To anyone following the brouhaha surrounding fitness standards across the U.S. military, the Air Force’s six-month delay in resuming body composition measurements comes as no surprise. Three years after body mass index assessments were halted during COVID, it was announced that a new metric, waist-to-height ratio, would determine who was too overweight to serve — and, in the process, alleviate recruiting woes by giving more applicants a chance to meet standards. Delaying its induction by another six months postpones a long overdue conversation: what services will do when forced to reckon with the scale of the military obesity crisis.
The Air Force’s ongoing controversy and adjustment of body mass testing tools reflect a broader trend within the armed forces, where non-evidence-based body composition policies fail to keep troops in shape but are nevertheless maintained (with constant tweaks) to avoid reversing centuries of military policy. The hesitation to admit that obesity is a disease despite ongoing breakthroughs in medical science prevents the armed forces from tackling its crisis head-on, perpetuating a cycle where overweight personnel are unfairly judged and yet not given the tools to succeed. To move forward, agency focus must shift from appearance-based metrics to health interventions proven to treat servicemembers with obesity.
Identifying the Problem
The military manpower shortage ranks high among national security concerns for policymakers, commanders, and the public. The post–Cold War drawdown, which relied heavily on suppressing enlisted recruitment, triggered a 41 percent decline in active component end strength and imposed personnel shortfalls throughout Operations Desert Shield and Desert Storm, wars in Iraq and Afghanistan, and regional interventions against the Islamic State of Iraq and the Levant and al-Qaeda. Recruiting has never been easy, but with active wars in Ukraine and the Middle East and an increasingly hostile Russia, China, and North Korea, the scale and number of threats to the United States are rising faster than offices can keep up.
Commonly cited inhibitors to enlistment include historically low rates of unemployment, reduced proclivity to serve, drug use, medical standards, and low aptitude test scores. In public discourse, however, the relative importance of these factors — and others such as vaccine mandates, new diversity, equity, and inclusion policies, and “wokeism” — rarely reflects reality. Youth propensity to serve has ranged from 9 to 15 percent since the post-9/11 era. Unemployment rates, once strongly correlated with military application rates, are no longer a statistically significant indicator. While over 40 percent of adolescents used illicit drugs in 1997, that statistic has dropped to only 27 percent today. As for academic requirements, 95 percent of people aged 25 to 29 now hold a high school diploma or equivalent, and only 0.77 percent of new enlisted in 2019 failed the Armed Forces Qualification Test. That leaves the one crucial factor: exceeding weight standards.
Disqualifications for obesity have outnumbered all other inhibitors for over a decade, even as body mass standards have loosened. Despite the American Medical Association recognizing it as a chronic disease since 2013, the Department of Veterans Affairs decided it was neither a disease nor a disability in 2017. As a result, exceeding weight standards was recategorized from a medical to an administrative disqualification and removed entirely from annual reports, placing it out of the public eye and into an ever-changing series of categories including “condition, not disability” and “other.” Without data being reported to policymakers or the public, the obesity epidemic’s steady, compounding effects on recruitment soon took a backseat to more novel and immediate threats.
The Obesity Crisis Today
Around 21 percent of military applicants were rejected for obesity and related disorders in 2017. Assuming the obesity crisis has not worsened (and, predictably, it has), a projected 52,000 applicants were disqualified from service based on their weight in fiscal year 2023 — 10,000 more than the services’ 41,000-person recruitment deficit. Given the unpopularity of lowering body mass standards, creative solutions have emerged to close this gap. Weight waivers issued by the Marine Corps now account for nearly half of all medical waivers granted by services, and the Army’s Future Soldier Preparatory Course makes applicants lose up to 1.7 percent body fat a week until they can “weigh in.”
While effective in the short term, however, these initiatives have only pushed the problem down the line. Nearly all formerly overweight personnel gain the weight back, and as of 2023, around 22 percent of active-duty servicemembers are categorized as having obesity. By age 35, these personnel are more likely to have obesity than their civilian counterparts. Overweight rates have similarly skyrocketed; 67 percent of active duty and 80 percent of those over 35 now have an excess adiposity of 25 kilograms per square meter, the leading risk factor for both hypertension and heart disease. Figures are even worse in the Reserve and National Guard populations.
