Written in collaboration with George Maliha
Napoleon Bonaparte famously quipped that "an army marches on its stomach." Unfortunately, as America's obesity epidemic grows, Napoleon's warning may prove literally true. While obesity is traditionally considered a public health and medical issue, the rapid increase in the national prevalence of obesity from 15 percent in 1980 to over 30 percent today and overweight from 50 percent to 68 percent is affecting America's ability to defend itself militarily and perform competitively in business. In fact, today, obesity is the leading medical reason why applicants fail to qualify for military service. As 27 percent of young people aged 17 to 24 are too heavy to serve in the armed forces and because overweight employees reduce workplace productivity, obesity is quickly becoming a significant national security concern. Of particular worry is the rapidly rising rates of obesity among children -- the future leaders and workers of the nation. The prevalence of this epidemic demands action before obesity further erodes American competitiveness and our national security.
The fact that current and retired military leadership has called obesity a serious national security threat warranting immediate action reflects the gravity of the issue. Indeed, the last major instance of the military becoming involved in nutrition in America was after the Great Depression, during World War II. Military planners were keenly aware that the health of school-aged children would have a bearing on the fitness of future military recruits. In fact, the 1946 Congressional testimony of Major General Lewis Hershey about the uniformed services having to reject 16 percent of willing recruits during World War II because of their malnourishment convinced lawmakers of the importance of establishing the Federal School Lunch Program as critical to the national security of the United States.
Today, as economic growth remains sluggish and young people contemplate career options, joining the military represents an opportunity for young people to serve their country, learn marketable skills for their future careers, and to earn income that helps some to rise out of poverty. Although the military is currently meeting its recruitment goals, leaders in the armed forces worry that 75 percent of young people aged 17 to 24 cannot serve in the military today. The reasons for ineligibility vary from felony convictions to lack of a high school diploma or its equivalent. However, one-third of those ineligible cannot serve because they are overweight -- even though the armed forces have relaxed their entry requirements to accept females (aged 21 to 27) with body fat content of 32 percent or less and males with 26 percent or less, which is twice that expected of current soldiers. Although the military has made an effort to accept people at borderline weight, in the Navy for instance, 2,000 personnel are discharged annually from service because of obesity -- at a cost of $300 million to taxpayers. Furthermore, overweight soldiers tend to suffer more orthopedic stress injuries. In fact, it is estimated that a quarter of military air evacuations to Germany from the wars in Iraq and Afghanistan were due to such injuries -- a percentage that is greater than due to combat.
Furthermore, because a significant portion of the defense budget is allocated to caring for military service members and their families, obesity and its accompanying complications impose a real financial cost on, and threat to, military programs. In fact, military health care spending has shot up to over $50 billion annually -- a 167 percent increase since 2001 that dwarfs the rate of increase in national health care spending. This amount represents 10 percent of the overall Department of Defense budget. Of that, DoD's obesity-related expenses totaled over $1 billion and, as the military pays for healthcare costs throughout a service member's lifetime through Tricare (37 percent of veterans are obese and gain approximately 13 pounds after completing their military service), these mounting expenditures will begin to overwhelm other defense spending needs. Indeed, even as the wars in Iraq and Afghanistan draw to a close, DoD's health care costs are not expected to fall appreciably. As policymakers consider cutting the defense budget over the next several months, addressing health care costs and implementing strategies to prevent obesity-related conditions will be critical for stretching limited financial resources.
However, obesity harms U.S. national security by not only weakening this nation's fighting forces but also diminishing productivity in the workplace. For instance, America's system of first responders requires fit individuals who can handle physically stressful situations. With the growth of the obesity epidemic, the pool of applicants for jobs such as firefighters, policemen, and other law enforcement personnel who meet weight requirements is shrinking. The problem, though, is not confined to first responders. Some manufacturing jobs require rapid or flexible movement that obese individuals simply cannot perform efficiently or safely -- physically disqualifying them from these jobs, decreasing their productivity, and increasing occupation-related injuries.
The increased weight of the U.S. population has also imposed other hidden costs on consumers and businesses that have to compete globally. For instance, some businesses have had to purchase special equipment or office furniture to accommodate obese employees. Nonetheless, it is the increased health care expenditures and lost productivity from obesity and its associated conditions that have taken an enormous toll on businesses. Although the numbers are debated, some estimate that obesity costs American businesses collectively more than $70 billion annually. Indeed, much of the loss comes from sick workers coming to the office despite not being able to provide a full day's worth of work -- a trend known as "presenteeism" -- as well as absenteeism. These costs are only expected to rise as current workers retire and are replaced by younger individuals who are more likely to be obese if the current trends do not reverse.
