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Body Composition and Physical Performance 1992. Pp. 31-55. Washington, D.C. National Academy Press Body Composition and Military Performance: Origins of the Army Standards Karl E. Fried! Excessive body fat connotes a lack of personal discipline, detracts from military appearance, [and] may indicate a poor state of health, physical fitness, or stamina. INTRODUCTION (AR 600-9, 1986) The primary intent of physical standards in the military has always been to select soldiers best suited to the physical demands of military ser- vice. This standard has usually meant the selection of soldiers who at least looked as though they could carry loads and fight well. Currently, body fat standards are part of the U.S. Army's fitness emphasis to ensure that forces "possess the stamina and endurance to fight in extreme climatic and terrain environments" (Study of the Military Services Physical Fitness, 1981~. For most of the past century, weight-for-height has been a key physical discriminator of a recruit's fitness for military service, but until recently, these standards were used only to exclude underweight candidates. Weight- for-height standards were relevant when a sizable proportion of draftees and volunteers were malnourished, tuberculous, or had parasitic diseases; un- derweight was a good marker of such individuals who were clearly unsuited to the physical demands of the military. The need for height-weight stan- dards has diminished as the importance of these diseases has diminished. In addition to advances in health care, improved nutrition over the past century has produced increases in the mean height, weight, and fat-free mass of soldiers (Table 3-1) (Karpinos, 1961~. However, improved nutrition has also increased the importance of health risks at the other extreme of body size, with excessive fatness due to overnutrition. Although tuberculosis J 1

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32 KARL E. FRlEDL TABLE 3-1 Comparison of Some Anthropometric Characteristics of Male Soldiers in 1864, 1919, 1946, and 1984 Year of Study (n)* Anthropometric 1864 1919 1946 1984 Characteristic (23,624) (99,449) (85,000) (869) Height (inches) 67.2 67.7 68.4 68.6 Weight (pounds) 141.4 144.9 154.8 166.8 Age (years) 25.7 24.9 24.3 26.3 Neck girth (inches) 13.6 14.2 14.5 14.5 Chest girth (inches) 34.5 34.9 36.4t 35.5 Waist girth (inches) 31.5 31.4t 31.3t 32.7 Estimated body fat (percent) 16.9 15.7 14.4 17.3 Fat-free mass (pounds) 117 122 133 138 NOTE: Relative body fat is estimated from mean values for height, neck, and waist, using the Army circumference method as published in AR 600-9 (AR 600-9, 1986). The value is based on hydrostatically determined body fat estimated in 1984 soldiers. *n = number of men in the study tChest circumference measurement did not specify expiration although it was the specified standard in the physical examination regulation in existence at the time; the other three values are for chest at expiration. "Measurement at natural waist adjusted upward by 1.66 cm, the mean difference between "natural waist" circumference and circumference at the umbilicus in 1984 soldiers; no adjustment was made for 1864 because measuring was done over clothing. SOURCE: 1864: Gould (1869); 1919: Davenport and Love (1921); 1946: Randall (1947); 1984: Fitzgerald et al. (1986). Used by permission. was a leading cause of death in the early l900s, the leading cause of death in 1987 was heart disease (Surgeon General's Report on Nutrition and Health, 1988~. Prompted by these health trends and the current national obsession with body fat and fitness, the principal target of physical standards in the Army has shifted from underweight to overfat soldiers. The use of these standards has also changed from simple entry selection criteria to standards that must be maintained throughout an Army career by appropriate nutrition and exercise. The current U.S. Army Weight Control Program (AR 600-9, 1986) and the objectives of this regulation will be outlined here, as well as earlier policies and how the Army arrived at the current policy, standards, and method of assessment. From this historical review it will be evident that in the last decade, two important considerations have been dropped, possibly inadvertently, from the current standards: (1) the low-end standard (or strength testing) to emphasize the importance of an adequate fat-free mass and (2) the confidence interval built into these standards, based on the

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ORIGINS OF ARMY STANDARDS 33 precision of the measurement methods and the relative strength of the rela- tionship between body composition and the desired objective, retention of combat-ready soldiers. THE CURRENT ARMY WEIGHT CONTROL PROGRAM: POLICY AND GOALS All soldiers, regardless of rank, are weighed at 6-month intervals to demonstrate that they are below tabled height-weight limits (divided by gender and into four age categories). Soldiers exceeding these screening weight standards are assessed at the unit (company) level for body fat by an Army-developed circumference method, which is described below. If a soldier exceeds fat standards prescribed by gender and age, the unit com- mander must enter the individual in the U.S. Army Weight Control Pro- gram. The commander is required to provide motivational programs to the soldier, including nutrition education sessions and exercise programs. As additional incentive to achieve the standards, the soldier's records are flagged to prevent: reenlistment, assignment to command positions, favorable ac- tions such as awards, and transfer to any professional schooling beyond initial entry training. A soldier who fails to make satisfactory progress toward weight or fat loss determined as failure to achieve a 3- to 8-pound weight loss/month in 2 consecutive months~an be discharged from the Army under a separation action for failure to meet the weight-control stan- dards. A medical evaluation is required for a soldier being considered for separation to ensure that the overfatness is not due to an underlying illness. A soldier is cleared from the program only by achieving the body fat stan- dard by the Army circumference method. The upper limits of permissible body fat are shown in Table 3-2. Although personnel are held to these TABLE 3-2 Upper Limits of Permissible Body Fat, U.S. Army, 1990* Percent Body Fat Age Range Men Women 17-20 20 percent 28 percent 2 1 -27 22 30 28-39 24 32 40 26 34 *These limits were increased by 2% for women since this meeting was held. (See Chapter 2) SOURCE: AR 600-9 (1986).

