fat per month or a weight loss of 3 lb per month for a woman) may be subject to increasingly severe administrative actions, culminating in discharge or separation, as described in Air Force Instruction 40-502 (1994).

Navy and Marine Corps

The Navy Weight Loss Program is described in Naval Operations Instruction 6110.1D (1990), "The Physical Readiness Program." Commanding officers are responsible for providing a conditioning program comprising fitness and nutrition education. The program is administered by certified fitness counselors. Navy and Marine Corps personnel undergo weighing every 6 months in conjunction with the physical readiness test (PRT). Those individuals who exceed the gender- and height-specific weight standards (Navy standards are not age specific) are subject to circumferential measurement. Those whose body fat exceeds the 30 percent standard may be referred to a counseling and assistance center rehabilitation program. Prior to 1995, this program comprised three tiers. Level I consisted of a command-directed, remedial, physical conditioning program lasting approximately 6 months and sometimes incorporating nutrition education and other elements; failure to progress in Level I resulted in assignment to Level II, which consisted of a 2- to 6-wk intense outpatient weight management counseling program. Level III was a 4- to 6-wk inpatient obesity treatment program and required a diagnosis of "compulsive overeating" (not recognized by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV] or Naval Bureau of Medicine) for entry. In 1995, Level III was eliminated, because it was felt that the majority of overweight personnel need education rather than inpatient treatment and because the criterion for entry was not a true diagnosis. In 1996, a 2-wk outpatient weight management program was adopted, focusing on nutrition education and lifestyle behavior changes. The command-directed physical conditioning program consists of mandatory exercise sessions with regular monitoring of the individual's body composition; it is designed to motivate the development of regular exercise habits.

The Navy Weight Loss Program now relies on the "Navy Nutrition and Weight Control Self-Study Guide: Forge the Future" (NAVPERS 15602A, 1996), which was developed to be the principal tool to enable service personnel to improve individual health and fitness. The study guide is used in conjunction with the command's physical conditioning program by every member of the Navy who exceeds body fat standards. The study guide was prepared by Navy personnel, including physicians, nurses, and registered dietitians. This guide provides an overview of nutrition, behavior modification, and exercise and includes recommended readings and references. The weight loss diet is based primarily on decreasing the dietary intake of fat and increasing the dietary intake of fiber from grains, fruits, and vegetables.

Outcome Assessment for Military Weight Management Programs

None of the military nutrition or personnel professionals contacted were able to identify any research to determine the availability of nutritionally trained health care professionals, the uniformity in implementation of weight control programs, or outcomes of these programs at military sites around the world. Data were not available on the numbers of individuals who were



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