Level of DOD’s fitness funding questioned by health officials
WASHINGTON — Like the general U.S. population, the military community is struggling with the growing problem of obesity, military health officials said Tuesday.
Health leaders want to boost preventative measures, but they say they lack the funding to implement programs that would include routine doctor’s visits and prescription drugs to aid servicemembers and others in their charge in shedding the pounds.
“It’s frustrating to come across roadblocks in funding that are available for the tail end of the problem, but not for preventative treatments to help patients before they get to that critical point,” said Air Force Capt. James Weinstein, a dietitian at Travis Air Force Base in California.
That “tail end” includes bariatric surgery, sometimes called stomach stapling, which is done on patients determined to be morbidly obese.
In fiscal 2002, the military health system spent $15 million for 1,905 procedures in civilian and military facilities, with nine of those surgeries performed on active-duty members, said Air Force Lt. Col. Joyce Grissom, deputy medial director at Tricare Management Activity.
Co-morbidity ailments such as heart disease, high blood pressure, diabetes and even Alzheimer’s disease outnumber complications associated with smoking, Grissom said.
Obesity is defined as a Body Mass Index of 30 and above, or about 56 or more pounds overweight for a person 5 feet, 6 inches tall.
BMI is calculated by dividing one’s weight in kilograms by height in meters squared, and is the guide most used by the military. Other methods, such as waist circumference, also are used.
According to the National Institutes of Health, BMI is a reliable indicator of total body fat, but has its limits. It may overestimate body fat in athletes and others who have a muscular build.
Within the military, 16 percent of active-duty members are deemed obese using BMI tables, and more than one-third of adult dependents fall into that category. Nearly 19 percent of DOD adolescents are obese, according to TMA numbers.
Our sedentary ways
It doesn’t help that today there are remote controls for all kinds of electronic gizmos, food is sold in supersized portions and even some vacuum cleaners are robotic, said Vice Adm. Michael Cowan, the Navy’s surgeon general, addressing an auditorium full of medical professionals at Tricare’s annual conference this week.
“It’s a fundamental problem,” Cowan said. “We can’t seem to get moving at all.”
Nationwide, more than $100 billion is spent annually on obesity-related health care, and employers lose more than $12 billion each year due to higher health care usage, lost work days and higher insurance premiums, Grissom said.
Part of the reason for a lack of funding earmarked for prevention is because there’s little to no data to prove that patients treated for obesity will, in fact, keep off the weight once they shed the pounds, said Air Force Col. Daniel Cohen, director of the Tricare Management Activity.
But health officials are pushing for a trial program to acquire more data, Cohen said. The trial program has yet to be presented to the Pentagon’s Health Affairs office, which must sign off on such studies, he said.
Benefits provided by the Tricare health system do not mirror benefits provided by some private health care plans, Grissom said, using Blue Cross/Blue Shield of Massachusetts for comparison. The private company offers to pay for beneficiaries’ routine doctor visits, nutritional counseling, $150 toward a fitness center membership and drug therapy — none of which are offered by Tricare.
Some are doing what they can with the funding provided, she said, and promoting various weight-loss programs aimed at helping active-duty members and their families trim down. In the active-duty ranks, programs include the Army’s “Weigh to Stay,” the Navy’s “Ship Shape” and the new Air Force fitness plan that promotes unit-run exercise programs and time during the workday for PT.
Other efforts include counseling from dietitians to teach families how to change eating habits and the foods that stock the pantries, programs that reward exercise instead of punishing noncompliance, and keeping diaries of food consumed and exercise plans.
Mess halls also have pitched in, with 1,700 revamped recipes in DOD dining facilities to included foods that have been reduced in salt, fat and calories and increased with fruits, vegetable and complex carbohydrates, she said.