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34 TABLE 3-3 Chronology of U.S. Army-Relevant Body Composition Studies and Policies KARL E. FRIEDL 1863-1865 U.S. Sanitary Commission Study of Civil War soldiers. Detailed inquiry into soldier physique by B. A. Gould. 1875 1887 1912 1917-1919 1907-1928 1943 1946 1960 1976 1980 1983 1984 1986 Statistics compiled from physical examinations of approximately 500,000 Civil War recruits by J. H. Baxter. First U.S. Army height-weight standard tables. Medico-Actuarial Mortality Investigation. Davenport and Love analyze physical examination data of 2.5 million World War I draftees (1917-1918) and anthropometry of 100,000 demobilizing soldiers. Biometric study of U.S. Army officers. Analysis of annual health examination data over 20 years. Height-weight means of 465,000 World War II selectees collected and later tabulated by B. D. Karpinos (Office of the Surgeon General). Quartermaster Corps conducts an anthropometric study involving 66 body measurements of 105,062 men at six Army separation stations. Photographs of 39,376 of the men were somatotyped by Hooton. New maximum weight limits issued, tabled by age and by gender (Army Regulation 40-501). Army Physical Fitness and Weight Control Program regulation is released with new tables (AR 600-9). Review of military fitness is ordered by President Carter. This results in Department of Defense directive 1308.1 (June 1981), directing the use of body composition standards and a proactive emphasis on fitness and weight control. Revision of AR 600-9, issued as "The Army Weight Control Program", specified use of body composition standards with penalties for soldiers not meeting standards. Use of Durnin-Womersley equations as interim method. Army Body Composition Project developed Army body fat equations by comparison to hydrostatic weights in Army men and women and collected information on fat relationship to fitness and military appearance. Revision of AR 600-9 detailed circumference-based methods of fat estimation. standards, the regulation encourages all personnel to achieve the more stringent Department of Defense goal of 20 and 26 percent body fat for men and women. The intended purpose of these standards, as stated in the current Army Regulation 600-9 (AR 600-9, 1986) is explicit. It is "to insure that all personnel: (1) are able to meet the physical demands of their duties under combat conditions, Land] (2) present a trim military appearance at all times."

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ORIGINS OF ARMY STANDARDS 35 The use of physical standards to ensure the combat readiness of the Army comes out of a long evolution (see Table 3-31. THE DEVELOPMENT OF MILITARY ACCESSION STANDARDS Physical Standards in Relation to the Demand for Soldiers Some physical standards have changed easily with the need for soldiers, which suggests that what may be portrayed as a soldierly characteristic may not be solidly rooted in combat necessity. Height is an example. European monarchs prided themselves on their tall soldiers; it was also convenient to have men of about the same height for drill and ceremony. Some eugeni- cists claimed that criminals tended to be shorter than the rest of the popula- tion (Baxter, 1875), and a retired military surgeon proposed that physical characteristics could identify future heroes (Foster et al., 1967~. Thus, the minimum height for U.S. soldiers was 66 inches early in the nineteenth century and has progressively lowered, with the least stringent requirements (no minimum height standard during part of the Civil War) coinciding with national emergencies when new recruits were in greater demand (Figure 3-11. The Romans also imposed height standards on their soldiers, and the usefulness of this selection standard was questioned even then. Vegetius Renatus, a military philosopher, suggested using a more subjective visual appraisal of potential recruits, noting that "when all these marks are found in a recruit, a little height may be dispensed with, as it is of much more importance that a soldier should be strong than that he should be tall" (Baxter, 18751. When health screening capabilities were less advanced, height standards served a health fitness screening purpose; for example, short stature could reflect disease and poor physical development. Thus, even after careful review of physical standards during World War II, men less than 60 inches in height were "nonacceptable" (U.S. Congress, 1944~. Today, the best rationale for current height standards is practical: to limit the range of sizes for uniforms, protective ensembles, and workspace di- mensions. However, when other reasons are dismissed, commanders argue from anecdotal experience that short soldiers simply cannot carry the same load as their average-height peers (Davenport and Love, 19214. Early Scientific Investigations of Soldier Physique More than a century ago, scientists such as Benjamin Gould recognized the importance of military anthropological studies. Gould was invited by the U.S. Sanitary Commission to perform an ambitious study on soldier physique with detailed demographic and anthropometric measurements on 23,785 soldiers studied at various Civil War camps, and with substudies on

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36 68 67 66 65 64 63 62 61 60 59 58 KARL E. FRIEDL MINIMUM ACCEPTABLE HEIGHT (inches) sources: references #3 & 9 . ............ B................ A................ _ ~ ~ _ · ~ _ _ __ it_ . - - 1802 1846 1861 1864 1867 1874 1917 1918 1919 1923 1940 1944 DATE OF REGULATION FIGURE 3-1 U.S. Army male standards for minimum acceptable heights, as they have changed with the demand for soldiers. SOURCES: Davenport and Love (1921~; Foster et al. (1967~. captured rebels, Iroquois Indians, Black soldiers, and freed slaves (Gould, 1869~. Although the study was curtailed by the Secretary of War, it suc- cessfully outlined some anthropometric relationships with respect to age, health, and strength among Civil War soldiers (see Figure 3-2~. Gould tested several proposed relationships between adult weight and height and concluded that the weight/height2 formula of the Belgian scien- tist, Lambert A. J. Quetelet, was the most suitable. Current weight screen- ing tables are based on Quetelet's index. Gould also discovered that mean weights did not change significantly in this study population after age 22. This trend was not readily apparent in subsequent studies, presumably be- cause of reduced activity levels and improved nutrition, with consequent increases in weight and fatness becoming virtually inevitable with age. Weight was investigated in terms of height, chest size, age, health, race, service (Army versus Navy), length of service, pulse and respiration. Some of these latter investigations were influenced by the earlier work of John Hutchinson, who had pioneered studies of vital capacity and had also developed some of the first tables of "desirable" weight-for-height (ranging from 21.4 to 23.0 kg/m2) for life insurance companies. In 1846, Hutchinson observed a loss of vital capacity with excess weight and concluded that individuals as little as 7 percent over his weight tables had a measurable reduction in vital

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37 ,~ _ - , - -.~;90 by' '1 A;'' ~ me . 1 1 ~ 1 1 ~ 1 .` A- - ~ ~ ~ I i , I jar, \N L\__~ T FIGURE 3-2 Dr. Gould's "andrometer", one of several devices designed for anthro- pometric and physiological data collection on Civil War soldiers. This device en- abled rapid measurement of height, crotch height, lower leg length, and breadths of the neck, shoulders and pelvis. It was based on a device used by an Edinburgh tailor commissioned to manufacture uniforms for the English Army. SOURCE: Gould (18691.

