1
Introduction

The lifting of the combat exclusion rule in 1993 resulted in the opening of large numbers of military occupational specialties previously closed to women. Consequently, the percentage of female active-duty personnel is steadily increasing. As a result of the downsizing of the military (drawdown), the opening of more positions to women, and the increasing frequency of sudden deployment, women in the military must be prepared to perform many types of tasks, both cognitive and physical, under conditions that may, at times, be extremely adverse. According to an Army operations manual, "U.S. Army forces must be prepared to fight and win on short notice anywhere in the world, from blistering deserts to frigid wastelands, in rain forests, tundra, mountains, jungles and swamps, urban sprawl and all types of terrain in between" (FM 100-5, 1993). They must, in short, display readiness. Readiness in military terms encompasses optimum health, fitness, and performance. Military personnel are required to adhere to standards of body composition, fitness, and appearance1 for the purpose of achieving and maintaining readiness.

1  

The appearance standard is a policy enunciated by the Department of Defense (DoD) and shared among, but described slightly differently by, each branch of the Services. According to DoD Directive 1308.1 (1995), "Physical Fitness and Body Fat Programs," "maintaining desirable body composition is an integral part of physical fitness, general health, and military appearance" (p. 1). According to DoD Instruction 1308.3 (1995), the first line of body composition evaluation is by weight/height and appearance. Army Regulation 600-9 (1986) states, for example, that soldiers are to present a physical appearance in uniform ''that is trim and



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--> 1 Introduction The lifting of the combat exclusion rule in 1993 resulted in the opening of large numbers of military occupational specialties previously closed to women. Consequently, the percentage of female active-duty personnel is steadily increasing. As a result of the downsizing of the military (drawdown), the opening of more positions to women, and the increasing frequency of sudden deployment, women in the military must be prepared to perform many types of tasks, both cognitive and physical, under conditions that may, at times, be extremely adverse. According to an Army operations manual, "U.S. Army forces must be prepared to fight and win on short notice anywhere in the world, from blistering deserts to frigid wastelands, in rain forests, tundra, mountains, jungles and swamps, urban sprawl and all types of terrain in between" (FM 100-5, 1993). They must, in short, display readiness. Readiness in military terms encompasses optimum health, fitness, and performance. Military personnel are required to adhere to standards of body composition, fitness, and appearance1 for the purpose of achieving and maintaining readiness. 1   The appearance standard is a policy enunciated by the Department of Defense (DoD) and shared among, but described slightly differently by, each branch of the Services. According to DoD Directive 1308.1 (1995), "Physical Fitness and Body Fat Programs," "maintaining desirable body composition is an integral part of physical fitness, general health, and military appearance" (p. 1). According to DoD Instruction 1308.3 (1995), the first line of body composition evaluation is by weight/height and appearance. Army Regulation 600-9 (1986) states, for example, that soldiers are to present a physical appearance in uniform ''that is trim and

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--> The purpose of this report, prepared under a grant from the Defense Women's Health Research Program, is to examine whether the present standards for body composition, fitness and appearance support readiness by ensuring optimal health and performance of active-duty women. In 1992, the Committee for Military Nutrition Research (CMNR) of the Institute of Medicine (IOM) released a report concluding that the standards of body composition required for women to achieve an appearance goal seemed to conflict with those necessary to perform many types of military tasks (IOM, 1992). The committee recommended that body composition standards be based primarily on considerations of task performance and health and that they be validated with regard to the ethnic diversity of the military. In addition, the committee recommended that task-specific performance tests be developed; that appearance standards, if deemed necessary, be made objective; and that research be conducted on the relationships among body composition, health, and physical performance of military personnel, as well as on the long-term outcome of individuals referred to military weight management programs for failure to adhere to standards. Committee Charge With the current report, a subcommittee of the CMNR, the Committee on Body Composition, Nutrition, and Health of Military Women (BCNH committee), reexamined these issues, focusing specifically on active-duty women. In light of recent efforts to consider creation of Department of Defense (DoD)-wide fitness and body composition standards (Personal communication, LTC K. E. Friedl, U.S. Army Medical Research and Materiel Command, Fort Detrick, Frederick, Md., 1997), calls to ensure that personnel are physically able to perform the tasks to which they are assigned, and evidence suggesting that efforts to adhere to body composition and appearance standards may place active-duty women at special risk for inadequate nutrient intake, the subcommittee undertook to respond to the following questions posed by the Army:  What body composition standards best serve military women's health and fitness with respect to minimum lean body mass, maximum body fat, and site specificity of fat deposition? Are the appearance goals of the military in conflict with military readiness?     smart," one of the two goals of weight control. The regulation goes on to qualify the standard by emphasizing that enlarged waistlines, "potbellies," detract from good military appearance. No objective criteria (rating scales) have been associated with the appearance standard as it is enforced. (This is discussed further in Chapters 2 and 3). Only a small number of studies have examined how the appearance standard as enforced is linked to body composition. Although appearance is slightly associated with body fat, it is associated more significantly with abdominal circumference (AR 600-9, 1986; Hodgdon et al., 1990; Vogel and Friedl, 1992). Although Army, Navy, and Marine Corps personnel must supply recent photos of themselves to their selection (promotion) boards (this practice has been eliminated by the Air Force and de-emphasized by the Navy), appearance judgments can be rendered at any time. When these involve a suspicion of overweight (as opposed to untidy uniforms or other details of appearance), the individual must be weighed and may be required to have a body fat determination, and if necessary, to enter the weight management program (with attendant career consequences).

