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Assessing Readiness in Military Women
U.S. military personnel are required to adhere to standards of body composition, fitness, and appearance for the purpose of achieving and maintaining readiness. Military readiness, while encompassing many factors, can be defined briefly as maintenance of optimum health and performance so that deployment can occur at any moment.
In 1992, the Committee on Military Nutrition Research was asked by the U.S. Army to evaluate the body composition and fitness standards for personnel accession and retention in all branches of active service, with regard to the impact of these standards on recruitment, physical fitness, and task performance in the Armed Forces. After conducting a workshop to investigate these issues, the CMNR released a report concluding that the standards of body composition required for women to achieve the desired appearance goal (low fat-free mass [FFM] and percent body fat) seemed to conflict with those necessary for performance of many types of military tasks (higher FFM often accompanied by increased body fat) (IOM, 1992a). 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 population. In addition, the committee recommended the development of task-specific performance tests; development of objective appearance standards, if these were deemed necessary; and continuation of research on the relationships among body composition, health, and physical performance of military personnel. Also recommended was evaluation of the long-term outcome of individuals referred to military weight management programs for failure to adhere to standards.
At the autumn 1994 conference of the Defense Advisory Committee for Women in the Service (DACOWITS), one of the concerns identified by the group was the need to address the body composition and physical fitness
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standards of the military and the impact of these standards on the health of women, particularly with regard to the potential influence of the standards on food intake and nutritional status. A report, released by the IOM in 1995, which provided recommendations for research on the health of military women identified a number of gaps in research pertaining to the health and performance of military women. These included research on optimal physical fitness for military women, injury prevention, and ways to achieve and assess physical fitness, as well as fitness standards, including those for fitness during pregnancy and the postpartum period.
In 1995, in light of efforts to consider creation of DoD-wide fitness and body composition standards, calls to ensure that all personnel are physically able to perform their assigned tasks, and evidence suggesting that attempts to adhere to body composition and appearance standards may place active-duty women at special risk for inadequate nutrient intake, the CMNR was asked to appoint a subcommittee to examine issues of body composition, fitness, and appearance standards and their impact on the health, nutritional status, and performance of active-duty military women. Specifically, they were asked by the Army to address the following questions:
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?
Should any part of the Military Recommended Dietary Allowances (MRDAs) 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?
In April 1996, the CMNR convened a subcommittee comprising experts in the areas of body composition, exercise physiology, obesity, women's nutrition, epidemiology and survey design, cognitive psychology, and pregnancy and lactation. Several members of the parent committee were included to provide continuity. The subcommittee was designated the Subcommittee on Body Composition, Nutrition, and Health of Military Women (BCNH).
In considering the questions posed by the military, the subcommittee consulted with a liaison panel composed of military researchers and health care personnel. A workshop was convened in September 1996 to bring together additional military personnel in the areas of physical fitness assessment, training, medicine, and nutrition, as well as civilian researchers and practitioners in the areas of physical fitness and performance, pregnancy, eating disorder assessment, and nutrition.
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Conclusions and Recommendations
On the basis of the workshop presentations, review of the relevant scientific literature and current military policies the BCNH subcommittee concluded that while the DoD maximum body fat for women is 36 percent, each service sets its own (lower) standards; thus personnel who are out of compliance in their own service may be within the standards of another service. Agreement is poor among results of the service-specific equations used to calculate percent body fat, and in addition, validation of the equations has been called into question because the population used for validation diverges significantly in ethnic profile from that of today's military.
Fitness is assessed by the military coincident with, but independent of, body composition. Data suggests that significant numbers of younger personnel cannot pass the fitness tests. Efforts to show a relationship between body composition and fitness among military women have reached the conclusion that women who are judged to be out of standard with respect to body fat perform better in tests of strength than women who are within the body fat standards. Thus the current body composition assessment procedures may select against retention of those who may be most capable of performing the tasks necessary for military operations while selecting in favor of those who fit an appearance standard.
A summary of the subcommittee's key recommendations are:
Incorporate the use of body mass index (BMI) and fitness assessment into the current two-tier body composition assessment procedures used to determine compliance with body composition standards (first tier, weight-for-height; second tier, body fat assessment).
Set the maximum allowable BMI at 25, based on considerations of health and chronic disease, with a maximum body fat of 36 percent if fitness test is passed.
Develop and validate a single, service-wide, circumferential equation for the assessment of women's body fat.
Develop task specific, gender-neutral strength and endurance tests and standards for use in the determination of placement in military occupational specialties that require moderate and heavy lifting.
Encourage military women to achieve and maintain healthy weights through a continuous exercise and fitness program, and provide nutrition education and ongoing counseling if weight loss is a goal.
Reinforce efforts to provide complete nutritional labeling of all operational ration components and to design ration components that concentrate the nutrients that may be limiting in women's diets.
Encourage women to engage in a moderate exercise program during pregnancy when medically feasible.
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Set the time allowance for postpartum fitness testing at 180 days, and extend exemption from deployment to 6 months.
Endorse the 1990 Institute of Medicine guidelines for gestational weight gain, and extend the time allowance for attainment of body weight standards to 1 year when satisfactory progress is being made.
Redesign surveys to link demographic and personnel information to medical and health information.
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The committee's responses to the questions, conclusions, and recommendations from this report are included in Appendix I.
Representative terms from entire chapter:
body fat