Like its impacts on recruitment, obesity’s effects on readiness are pervasive and understated. Pressure on respiratory, circulatory, and musculoskeletal systems cause shortness of breath, fatigue, vascular dysfunction, and joint pressure, raising a servicemember’s risk of in-service injuries by up to 47 percent. The effects of excess fat then spread across all body systems, significantly increasing the risk of 30 of 39 leading military diagnoses. Eventually, these conditions trigger health events such as strokes, heart attacks, organ failure, and pulmonary embolisms that cause permanent disability or death. The direct healthcare costs of obesity to the Military Health System were last estimated in 2007 at $1.1 billion, which is more than $1.7 billion when adjusted for inflation.
Like disqualifications, the Department of Defense no longer publishes separation data for exceeding weight standards. According to written policy, initiation of separation action is required after only 6 to 12 months of participation in a weight-control program. However, severe manpower shortages in combat arms and at critical intersections make compliance impossible. One in three Navy enlisted have obesity, and so do one in four senior officers. Positions requiring years of expensive technical training, like engineering, cyber security, and geospatial analysis, are similarly predisposed. For this reason, exemptions to separation due to “good military appearance,” high combat or fitness test scores, and commander discretion are plentiful — and, by the Marine Corps’ own admission, arbitrary.
Clinging to the Past
Once excluding individuals with obesity from service became impractical, in-service prevention and treatment in line with evidence-based best practices should have become the goal. Instead, in stark contrast with the scientific literature, it was proposed that the body measuring tools were to blame. The clinical standard, body mass index, had long been accused of classifying healthy-weight soldiers as “obese” — even when military research consistently and overwhelmingly found that it underestimated excess fat in servicemembers. A multi-million-dollar effort was launched to prove that a proportion of personnel with obesity were actually exceedingly muscular and healthy, only to find the crisis was worse than predicted. In one of many trials, body mass index and “tape test” results were checked against sophisticated body fat scanners — costing between $36,000 and $100,000 per unit — which found that less than 1 percent of Army soldiers are inaccurately found to be overweight. Moreover, error rates were attributed to improper measurement practices, not excess musculature. Services were empowered to choose replacement standards anyway; as a result, all branches selected different systems, each more generous than the last.
While accurate measurements are important, spending millions to tweak and retweak standards distracts commanders and the public from the real problem: Once you’ve successfully identified obesity, you must have a plan to treat it. And yet, this is the point at which military policy diverges from the science. In an interview for this piece, Dr. Richele Corrado, director of the Walter Reed National Military Medical Center’s comprehensive weight management program, says that evidence-based treatment for obesity remains shockingly low. Only 0.44 percent of eligible servicemembers in the Military Health System received treatment for obesity with pharmacotherapy between 2018 and 2022, and the services employ only a few hundred registered dietitians. Why?
In part, blame history. Body composition standards were written by commanders long before obesity was understood, with a single body mass index metric determining both health status and suitability for service. “Good military appearance” has been the foundation of body composition policies since. Says Dr. Corrado, “From West Point to boot camp, your military bearing and appearance are incredibly important. You are rated on it. It determines how good a given officer or enlisted person you are.” As appearance standards have loosened, the point at which obesity causes adverse health effects has stayed the same, resulting in a metric that both unnecessarily excludes individuals due to their weight and fails to intervene when those same personnel need medical treatment. To fix this, services need to keep the line for obesity screenings consistent with clinical guidelines while re-evaluating whether a separate appearance- or readiness-specific body fat limit is still needed — especially in mission-critical, non-combat positions.