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-->  Should any part of the Military Recommended Dietary Allowances be further adjusted for women? Should there be any intervention for active-duty women with respect to food provided, dietary supplementation, or education?  What special guidance should be offered with respect to return-to-duty standards and nutrition for women who are pregnant or breastfeeding? The current body composition and fitness standards of the four service branches (see Appendix B) were examined in light of research exploring the relationships among body composition, fitness, performance, and health. Body composition assessment methodologies used by the military were examined with regard to the demographics of active-duty women and recent advances in assessment technology. In response to one of the major recommendations of the earlier IOM report (1992), fitness and performance testing methods currently in use by municipal police and firefighting services, other government agencies, and the Canadian Forces were explored. To investigate the implications of meeting the body composition and appearance standards for women, the military weight management programs and dieting practices were examined and compared with civilian programs and practices. The potential health risks of chronic dieting were discussed in light of the high level of performance expected of military personnel. In addition, the subcommittee examined the risk of nutrient inadequacy that may result from women's need to maintain weight while consuming military rations or dining hall meals, assessed the implications of the average military woman's activity level for acquisition of adequate nutrients, and noted areas where further research is needed. Finally, the impact of current policies regarding the time allotted to women postpartum to comply with body composition standards and pass their fitness tests was discussed with respect to the effect of exercise during pregnancy on pregnancy weight gain and loss, pregnancy outcome, and lactation. Demographic Description Of Active-Duty Military Women As shown in Table 1-1, nearly 200,000 women serve on active duty in the Army, Navy, Marine Corps, and Air Force today, comprising 12 to 16 percent of the enlisted and officer personnel (data provided by personal communication with DoD contacts in the Defense Manpower Data Center, Rosslyn, Va.). Of the women serving on active duty, 83 percent are in the enlisted corps, 1 percent are warrant officers, and 16 percent are commissioned officers; this age distribution by rank is similar to that for male personnel. Approximately 36 percent of these women serve in the Army, 33 percent in the Air Force, 27 percent in the Navy, and 4 percent in the Marine Corps (Bray et al., 1995). The age distribution of active-duty women is shown in Table 1-2. While the majority of enlisted women are under the age of 25, the majority of officers are over the age of 25. Because of the much greater representation of enlisted women in the services, however, the vast majority of active-duty women are 25 or younger.

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--> TABLE 1-1 Number of Women Serving on Active Duty in the Department of Defense (DoD) as of September 30, 1996 Branch of Service Enlisted Warrant Officer Commissioned Officer DoD (total) Army 58,069 661 9,865 68,595 Air Force 52,128 0* 12,047 64,175 Navy 43,240 121 7,748 51,109 Marine Corps 7,821 125 625 8,571 DoD (total) 161,258 907 30,285 192,450 NOTE: Enlisted, pay grades E1 to E9; warrant officer, pay grades W1 to W5; commissioned officer, pay grades O1 to O11. * The Air Force does not have personnel classified as warrant officers. SOURCE: Defense Manpower Data Center (Rosslyn, Va., 1996). TABLE 1-2 Percentage of Women in the U.S. Armed Forces by Rank and Age as of September 30, 1996 Rank Age (years) Number Percentage Enlisted Unknown 22 0.01   17–25 87,859 54.48   26–40 67,350 41.77   41–65 6,027 3.74   Total 161,258 100.0 Warrant officers* Unknown 0 0   17–25 21 2.32   26–40 706 77.84   41–65 180 19.85   Total 907 100.0 Commissioned officers Unknown 76 0.25   17–25 4,843 15.99   26–40 19,726 65.13   41–54 5,640 18.62   Total 30,285 100.0 * The Air Force does not have personnel classified as warrant officers. SOURCE: Defense Manpower Data Center (Rosslyn, Va., 1996).

