Apart from the obvious need to increase energy expenditure relative to intake, none of the strategies that have been proposed to promote weight loss or maintenance of weight loss are universally recognized as having any utility in weight management. The efficacy of individual interventions is poor, and evidence regarding the efficacy of combinations of strategies is sparse, with results varying from one study to another and with the individual. Recent studies that have focused on identifying and studying individuals who have been successful at weight management have identified some common techniques. These include self-monitoring, contact with and support from others, regular physical activity, development of problem-solving skills (to deal with difficult environments and situations), and relapse-prevention/limitation skills. However, an additional factor identified among successful weight managers, and one not generally included in discussing weight-management techniques, is individual readiness that is strong personal motivation to succeed in weight management.
Committee projections based on data provided by the Army suggest that a shift toward a higher BMI force would be unlikely to adversely impact injury and attrition risk in men, but might slightly increase the attrition risk in women. It is important to note that this conclusion is based on data from individuals who qualified under the current standard.
Recommendation 5-1: As BMI is less predictive of injury and attrition than aerobic fitness, we recommend that it not be used as a proxy measure for fitness in the military population.
Recommendation 5-2: As a BMI standard is not justified on the basis of links to injury or attrition, we recommend that such links not be used as the basis for any use of BMI.
Standards for appearance and bearing are issues of military values and thus are outside the committee’s charge.
Although a relatively small number of individuals with high motivation and high self-control can lose weight and retain that weight loss through diet and high levels of physical activity, such results are not the norm, and research has not identified programs that have a high likelihood of success for achieving long-term substantial, sustainable weight loss. Given the evidence regarding the difficulties of maintaining weight loss, the committee thinks that it is unrealistic for retention standards to be more stringent than accession standards.