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Conclusions and Recommendations CONCLUSIONS As stated in the Introduction, the Committee on Military Nutrition Re- search (CMNR) was asked to respond to seven specific questions dealing with the body weight and composition standards of the military. The com- mittee's responses to these questions are as follows: 1. Can or should physical performance assessments be used as cri- teria for establishing body composition standards in the services? Aerobic fitness, as assessed by the current physical training tests, is an appropriate indicator of physical fitness for military personnel. However, serious consideration should be given to developing job-related performance tests, such as lifting and carrying tasks, that are more closely related to actual military activities. These tests should be used to help develop body composition standards that are more closely related to physical performance of military tasks. 2. What is the relationship between body composition and perfor- mance? Within the range of body composition exhibited by current military person- nel, there is no consistent relationship between body fat content and physi- cal performance. There is, however a direct relationship between physical performance as measured by tests of load carrying ability and lifting abili- ties and the amount of lean body mass. 25

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26 BODY COMPOSITION AND PHYSICAL PERFORMANCE 3. The services currently use a maximal body fat standard. Should they also establish a minimum fat-free or lean body mass standard? In view of the positive relationship between fat-free or lean body mass and physical performance, the military should seriously consider establishing a minimum standard for lean body (that is, fat-free) mass. There is doubt among the members of the CMNR as to whether the military should contin- ue to employ a maximal body fat standard. 4. What factors should be considered in setting body composition standards? A body composition standard in the military should be based primarily on ability to perform required physical tasks and secondarily on long-term health implications. A stronger rationale needs to be developed for basing the standard. This conclusion relates only to service-wide standards, not the more stringent standards required for particular military occupation specialties. 5. Are performance and body composition standards redundant? If job-related performance standards were in place, a body composition standard would be unnecessary in relation to physical performance. 6. If performance criteria exist, are weight-fat standards needed? Because body weight and composition have health implications entirely aside from the question of physical performance, such standards are desir- able. Also, if the military determines that appearance is a sufficiently critical factor that it outweighs the cost of enforcing weight/fat standards, then appearance standards would be needed. 7. How does one rationalize the different uses of body composition for performance, appearance and health? As stated above, body fatness is related to long-term health, and lean body mass is related to some aspects of physical performance. Appearance of different individuals at the same body weight and fat content can vary considerably depending on other factors. A stronger rationale for an ap- pearance criterion and standards that define acceptable and unacceptable appearance needs to be developed. RECOMMENDATIONS On the basis of the papers presented by the invited speakers, discussion at the workshop, and subsequent committee deliberations, the Committee on Military Nutrition Research (CMNR) presents the following recommenda- tions to the Army Medical Research and Development Command regarding body composition and physical performance as it relates to accession and retention standards for the military services: · All services should develop job-related physical performance tests to use for accession into military service.

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CONCLUSIONS AND RECOMMENDATIONS 27 · The differences between accession and retention standards for body weight need reevaluation for all services.) · An inequity exists in body composition standar~l~ ~ ~ -ram ^ of = for men and wom- en. Accession and retention standards for body weight and body fatness in men and women should be reevaluated in the light of all factors discussed in this report. · The appropriateness of current body composition standards needs to be validated for the significant ethnic groups represented in the military services. · A relationship between trim military appearance and military perfor- mance could not be identified. If the military determines that a trim mili- tary appearance is important, objective criteria should be developed to the extent possible for appearance evaluation. · For individuals who face separation from the service for failing to meet body composition standards, it is suggested that the military identify a limited number of military centers that can perform more specific measure- ments of body composition (for example, dual photon densitometry, under- water weighing, and body water) and to which the individuals in question could be referred for further evaluation. ~ ~ . AREAS FOR FUTURE RESEARCH The Committee on Military Nutrition Research (CMNR) suggests sev- eral areas for future research within the military related to body composi- tion and physical performance. The CMNR believes that the military ser- vices, through its pool of volunteer personnel, have an excellent and often unique opportunity to generate statistics about nutrition, health, and well- being of service personnel that can be directly applied toward improved 1In April, 1991, Dr. J. A. Vogel and MAJ K. E. Friedl, Occupational Health and Perfor- mance Directorate, U.S. Army Research Institute of Environmental Medicine, presented a briefing and a proposal for revisions to Army Accession (AR 40-501) and Retention (AR 600- 9) Standards to LTG Reno. These recommendations (See Appendix D) were approved at the briefing. As a result, on May 7, 1991 the Army retention standard (AR 600-9) was amended for women by increasing the allowable percent body fat standards by 2 percent body fat units for each age group as follows: 17-20 y: formerly 28 percent amended to 30 percent; 21-27 y: formerly 30 percent amended to 32 percent; 28-39 y: formerly 32 percent amended to 34 percent; 40+ y: formerly 34 percent amended to 36 percent. Changes to the Army Accession Standard (AR 40-501) as proposed went into effect on October 1, 1991. These changes result in the Army switching to a body fat standard for accession, reducing the accession standard for men to not exceed 4 percent body fat units over retention fat standards, and make the body fat accession standards for women the same as the newly revised retention standards (Appendix E).

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28 BODY COMPOSITION AND PHYSICAL PERFORMANCE health of military personnel and for the general U.S. population. Research on the following topics is recommended: · the development of service-specific standard tests of military perfor- mance that more accurately reflect military activities; · the relationship of body composition to military and physical perfor- mance among men and women, including consideration of the relationships of lean body mass, height, and physical performance; · the relationship of body fat distribution and body composition to long-term health outcome in career military personnel, specific for race and gender; and · the relationship of injuries to components of body composition (spe- cifically bone density and lean body mass). Two additional areas of research were not specifically mentioned in the task posed to the committee for this project; however, in view of the unique opportunities available for research within the military setting and afforded by its data bases, the CMNR recommends that the military conduct research in these areas to increase general knowledge related to body composition and physical performance: · A retrospective study of the Medical Remedial Enlistment Program (MREP) data base to evaluate (a) long-term health status and performance of overweight recruits and overweight personnel in general, and (b) cost- benefit analyses of enrolling individuals who are overweight at the time of enlistment. · The relationship of body composition to emotional and psychological factors in military units: (a) psychological effects of being overweight and underweight on individuals in a military setting; (b) psychological effects on unit morale of having overweight and underweight individuals present in the unit; and (c) an evaluation of officers' and noncommissioned officers' attitudes and possible biases toward the presence of overweight and under- weight individuals in potential combat situations. The Committee on Military Nutrition Research is pleased to participate with the Division of Military Nutrition, USARIEM, U.S. Army Medical Research and Development Command, in programs related to nutrition and health of American military personnel. The CMNR hopes this information will be useful and helpful for the Department of Defense in developing programs that continue to improve the lifetime health and well-being of service personnel.