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38 KARL E. FRlEDL capacity (Baxter, 1875). Unfortunately, Gould never completed these anal- yses or those from his intriguing strength measurements. For these studies a dynamometer was devised to measure something approximating deadlift performance: healthy White soldiers could lift an average of 330 pounds (n = 12,157), with a strength apex at 24.5 years of age. He found that the bigger men were the stronger soldiers, with mean lifting strength equal to about 2.25 to 2.5 times their body weight, although Iroquois Indians far surpassed all other subjects in this measure (Gould, 1869~. Gould also warned about a significant bias that is still a problem for military data collected today: the data are limited because they pertain to only one gender and "to those ages, for that sex, in which the physical changes are least marked." The ultimate report consisted of only a portion of what the Sanitary Commission had hoped to present as "an incidental contribution to military and anthropological knowledge." The National Academy of Sciences pro- posed to follow up on Gould's work with a study of World War I draftees, but the study was turned down by the War Department as inappropriate during the national emergency (Davenport and Love, 19211. No single study, quite as ambitious in scope, has since been attempted. Standards of Physique in the Civil War: Eye of the Physician At the time of the Civil War, general regulations specified that the surgeon would ascertain whether a draftee's "limbs are well formed and sufficiently muscular . . . his chest is ample and well formed, in due propor- tion to his height and with power of full expansion . . . whether the abdomen is ~,~11 [rumba q^~1 nut the ~rntilhF~r~nt Wall l~Jllll~= ~1- 5~ ~ r4~v~ ... (Baxter, 1875). Height and chest circumference measurements were to be considered, but only as part of the screening physician's subjective "estimate of the man's physical capacity." These regulations were influenced by standards imposed by European armies, such as the British and French, which involved minimum heights and chest circumferences. However, in those countries, the standards were administered by the recruiting officer in advance of any medical screening. Weight was less consistently assessed during the Civil War but if used, it was by a screening physician to evaluate for underweight, not overweight (Ordronaux, 18631. Nevertheless, conscripts with notable obesity, such as one 51-inch man weighing 313 pounds, were exempted (Baxter, 18751. Colonel Jedidiah Baxter (1875) summarized the rationale for physical standards of his time: Weight is not a regulated quality in any code of laws governing the enlist- ment of recruits. The circumference of chest thought to be indispensable as an accompaniment to certain decrees of stature, is carefully laid down in the English regulations, but weight is not even mentioned. It is presumed

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ORIGINS OF ARMY STANDARDS 39 that the matter is left to the discretion of the examining surgeon, with whom the decision as to the other qualities named might, it is thought, be also left with advantage. A due proportion in the weight is quite as essen- tial in the soldier as a well-formed chest, and is of greater importance than lofty stature. In former times, when it was necessary to make use of a ramrod in loading a musket, men of a certain height were absolutely neces- sary for the service; but in these days of breech-loading arms, a man from 5 feet to 5 feet 4 inches in stature, and well proportioned in build and weight is, ceteris paribus, as serviceable a soldier as can be desired. Thus, it was a physician's subjective assessment of a recruit's suitabili- ty to the demands of military service that determined Civil War selections, and this evaluation emphasized adequate weight, height, and chest size. The first U.S. Army table of weight-for-height was published later, in 1887 (Reed and Love, 1932~. Published Standards for Physician Guidance By the time of the World War I call-up, the earlier physical standards were codified with specific guidance for examining physicians. Desirable weight-for-height standards were clearly specified, but men who were evi- dently vigorous and healthy were permitted a lower minimum weight (Table 3-4~. Below these absolute limits, men were classified as underweight, which was usually grounds for rejection (Love and Davenport, 1919~. Draftees were also rejected for deficient chest measurements as a reflection of not being "well developed and muscular." A man was considered unfit for military service if general examination proved him to be "undersized, un derweight, undeveloped, pale and emaciated, poorly nourished with thin flabby muscles, or manifestly lacking in stamina and resistance to disease." In contrast, obese applicants were eliminated only for overt morbidity or if their weight was excessive for cavalry service (Foster et al., 1967~. Thus, variations in weight above the standard are disqualifying if sufficient to constitute such obesity as to interfere actually or potentially with normal physical activity, as may be evidenced by high blood pressure, a beginning nephritis, breaking down of the arches of the feet, or other defects incident to such condition. No applicant will be accepted for Cavalry service whose weight is in excess of 180 pounds (AR 40-105, 19231. In 1918, 2.6 percent of all candidates (approximately 75,000 men) were rejected for military service for being underweight; only 4,211 men were rejected for obesity and others classified as obese were still accepted for military service because "the variation was correctable with proper food and physical training" (Love and Davenport, 1920~. Thus, obesity was functionally determined by the examining physician, and underweight was now defined by published height-weight tables.