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--> The educational achievement of active-duty men and women is shown in Tables 1-3A and 1-3B. All active-duty service personnel are expected to have a high school graduation certificate or its equivalent; commissioning requires additional educational achievement. The range of educational achievement for active-duty women is extremely wide. With the exception of Marine Corps officers, women's educational attainment is equal to or better than that of their male counterparts in all services and ranks. Across the services, ethnic minorities represent approximately 40 percent of active-duty women (Table 1-4). More complete data on the ethnic distribution of active-duty women are presented in Table 2-2. Data on the marital status and parity of active-duty women are presented in Chapter 6. TABLE 1-3A Educational Attainment of Active-Duty Men in the U.S. Military Branch of Service Rank Unknown No High School High School Graduate Some College BA/BS+ Other Army Enlisted 11.2 0.2 78.7 6.3 3.5 0.0   Officer 4.3 0.0 3.4 5.0 87.2 0.0 Air Force Enlisted 0.6 0.0 18.1 76.2 4.9 0.2   Officer 1.0 0.0 0.0 0.4 98.6 0.0 Marine Corps Enlisted 0.0 0.1 94.6 1.4 1.2 2.6   Officer 0.3 0.1 10.2 1.7 86.7 1.0 Navy Enlisted 0.4 2.3 91.1 2.0 2.7 1.5   Officer 8.8 0.0 5.1 1.8 84.2 0.0 TABLE 1-3B Educational Attainment of Active-Duty Women in the U.S. Military Branch of Service Rank Unknown No High School High School Graduate Some College BA/BS+ Other Army Enlisted 14.8 0.2 70.7 9.0 5.3 0.0   Officer 3.1 0.0 1.6 2.5 92.9 0.0 Air Force Enlisted 0.7 0.0 26.1 67.9 5.1 0.1   Officer 1.5 0.0 0.0 0.8 97.7 0.0 Marine Corps Enlisted 0.3 0.0 91.9 2.9 2.7 2.2   Officer 0.1 0.3 13.8 2.0 83.2 0.5 Navy Enlisted 0.4 0.4 92.8 2.9 3.1 1.0   Officer 9.0 0.0 2.8 1.8 86.4 0.0 NOTE: Highest level of education completed, expressed as percent of total number in rank and service, as of June 1997. SOURCE: Defense Manpower Data Center (Rosslyn, Va., 1997).

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--> TABLE 1-4 Percentages of Minority* Active-Duty Women in the U.S. Military by Service, Age, and Rank as of September 30, 1996 Service/Age (years) Enlisted (%) Warrant Officers† (%) Commissioned Officers (%) Army 17–25 54 10 24 26–40 66 46 31 41–65 63 37 28 Navy 17–25 45 0 22 26–40 44 27 20 41–65 33 16 14 Marine Corps 17–25 40   14 26–40 49 34 15 41–65 45 24 9 Air Force 17–25 31   18 26–40 36   18 41–65 40   19 * According to IOM (1995), approximately 75% of minority women in the military identify themselves as African American, 12.5% as Hispanic, 6.25% as Asian-American/Pacific Island, and 3.75% as Native American or other. These breakdowns were not available for individual branches of service. † Warrant officers are a group of enlisted personnel who hold positions requiring highly specialized technical skills, but who are not commissioned officers. The Air Force does not have personnel classified as warrant officers. The Army, Navy, and Marine Corps are eliminating this category of jobs. SOURCE: Defense Manpower Data Center (Rosslyn, Va., 1996). Methods And Resources Used For The Report To help gather information, the BCNH committee, in consultation with a liaison panel of military researchers and health care personnel, convened a workshop of additional military personnel and civilian researchers and practitioners in the areas of physical fitness and performance, nutrition, and pregnancy. The proceedings of this workshop, summarized in Appendix A, helped to focus the questions originally provided by the Army.