Secondly, without a Veterans Affairs Schedule for Rating Disabilities code or disability protections for obesity, personnel can be legally discriminated against for exceeding weight standards,” rendering them ineligible for benefits like promotion, educational privileges, deployment, and disability compensation. No commander or provider wants to put a servicemember in that position, so they ignore and sometimes even falsify body mass readings. Furthermore, service-specific policies on anti-obesity medications are “outdated and confusing,” reports Dr. Corrado, leading many Military Health System providers to believe they cannot treat eligible servicemembers for fear of formal reprimand. As a result, less than 7 percent of servicemembers with obesity are diagnosed, and a 2016 study found that just 5.5 percent of those with pre-diabetes indicators had been screened or treated. To reverse this trend, services need to pull the bandage off and acknowledge obesity as a disease, then diagnose and treat it like they would any other condition.
Finally, says Dr. Corrado, “Education about the disease of obesity and its effective treatment options has been lacking for decades.” Misinformation is rampant, both inside and outside the Department of Defense. Common myths, such as that body mass index isn’t accurate for military personnel or that individuals with obesity can be “healthy at every size,” sustain outdated policies that maintain and even worsen trends in the long run. “Commanders say, ‘Well, I get up at five in the morning and I work out and I eat healthy, and I sleep and do all these things to maintain my weight. Why can’t you do it?’” Dr. Corrado sighs. “There’s just so much shame and stigma.” Specialists have been actively working with service branches to brief commanders and providers on best practices, but more attention is needed to reverse lifetimes of hope- and willpower-based thinking around obesity.
The Right Remedy
Obesity is a chronic, progressive, and relapsing neurobehavioral disease where up to 55 percent of cases are genetically inherited. Since its effects vary widely, there is no standardized program that universally represents the most effective approach. However, while the military tends to rely on aggressive diet and exercise regimens, lifestyle modifications are rarely sufficient to repair the body’s neurohormonal weight regulatory system after it becomes dysfunctional. In civilian care settings, registered dietitians develop medical nutrition therapy plans while licensed obesity specialists intervene with treatments for hyperlipidemia, high blood pressure, inflammation, and hypertension. Psychoeducation and cognitive behavioral therapy can help manage expectations and triggers, while fitness coaching gives incentives that help mitigate symptoms. An individualized and sustained combination of treatments has been proven to drive weight loss in the short term; even so, anti-obesity medications, which dampen the body’s desire to consume and store calories, may be necessary for most to stabilize these systems in the long run.
At the outset, these treatments may seem extensive — and expensive. However, for about one in five individuals with obesity, a $30 obesity screening may be sufficient to prevent years of suffering from diseases like fatty liver disease and heart failure. Additional treatments are added only after previous ones fail to induce and sustain weight loss. Up-front investments in obesity treatment are offset by long-term savings in end-of-life care, saving tens of thousands of dollars per patient. If obesity were to be successfully eliminated, the resulting cascade of benefits would greatly improve military readiness, save the Military Health System over a billion dollars annually, significantly decrease veteran disability ratings, and ensure continuing recruitment and retention of capable personnel.
There is hope on the horizon. After years of stagnation, obesity care advocacy campaigns and public discourse around popular glucagon-like peptide 1 agonists like Wegovy have helped put the issue back on the driver’s seat. According to Dr. Corrado, “Medical providers and society are starting to learn more about obesity and recognizing that it is not a moral failing, but rather a complex disease influenced by one’s genes, biology, and environment.”
For now, however, service branch momentum on addressing obesity remains stuck on body fat measuring tools. After years of back-to-back controversies regarding standards, the Marine Corps recently implemented a policy requiring all Marines who fail a tape test to be given an advanced body fat measuring scan. “Does every single person need a [bone density] scan?” muses Dr. Corrado. “Probably not. Is that financially cost effective? Probably not. But let’s say you do it anyway. How is that going to be helpful if you’re not going to treat them?”
Courtney Manning is a senior research scientist at the American Security Project, leading the project’s portfolios on military recruitment and readiness, strategic competition with China, and emerging technology risks. She holds an M.I.A. in international security policy from Columbia University and a B.A. in international relations from the University of Denver.
Image: Sgt. Jamean Berry
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