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40 KARL E. FRIEDL TABLE 3-4 U.S. Army Standards for Weight and Chest Girth, 1917 Standard Accepted Measurement Permissible Minimum Variation* Height Weight Chest Circumference Weight Chest Circumference (inches) (pounds) (inches)" (pounds) (inches)" 61 118 31 110 30 62 120 31 110 30 63 124 31 112 30 64 128 32 113 30 65 130 32 114 30 66 132 32 1/2 116 30 1/4 67 134 33 118 301/2 68 141 33 1/4 121 303/4 69 148 331/2 124 31 70 155 34 128 31 1/4 71 162 34 1/4 133 31 3/4 72 169 34 3/4 138 31 1/4 73 176 35 1/4 143 32 3/4 74 183 36 1/4 148 33 1/2 75 190 36 3/4 155 34 1/4 76 197 37 1/4 161 34 3/4 77 204 37 1/2 168 35 1/4 78 211 38 1/4 175 35 3/4 NOTE: A separate table for Filipinos included a lower range of heights. ~ Variations from standard permissible when applicant is active, has firm muscles, and is vigorous and healthy. ~ Chest girth at expiration. SOURCE: Selective Service Regulations, Pt VIII (1917); later, AR 40- 105 (1923), with only a change in range of permissible heights, beginning at 64 inches. The minimum standards were also clearly rooted in health and mini- mum strength concerns. Love and Davenport (1920) noted that "common observation indicates that the Southern men have a tendency to lankiness, and this has often been attributed to infection with malaria, hookworm, and other parasites found prevailingly in the South." Taller men were also required to carry greater weight-for-height, with a linear 7 pound/inch in- crease above average height (approximately 68 inches) in the tabled values. This requirement may have reflected a bias against young tuberculous men. Pulmonary tuberculosis, if not readily evident, was screened by low weight. It was particularly suspected in tall persons (Davenport and Love, 1921) because tuberculous men averaged 1/2 inch more in height and 12 pounds less in weight (n = 10,701) compared to the average of healthy World War I registrants (Davenport and Love, 1921~. Regardless of how it

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ORIGINS OF ARMY STANDARDS 41 was established, this standard served to eliminate only the lowest- weight men. WORLD WAR II HEIGHT-WEIGHT STANDARDS The U.S. Army height-weight tables used for World War II draftees still contained no upper limit of body weight, only prescribing desirable standards and lower limits for weight and chest circumference (Foster et al., 1967~. The previous standards were slightly modified, with chest circum- ferences set to regular 1/4 inch increments and ideal weight increased by 4 pounds/inch, above 64 inches in height (Table 3-5~. The chest circumfer- ence standards were consistent with scientific data demonstrating this rela- tionship between chest girth and height in over 250,000 20-21 year old Italian men (Frassetto, 1926~. The "standard" values of weight were much closer to the "desirable" weights for 20-year-old men in the 1912 Medico TABLE 3-5 Standard and Minimum Measurements of Height, Weight, and Circumference of Chest, U.S. Army, 1940 Standard Measurement Minimum Measurement Height Weight Chest Circumference Weight Chest Circumference (inches) (pounds) (inches)* (pounds) (inches)* 60 116 31 i/4 105 28 3/4 61 119 311/2 107 29 62 122 31 3/4 109 29 I/4 63 125 32 111 29 1/2 64 128 32 I/4 113 29 3/4 65 132 32 i/2 115 30 66 136 323/4 117 301/4 67 140 33 121 301/2 68 144 33 1/4 125 30 3/4 69 148 33 I/2 129 31 70 152 33 3/4 133 31 I/4 71 156 34 137 311/2 72 160 34 1/4 141 31 3/4 73 164 34 I/2 145 32 74 168 34 3/4 149 32 1/4 75 172 35 153 32 1/2 76 176 35 1/4 157 32 3/4 77 180 351/2 161 33 78 184 35 3/4 165 33 I/4 *Chest circumference to be taken at expiration. SOURCE: Mobilization Regulation 1 -9 (1940).

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46 280 260 240 220 200 180 160 140 120 100- 1 , 1 1 1 1 , 56 WEIGHT (Ibs) , . . ,, 1912 MEDICO-ACT STD O 1940 STANDARD 1976 MAXIMUM *1983 RET SCREEN *1983 ACC MAXIMUM A: KARL E. FRlEDL , ,..,.., ,...,.,.,; be, .... , , , . . , , , , ,,f, ....... ....... :''''' awes'' 1 - it- - -~,f - ............ .. ... . . . .. A = : -' , , , .~, ....... , , . , .................. ,~ , , I , I 58 60 62 64 66 68 70 72 74 76 78 80 82 HEIGHT (inches) * males, aged 17-20 category shown only; this is the most stringent retention max FIGURE 3-3 Evolution of U.S. Army weight-for-height tables for men. NOTE: The "desirable" weights of the 1912 Medico-Actuarial tables, representing the mean values for insured men at age 20, formed the basis of the World War II "standard" weights. Even "evidently vigorous and healthy men" who fell below 90 percent of these weights were usually excluded from service. In 1976, General Rogers established a new maximum weight limit for active duty soldiers to observe (standards for retention in the Army); this was 125 percent of the World War II standard weights. This limit later became the screening weight standard for the 40- and-over age category in the new two-tiered U.S. Army Weight Control Program, with a secondary body fat assessment for the high-risk individuals. More stringent weight screens and body fat standards extend down to the youngest age category (17 to 20 years), illustrated here as the retention screen (triangle symbols). The current "accession" weight maximum, which determines entry into the Army, is also shown for this youngest age group (diamond symbols). The wearing of the Army uniform should be a matter of personal pride and satisfaction. Each soldier is a representative of the United States Govern- ment, and should have a physical configuration and posture when in uni- form that is trim and smart. Waistlines that stretch the front of an other- wise well-fitting blouse or shirt, and "pot-bellies" detract from good military appearance. (AR 600-9, 1976)

