A Pound Here, a Pound There, and Talk Turns Weighty

DoD wants service members and their families -- especially children -- retirees and civilian employees to enjoy lifelong health and fitness, said Air Force Col. (Dr.) Daniel L. Cohen, chief medical officer and deputy operations director in the Office of the Assistant Secretary of Defense for Health Affairs.

Cohen said the military medical system today stresses a "condition management approach" to obesity. That means working with beneficiaries to prevent the problem rather than have to treat it. The approach marks a change in traditional thinking, one that requires a close partnership with beneficiaries.

It's for their good, but also the military medical system's, he noted. There's a healthier population of beneficiaries -- and also lower healthcare costs, he said.

All the services have body weight and conditioning standards. The Body Mass Index ratio developed by the National Institutes of Health in 1998 is one indicator. Its is the ratio of weight in kilograms to height in meters squared. A BMI of less than 25 is considered normal, 25 to 29.9 is overweight, and over 30 is obese.

About a thousand of service members are discharged each year because of their weight. That's sad, Cohen said, but the active force's problem is minor compared to family members, who mirror the general public. Using the BMI, he said, studies suggest 60 percent of Americans are overweight or obese.

About 15 percent to 20 percent of children are overweight or obese, he said. About 40 percent weigh over 80 percent of their ideal body weight.

The services' elite forces are most effective at weight control, probably because of their culture, which stresses physical prowess, agility and team coordination, Cohen observed.

"My anecdotal experience is that you do not commonly see overweight and obesity in our elite forces, though I haven't really studied that scientifically," he said.

Whether or not his hunch is correct, he noted, one thing is certain for everyone: It's easier to prevent overweight and obesity than to treat them. They're illnesses, he said, but many overweight individuals don't see themselves as sick or needing treatment.

"They do not recognize the steep and very slippery slope on which they sit," Cohen said. Obesity is linked to higher rates of chronic illness and worse physical quality of life than lifelong smoking, problem drinking and poverty combined, in the United States, he contended. Overweight and obesity are clearly associated with type-2 diabetes, gall bladder disease, hypertension, coronary artery disease, depression and elevated cholesterol and triglyceride levels in the blood.

Considering that an overweight 25 year old might gain 10 to 20 pounds per decade, he continued, it's not surprising nearly 30 percent of Americans at any given time are trying to lose weight. The cost is up to $50 billion per year, and most of it's wasted because it's spent on foods, nutritional programs, supplements and remedies of dubious value, he said.

"Losing weight and keeping it off is not easy, ever!" Cohen warned. The hardly secret truth about weight control is that it means adopting a lifestyle that combines prudent dieting and a sustained exercise program. It's the only way to prevent and to effectively treat overweight or obesity without resorting to medications, he said.

"Sustained exercise means 30 minutes of exercise, preferably vigorous, three or four times per week, and more often if one is inclined," Cohen explained. "The benefits of frequent exercise are well documented. Even walking is helpful as long as it is sustained. One should feel at least a little tired at the end of it, in my opinion."

A caution regarding children: Severely limiting children's caloric intake can adversely affect growth and development, especially during adolescence, when their needs increase, he said. The best ticket, he noted, is a balanced diet that's neither excessive in calories nor excessively restrictive coupled with age-appropriate exercise. Children attempting to lose weight should do so only under the care of physicians or nurse health managers, he added.

Embarking on this life change, one can hope to lose 1 or 2 pounds per month. Losing 12 to 20 pounds in a year is a real success story, he said.

A pound of fat contains about 3,500 calories. Vigorous exercise for 30 minutes may burn up to 350 calories, so even with daily exercise at this rate it would take 10 to 12 days to burn a pound of fat -- assuming you're eating only a normal complement of calories. An average adult requires 2,000 to 2,500 calories daily, so the goal should be to not exceed about 2,000, ever, Cohen said.

For more information on weight control problems and treatments, visit the Surgeon General's Overweight and Obesity Web site at www.surgeongeneral.gov/topics/obesity/. Also of possible interest, the National Institutes of Health has a discussion on drugs and weight loss at www.hhs.gov/news/press/1996pres/961217.html and a forum summary on childhood obesity and diabetes at www.hhs.gov/aspe/pic/9/pic6859.txt.

(Adapted from materials from the Office of the Assistant Secretary of Defense for Health Affairs.)