system and to veterans affairs later on down the line we should probably add. Any response yet? Have you gotten any word from the Pentagon or anybody that want to do something about this?

Courtney Manning No, not yet. I think it’s hard because we’ve done initiatives like this before at ASP, and I’m sure plenty of other think tanks do the same. We will send a letter and not receive a word back from about two weeks or two and a half weeks while they craft a response, and that’s expected. We are also meeting with some folks at the DoD that we’ve met with previously and have a good relationship with. We of course, update them that we have sent this letter and that we’d like to meet with them. And having so many great organizations on board does help. There are certain signatories, the YMCA, the Obesity Action Coalition, the American Diabetes Association, these groups have a little bit more influence in this space. And we’re hoping to get them to participate as well in some of these forthcoming meetings.