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ORIGINS OF ARMY STANDARDS 47 Obesity was defined as excessive fat "implying excessive caloric intake or a sedentary existence or both, as causative factors" (AR 600-9, 1976~. Much responsibility was placed on the commander to prevent this through early detection: "Particular attention must be directed to the general military appearance, physical condition, and the ability to perform assigned duties." Thus, obesity was an implied cause of poor military performance. The firm weight standard, imposed to determine who needed to be screened for obesity, was followed with the proviso that maximum weights "were not to be utilized as the sole criterion for a classification as obese." It was acknowledged that "evaluation of the body build, muscular devel- opment, and bone structure" may be necessary to differentiate between overweight and obese. The specific guidance to the examining physician was that a view of the entire body should be taken, noting the proportions, symme- try of the various parts of the body, chest development, abdominal girth, and the condition and tone of the muscles. An overweight member, who is obviously active, of firm musculature, evidently vigorous and healthy, and who presents a satisfactory military appearance, should not be classified as obese. (AR 600-9, 1976) These instructions read very much like those given to physicians who screened Civil War draftees a century before. As in all preceding regulations, this one called for the subjective determination by an Army physician although now it was also the responsibility of unit commanders- to "identify and counsel all personnel who do not present a suitable military appearance or satisfactory level of physical fitness because of an obese/overweight con- dition." The regulation thus provided a safety margin between precise weight standards and the elimination of good soldiers from the Army. Department of Defense Directive 1308.1 and the U.S. Army Body Fat Standards In 1980, President Jimmy Carter, another health- and fitness-minded President, asked for an assessment of military physical fitness programs. A review was conducted by a panel of government scientists (Study of the Military Services Physical Fitness, 1981), and a Department of Defense (DOD) directive was issued based on their recommendations (DOD direc- tive 1308.1, 19811. Included was a requirement that the services use body fat standards to assess obesity. It was directed that weight tables would still be used as a preliminary screen for retention standards, but the final deter- mination would be based on a new objective body fat assessment procedure instead of the physician's assessment. Obesity was defined by the panel as anything over 22 percent body fat

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48 KARL E. FRIEDL for men and 29 percent for women. Desirable body fat figures were origi- nally to be 15 percent for men and 23 percent for women. These values were based on a consensus by panel members who felt that the figures would require revision as a better understanding was gained of the relation- ship between health and body fat. Health concerns brought body fat assess- ment into the recommendations. However, health was construed to be a subset of military performance in terms of "man hours lost due to minor illnesses and lack of vigor." The panel's report (Study of the Military Services Physical Fitness, 1981) noted further that . . . to design our physical fitness programs in the military with the singu- lar focus on health enhancement and long-range health care cost savings would be an error in . . . emphasis [since] the most fundamental goal of military physical fitness programs and research efforts must be that of making the personnel of the Services as fit for combat as possible .... The American people are supporting the defense establishment with the under- standing that all our personnel are fit to fight and win. In this way, the use of body fat for health screening became confused with military performance objectives; it was easy to transfer body fat to physical performance without hard data because of the pervasive notion that a soldier who looks fat cannot adequately perform military duties. Never- theless, the DOD directive still indicated a health goal in the use of body fat standards and it noted that "standards shall be evaluated for consistency with health-fat relationships." The panel had relied heavily on the textbook of McArdle et al. (1981) for their recommendations (Study of the Military Services Physical Fitness, 1981~. This text suggested 20 and 30 percent body fat for men and women as desirable goals for all purposes; these values included a statistical interval of 5 percent body fat units over the average fatness of fit young men (15 percent body fat) and women (approx- imately 25 percent body fat) (McArdle et al., 1981~. The DOD directive that finally emerged recommended 20 and 26 percent body fat, with ser- vices "authorized to set more stringent standards." The panel apparently wanted to bring standards for women closer to the standards for men. These recommended standards were not based on health studies related to body fat, but rather on the mean values of fit individuals in the youngest adult category. Indeed, translating current body mass index health recommenda- tions (Surgeon General's Report on Nutrition and Health, 1988) into body fat would set limits for young men and women at about 26 and 36 percent body fat, respectively. The body fat standards in the DOD directive were construed to be recommended goals, and each service set their standards differently. The Army standards that were set revolve around the base value of 20 percent body fat for young men. They were established, in part, on the basis of

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ORIGINS OF ARMY STANDARDS 49 Army data on aerobic capacity of young male soldiers (Vogel et al., 1986), where a modest inflection point was inferred with lower maximal oxygen uptake above 20 percent body fat. The remainder of the standards were largely linked to this single value. Two percent body fat increments were included for increasing age, very roughly by decades (Table 3-2), to accom- modate accepted but poorly quantified age-related changes in body compo- sition. Standards for women were set at 8 percent body fat above those for men in each age category to account for gender-specific "essential" body fat. In retrospect, this 8 percent difference for women another "consen- sus" value-may have been overly restrictive. Certainly, the DOD recom- mendation of 26 percent body fat was too restrictive even for the youngest women, because Army data which were available at that time demonstrated that the average body fat of young women entering the Army was closer to 28 percent. This scheme for the standards also preserved the stringency of the pre- vious 1976 standards, a consideration in setting the Army body fat stan- dards. The 1976 maximum weights for men and women were assigned as the screening weights for age 40 (and over), and these appeared to suitably screen individuals who approached 26 percent (men) and 34 percent body fat (women). (Some adjustments were later made, with a 5 percent increase in all table weights for women.) This approach helped to establish upper limits of fatness for the oldest age category (Colonel D. D. Schnakenberg, personal communication). Body fat standards for the intermediate age cate- gories were then arbitrarily interpolated between the 20 and 26 percent male body fat limits, with 8 percent added for women. Thus, the current Army body fat standards were adopted as best guesses of performance- related standards, with consideration given to existing weight standards. At the time these standards were required to be enacted, the 20 percent body fat standard for young men was a relatively soft relationship, and the other values were not based on any empirically determined per- formance relationships. Attempts to empirically study the relationship of fatness to military performance in women are seriously hampered by the narrow range in body weights of accepted Army women. This limitation is a result of the acces- sion weight standards, which are sufficiently stringent that they exclude 28.7 percent of otherwise qualified young U.S. women (Laurence, 1985, 19881. There is also little difference between accession and retention stan- dards for women, so that substantially overfat women do not remain in the Army. Thus, studying Army women cannot provide enough information to determine if higher body fat limits could be compatible with female military performance. The male accession standards, by comparison, allow young men as much as a 40-pound margin over the screening weights for body fat (Figure 3-31. Thus, few men (3.0 percent) are excluded from joining the