Action must be taken now.
We need to get back to basics. Primary prevention and early intervention -- especially with children and adolescents -- are the most effective and proven methods to stop obesity. Efforts must be made to improve the nutritional quality of foods consumed by children, limit their caloric intake, and instill healthy habits for dietary intake and physical activity that can last a lifetime. Schools are essential in this regard, as children spend half their day and consume one-third to one-half of daily calories there. First, targeted nutritional and health education can be woven into current school curricula. Second, improving the nutritional quality of school breakfasts, lunches, and snacks is essential. Third, encouraging enrollment in and expanding physical education classes and sports programs will lay a foundation for healthful habits today as well as later in life. States and school districts play a key role in these three areas, and special recognition to well-performing districts could help incentivize improvements. Of course, parents must also be encouraged through education to provide their children with nutritious meals and snacks at home while promoting increased physical activity. Additionally, marketing of unhealthy food products to children must be curtailed.
The success of anti-tobacco campaigns in the United States provides many lessons for how to change the behavior of both adults and children. This decades-long, concerted effort by government, health authorities, public interest groups, civic leaders, and educators -- synergized by a national public awareness campaign and targeted regulations -- dramatically reduced the prevalence of smoking by 50 percent over the last 50 years.
The military itself has begun to make strides in improving nutrition among the uniformed services personnel, and its programs, such as the Soldier Fueling Initiative, could serve as a model. As such, military dining halls are starting to be stocked with healthy offerings, and its chefs are being trained to prepare nutritious food that tastes good for service members, further reinforcing healthful eating habits. At the same time, fast food restaurants and vending machines are slowly being phased off of bases, such as in Afghanistan. Even training and physical activity programs in the armed forces have been redesigned to incorporate the experience of athletic trainers as well as better reflect the needs of new recruits and the maneuvers on the battlefield. Over the last decade, to assist soldiers that have failed their physicals because of obesity, the various branches have instituted special training programs or, when necessary, revamped exercise equipment. For the family of service members, military daycare centers are beginning to implement the Let's Move Childcare initiative, providing children with more nutritious meals, increased physical activity, and limited time in front of televisions. Military insurance carrier Tricare has expanded its coverage of bariatric procedures as well.
These recent actions represent a strong start. While obesity rates appear to have plateaued in the general U.S. population, much more needs to be done in order to tip the scales on obesity. While initiatives in schools are important, there are no silver bullets to solve this crisis. A systems approach mobilizing all sectors of society is required with involvement by a broad array of stakeholders, including government, business, advocacy, health care, food and beverage manufacturers, restaurants, grocery stores, families, community, the transportation sector, and the media. There must be a critical examination of some of the food production, distribution, and subsidy policies we have had in place for decades. Public health must employ innovative marketing strategies to promote healthy nutrition and reverse obesity trends in America. In this regard, new technologies and social media can play a role in solving this crisis.
Obesity is a major cause of many costly, chronic medical conditions (such as diabetes and heart disease), and may soon become the leading cause of death in the U.S., surpassing tobacco use. If the current trends continue, this generation of children may not live as long or be as healthy as their parents. As a result, obesity's potential impact on national security and economic prosperity are significant and threaten our nation's future. Without question, obesity is a complex challenge -- but with bold, concerted, and strategic action, it can be reversed in the years ahead.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is also the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, as Chief of the Behavioral Medicine and Basic Prevention Research Branch and as Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association and was named a Rock Star of Science by the Geoffrey Beene Foundation. To learn more about Susan Blumenthal, M.D., visit 4globalhealth.org
George Maliha is a rising senior at Princeton University, studying molecular biology and pursing a certificate in public and international affairs from the Woodrow Wilson School. He serves as the editor-in-chief of the Princeton Journal of Bioethics and is vice president of Princetonians Against Obesity. In addition, he writes and edits for several campus publications, including American Foreign Policy, Business Today, and Princeton Asia Review. George is currently a health policy intern at the Center for the Study of Presidency and Congress in Washington, D.C.
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