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--> Drawing on the presentations at the workshop, background materials provided, and the expertise of the subcommittee, staff and National Academy of Sciences librarians searched the bibliographic databases Medline, Psychlit, Sport, National Technical Information Service (NTIS), and Defense Research On-line System (DROLS)/Defense Technical Information Center (DTIC) Work Unit and Technical Report (see Appendix D) for the years 1991–1996, inclusive. (The 1995 IOM report, Recommendations for Research on the Health of Military Women, and the 1992 IOM report, Body Composition and Physical Performance, which contained extensive bibliographies of earlier reference materials, were also used.) The goal of the searches was to capture both civilian and military research relevant to the main issues. The strategy used for the literature searches is described in Appendix D. Additional references and information were provided by searches of the General Accounting Office database and the World Wide Web, as well as by consultation with the military liaison panel; with individuals at the Pentagon, San Diego Naval Health Research Center, U.S. Army Research Laboratory, U.S. Army Center for Health Promotion and Preventive Medicine, U.S. Army Research Institute of Environmental Medicine, and U.S. Army Medical Research and Materiel Command; and with attendees at a symposium on Women in Uniform sponsored by the Women's Research and Education Institute. Finally, a sample of municipal firefighting and police services, as well as the U.S. Park Service and Forestry Service, Federal Bureau of Investigation, Drug Enforcement Agency, and the U.S. Marshals were contacted (see Appendix E) to obtain information on their body composition, fitness, and performance testing, as well as pregnancy policies. The multiple strategies used to gather reference material provided the committee with a wide array of information upon which to draw in formulating its conclusions. In selecting research reports for review, every attempt was made to include only those that demonstrated use of the highest quality study design. However, because of the limited availability of published research in a number of areas, particularly research of relevance to the military, a decision was made to include all available reports in such areas and to discuss the limitations of the work, where appropriate. References AR (Army Regulation) 600-9. 1986. See U.S. Department of the Army, 1986. Bray, R.M., L.A. Kroutil, S.C. Wheeless, M.E. Marsden, S.L. Bailey, J.A. Fairbank, and T.C. Harford. 1995. Health behavior and health promotion. Department of Defense Survey of Health-Related Behaviors among Military Personnel. Report No. RTI/6019/06-FR. Research Triangle Park, N.C.: Research Triangle Institute. DoD (Department of Defense) Directive 1308.1. 1995. See U.S. Department of Defense, 1995. DoD (Department of Defense) Instruction 1308.3. 1995. See U.S. Department of Defense, 1995. FM (Field Manual) 100-5. 1993. See U.S. Department of the Army, 1993. Hodgdon, J.A., P.I. Fitzgerald, and J.A. Vogel. 1990. Relationships between body fat and appearance ratings of U.S. soldiers. Report No. 90-01. San Diego, Calif.: Naval Health Research Center. IOM (Institute of Medicine). 1992. Body Composition and Physical Performance, Applications for the Military Services, B.M. Marriott and J. Grumstrup-Scott, eds. Committee on Military Nutrition Research, Food and Nutrition Board, Institute of Medicine. Washington, D.C.: National Academy Press. IOM (Institute of Medicine). 1995. Recommendations for Research on the Health of Military Women. Committee on Defense Women's Health Research. Washington, D.C.: National Academy Press.

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--> U.S. Department of Defense. 1995. Department of Defense Directive 1308.1. "Physical Fitness and Body Fat Programs." July 20. Washington, D.C. U.S. Department of Defense. 1995. Department of Defense Instruction 1308.3. "Physical Fitness and Body Fat Programs Procedures." August 30. 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. 1993. Field Manual 100-5. "Operations." June 14. Washington, D.C. Vogel, J. A., and K. E. Friedl. 1992. Army data: Body composition and physical capacity. Pp. 89–103 in Body Composition and Physical Performance, Applications for the Military Services, B. M. Marriott and J. Grumstrup-Scott, eds. Committee on Military Nutrition Research, Food and Nutrition Board, Institute of Medicine. Washington, D.C.: National Academy Press.