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so KARL E. FRIEDL Army (Laurence, 1988), even though some never achieve their fat standards and are later eliminated under provisions of the U.S. Army Weight Control Program regulation. Attrition from the Army is one of the useful end points to test the validity of body fat standards. It captures, in effect, unsatisfactory military performance for all reasons. If applied to new recruits, it is not confused by separation for failure to meet the standards of the weight control program. It can be reasonably predicted that at some level of fatness, fitness is im- paired enough to increase attrition of recruits from the Army. This assump- tion was originally suggested by M. T. Laurence (1988) who demonstrated higher attrition rates for individuals above 120 percent and below 80 percent of national mean weights. The upper end would correspond to men with a mean body fat of approximately 26 percent. Although there are few male Army recruits above this level, there is a trend toward higher attrition of male recruits with increasing fatness (Friedl et al., 19891. There is no such relationship apparent for women, presumably because of the even more re- stricted range of body fat. There is, however, a significantly higher attrition of women in the lower end of body mass index, which suggests that some mini- mum level of fat-free mass is important to success of women in the Army. Development of Army Body Fat Equations An Army study was conducted to establish population-specific body fat equations that could be used by soldiers to estimate body fat without special instruction and without costly equipment (Vogel et al., 19881. As an inter- im (1983-1986) method of body fat measurement, the Army adopted the Durnin-Womersley skinfold equations (Durnin and Womersley, 1974; AR 600-9, 19831. This method required the standardization of measurement procedures by trained medical personnel throughout the Army, using appro- priate equipment (usually Lange calipers). Commanders were distressed by the difficulty of obtaining consistent, accurate skinfold measurements and by the jump in body fat that occurred between certain birthdays for the same sum of skinfold measurements (because of the organization of the table by age intervals). Accordingly, the new method was to use simple measurements and avoid the use of age. The DOD directive noted that this assessment was to be applied only to the high-risk (of obesity) group who failed an initial weight screen. A later amendment to the directive (DOD directive, 1308.1, 1987) also required the services to use a circumference- based method, developed by comparison to hydrostatic weight, which achieved a minimum correlation of 0.85 (neither population, sample size, nor stan- dard error of the estimate were specified). The Army circumference equations were developed from a study in 1984 and 1985 in which 38 anthropometric measurements were obtained

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ORIGINS OF ARMY STANDARDS 51 from an ethnically diverse sample of Army personnel at Fort Hood, Texas and Carlisle Barracks, Pennsylvania, totalling 1,126 men and 266 women (Vogel et al., 1988~. The male equation estimates percent body fat from the difference of the abdominal circumference (at the navel) and the neck circumference, and a height factor is deducted. The female equation uses hip circumference and body weight as components of fatness, with neck, wrist, and forearm circumference and height factors having a lowering ef- fect on estimated percent body fat. Because this was a cross-sectional study, it did not validate the use of the equations to follow individuals over periods of weight loss or body composition change. In fact, there is some question about whether anthropometric equations, in general, can be accu- rately used to follow percent body fat change during weight loss, although they are routinely used this way. Because the development of these equa- tions is discussed and critiqued elsewhere in this book, only a few points will be highlighted here. The Army equations may be reasonably good predictors of total body fat in an ethnically diverse population, but this is difficult to evaluate using percent body fat estimated by hydrostatic weighing, because the latter is so greatly influenced by variations in bone density. There is also a problem in obtaining good hydrostatic weight measurements from nonswimmers who are uncomfortable with performing maximal exhalations under water; Black women were particularly overrepresented in the subpopulation of excluded hydrophobic subjects from the Army Body Composition Study (Vogel et al., 1988~. The method of residual volume determination used in conjunc- tion with hydrostatic weighing may also produce significant differences in estimated body fat, especially for men (Forsyth et al., 1988~. Anthropomet- ric methods may be more equitable than hydrostatic weighing across ethnic and gender groups, although this can only be established using another criterion method. Because circumference measurements necessarily emphasize certain sites, the standards become, in effect, circumference standards instead of total body fat standards. Accordingly, soldiers are not allowed to pick and choose their method of body fat estimation; they are held to Army circum- ference standards. This is reasonable if it can be demonstrated that desired objectives are still achieved using this standard. In fact, the circumference at the navel is a good site selection for men (a) as a marker of fitness, because it is the primary fat storage site in overnourished and underexercis- ing men; (b) as the single fat site most correlated with long-term health risk factors including reduction of HDL-cholesterol, reduced glucose tolerance, and directly with cardiovascular mortality; and (c) as the primary site of concern in appearance (the potbelly). It can also be shown from the data how abdominal circumference increases linearly (in proportion to hip cir- cumference) with hydrostatically estimated percent body fat, although the

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52 KARL E. FRIEDL strength of this relationship is less important if abdominal fat, not total fat, is the best discriminator of military performance objectives. Which site is ideal for women is less certain and there are more sites with more specific physiological roles to consider. Hip circumference appears to be one rea- sonable site as an indicator of fatness and fitness in healthy young women; as a primary site of fat deposition; and, with exercise, as a primary site of fat mobilization. CONCLUSIONS In the frontispiece to their book on human physique, Sheldon et al. (1940) showed photographs of three extremes of somatotype: an endomor- ph, who was characterized by pendulous fat deposits; a mesomorph, who looked well proportioned and muscular; and an ectomorph, who looked like a victim of anorexia nervosa. There can be little argument about which of these three types would make a suitable soldier. Without question, the massively obese endomorph would be unable to perform physically, would fail even the most subjectively lenient standards of military appear- ance, would likely encounter acute as well as long-term health problems as a direct consequence of excess fat, and would suffer miserably with work in even a moderately hot environment. At the other extreme of size, the ectomorph would be unable to carry a normal load on a standard road march task, would likely suffer health problems from extreme deficiency of muscle mass, and would be unable to effectively thermoregulate in a cold environment. The current Army body composition standards ignore the ectomorph, because this soldier is undetected by the height-weight screen- ing tables, even when the soldier is so deficient in fat-free mass that relative body fat is high. This omission is a change from the earlier standards, which emphasized the exclusion of physically weak individuals who would have difficultly with basic soldier tasks. At the upper end, the endomorph is clearly excluded by current Army standards, as are many individuals who may even approach the mesomorph in appearance and physical capabilities. Thus, the second change from previous standards is that current body fat standards draw a precise line, without confidence intervals, for acceptable fatness; these standards take into account neither the strength of the associ- ation between body fat and military performance nor the reliability of the method of estimation. Previously, a physician made the final subjective determination that a soldier was unsuited to the Army because of his or her obesity, but this was subjective and had little impact on offenders of mili- tary appearance. Without this buffer, the arbitrary standards have had a major impact. Thus, it becomes more important to test and carefully adjust body composition standards to performance end points to ensure that good soldiers are not eliminated.

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ORIGINS OF ARMY STANDARDS 53 ACKNOWLEDGMENTS ~ am grateful to the librarians who helped locate the documents cited in this report, especially to Vicki L. Friedl. I am also grateful to Everett Harman for his valuable comments on this manuscript. The documents cited came from four Boston area libraries: the Boston Public Library, the Natick Labs technical library, the Francis A. Countway Library of Medicine (Harvard University), and the documents library of Wellesley College. REFERENCES AR 40-100. 1942. See U.S. War Department. 1942. AR 40-105. 1923. See U.S. War Department. 1923. AR 40-501. 1960. See U.S. Department of the Army. 1960. AR 40-501. 1983. See U.S. Department of the Army. 1983b. AR 600-9. 1976. See U.S. Department of the Army. 1976. AR 600-9. 1983. See U.S. Department of the Army. 1983c. AR 600-9. 1986. See U.S. Department of the Army. 1986. AR 632-1. 1972. See U.S. Department of the Army. 1972. Baxter, J. H. 1875. Statistics, Medical and Anthropological, of the Provost-Marshal-General's Bureau, Derived from Records of the Examination for Military Service in the Armies of the United States During the Late War of the Rebellion, of Over a Million Recruits, Drafted Men, Substitutes, and Enrolled Men. Vol. 1. Washington, D.C.: U.S. Govern- ment Printing Office. Davenport, C. B. 1923. Body-build and its Inheritance. No. 329. Washington, D.C.: Carnegie Institution of Washington. Davenport, C. B., and A. G. Love. 1921. The Medical Department of the United States Army in the World War. Vol. 15. Statistics, pt. 1. Army Anthropology Based on Observations Made on Draft Recruits, 1917-1918, and on Veterans at Demobilization, 1919. Washing- ton, D.C.: U.S. Government Printing Office. DOD directive 1308.1. 1981. See U.S. Department of Defense. 1981. DOD directive 1308.1. 1987. See U.S. Department of Defense. 1987. Durnin, J. V. G. A., and J. Womersley. 1974. Body fat assessed from total body density and its estimation from skinfold thickness: Measurements on 481 men and women aged from 16 to 72 years. Br. J. Nutr. 32:77-97. Fitzgerald, P. I., J. A. Vogel, W. L. Daniels, J. E. Dziados, M. A. Teves, R. P. Mello, and P. J. Reich. 1986. The body composition project: A summary report and descriptive data. Technical Report T5-87, AD A177-679. U.S. Army Research Institute of Environmental Medicine, Natick, Mass. Forsyth, R., M. J. Plyley, and R. J. Shepard. 1988. Residual volume as a tool in body fat prediction. Ann. Nutr. Metab. 32:62-67. Foster, W. B., I. L. Hellman, D. Hesford, and D. G. McPherson. 1967. Physical Standards in World War II. Washington, D.C.: Office of the Surgeon General, Department of the Army. Frassetto, F. 1926. Relations between stature and chest-girth formula of normality and normal values. Proceedings of the National Academy of Sciences 12:583-587. Friedl, K. E., J. A. Vogel, M. W. Bovee, B. H. Jones. 1989. Assessment of body weight standards in male and female Army recruits. Technical Report T15-90, AD-A224 586. U.S. Army Research Institute of Environmental Medicine, Natick, Mass. Gould, B. A. 1869. Investigations in the Military and Anthropological Statistics of American Soldiers. Published for the U.S. Sanitary Commission. New York: Hurd and Houghton.

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54 KARL E. FRIEDL Hooton, E. A. 1959. Body build in a sample of the United States Army. Pt. 1. Body build in relation to military function. Technical Report EP-102, AD-214 177. Quartermaster Re- search and Engineering Center, Natick, Mass. Karpinos, B. D. 1958. Weight-height standards based on World War II experience. Am. Stat. Assoc. J. 53:408-419. Karpinos, B. D. 1961. Current height and weight of youths of military age. Hum. Biol. 33:335- 354. Laurence, M. T. 1985. Development of a methodology for establishing joint service height and weight standards for enlistment. AD-A185 417. Defense Manpower Data Center, Arlington, Va. Laurence, M. T. 1988. Enlistment height/weight standards and attrition from the military. Defense Manpower Data Center, Arlington, Va. Love, A. G., and C. B. Davenport. 1919. Physical Examination of the First Million Draft Recruits: Methods and Results. Bulletin no. 11. War Department, Office of the Surgeon General. Washington, D.C.: U.S. Government Printing Office. Love, A. G., and C. B. Davenport. 1920. Defects Found in Drafted Men: Statistical Informa- tion Compiled from the Draft Records Showing the Physical Condition of the Men Registered and Examined in Pursuance of the Requirements of the Selective-Service Act. War Department. Washington, D.C.: U.S. Government Printing Office. McArdle, W. D., F. I. Katch, and V. L. Katch. 1981. Exercise Physiology: Energy, Nutrition, and Human Performance. Philadelphia: Lea and Febinger. Mobilization Regulation 1-9. 1940. See U.S. War Department. 1940. Myers, D. C., D. L. Gebhardt, C. E. Crump, and E. A. Fleishman. 1984. Validation of the Military Entrance Physical Strength Capacity Test. Technical Report 610. U.S. Army Research Institute for the Behavioral and Social Sciences, Alexandria, Va. Newman, R. W. 1952. The assessment of military personnel by 1912 height-weight standards. Report no. 194. U.S. Army Quartermaster Climatic Research Laboratories, Lawrence, Mass. Ordronaux, J. 1863. Manual of Instructions for Military Surgeons, on the Examination of Recruits and Discharge of Soldiers. D. Van Nostrand, New York, N.Y. Randall, F. E. 1947. Certain considerations of stature-weight relationships of male White Army separatees. Environmental Protection Section Memorandum Report No. 16. U.S. Army Quartermaster Climatic Research Laboratories, Lawrence, Mass. Reed, L. J., and A. G. Love. 1932. Biometric studies on U.S. Army officers: Somatological norms, correlations, and changes with age. Hum. Biol. 4:509-524. Selective Service Regulations, Part VIII. 1917. See U.S. War Department. 1917. Sheldon, W. H., S. S. Stevens, and W. B. Tucker. 1940. The Varieties of Human Physique: An Introduction to Constitutional Psychology. New York: Harper and Brothers. Siri, W. E. 1961. Body composition from fluid spaces and density: Analysis of methods. Pp. 224-244 in Techniques for Measuring Body Composition, J. Brozek and A. Henschel, eds. Washington, D.C.: National Academy of Sciences. Study of the Military Services Physical Fitness. 1981. See U.S. Department of Defense. Office of the Assistant Secretary of Defense for Manpower, Reserve Affairs and Logis- tics. 1981. Surgeon General's Report on Nutrition and Health. 1988. See U.S. Department of Health and Human Services. 1988. Teves, M. A., J. E. Wright, and J. A. Vogel. 1985. Performance on selected candidate screen- ing test procedures before and after Army basic and advanced individual training. Techni- cal Report T13-85. AD-A162 805, U.S. Army Research Institute of Environmental Medi- cine, Natick, Mass. U.S. Congress, House. 1944. Committee on Military Affairs. Report of the Commission of Physicians Appointed to Examine the Requirements for Admission to the Army, Navy,

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ORIGINS OF ARMY STANDARDS 55 and Marine Corps. 78th Congress, 2d session. H.R. 452, Serial Set 10878. February 29. Washington, D.C.: U.S. Government Printing Office. U.S. Department of the Army. 1960. Army Regulation 40-501. "Standards of Medical Fitness." December 5. Washington, D.C. U.S. Department of the Army. 1972. Army Regulation 632-1. "Weight Control." April 13. Washington, D.C. U.S. Department of the Army. 1976. Army Regulation 600-9. "The Army Physical Fitness and Weight Control Program." November 30. Washington, D.C. U.S. Department of the Army. 1983a. Letter 40-83-7, HQDA (DASG-PSP). "Army Medical Department Support of the Army Weight Control Program." April 1. Washington, D.C. U.S. Department of the Army. 1983b. Army Regulation 40-501, Change 34. "Standards of Medical Fitness." December 1. Washington, D.C. U.S. Department of the Army. 1983c. Army Regulation 600-9. "The Army Weight Control Program." February 15. Washington, D.C. U.S. Department of the Army. 1986. Army Regulation 600-9. "The Army Weight Control Program." September 1. Washington, D.C. U.S. Department of the Army. 1988. Message, HQDA (DAPE-MPA). "Accession Height and Weight Standards." September 8. Washington, D.C. U.S. Department of Defense. 1981. Directive 1308.1. "Physical Fitness and Weight Control Programs." June 29. Washington, D.C. U.S. Department of Defense. 1987. Directive 1308.1, Change 1. "Physical Fitness and Weight Control Programs." January 15. Washington, D.C. U.S. Department of Defense. Office of the Assistant Secretary of Defense for Manpower, Reserve Affairs and Logistics. 1981. "Study of the Military Services Physical Fitness." April 3. Washington, D.C. U.S. Department of Health and Human Services. 1988. The Surgeon General's Report on Nutrition and Health. Summary and Recommendations. DHHS (PHS) publication no. 88- 50211. Washington, D.C.: Government Printing Office. U.S. War Department. 1907a. President Theodore Roosevelt's message to the Secretary of War expressing his concern about officer physical fitness, with accompanying orders to imple- ment Army fitness policy. General Orders No. 181, August 30. Washington, D.C. U.S. War Department. 1907b. President Theodore Roosevelt's guidelines to the Secretary of War for an officer physical fitness test, published for Army dissemination. General Or- ders no. 240, December 4. Washington, D.C. U.S. War Department. 1917. Selective Service Regulations, Part VIII. "Physical Examination Standards, No. 3." November. Washington, D.C. U.S. War Department. 1923. Army Regulation 40-105. "Standards of Physical Examination for Entrance into the Regular Army, National Guard, and Organized Reserves." May 29. Washington, D.C. U.S. War Department. 1940. Mobilization Regulation 1-9. "Standards of Physical Examination During Mobilization." August 31. Washington, D.C. U.S. War Department. 1942. Army Regulation 40-100. "Standards of Miscellaneous Physical Examination." November 16. Washington, D.C. Vogel, J. A., J. F. Patton, R. P. Mello, and W. L. Daniels. 1986. An analysis of aerobic capacity in a large United States population. J. Appl. Physiol. 60:494-500. Vogel, J. A., J. W. Kirkpatrick, P. I. Fitzgerald, J. A. Hodgdon, and E. A. Harman.1988. Der- ivation of anthropometry based body fat equations for the Army's weight control pro- gram. Technical Report T17-88, AD-A197 706, U.S. Army Research Institute of Medi- cine, Natick, Mass. Welham W. C., and A. R. Behnke. 1942. The specific gravity of healthy men: Body weight divided by volume and other physical characteristics of exceptional athletes and of naval personnel. J. Am. Med. Assoc. 118:498-501.

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