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Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
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2

Mission: Readiness

For the workshop’s keynote address, the planning committee invited an unexpected but welcome new ally with an interest in reducing obesity. Mission: Readiness1 is a national security nonprofit, nonpartisan organization of more than 250 senior retired military leaders founded in 2008 to ensure continued American security and prosperity by calling for smart investments in American children. The organization has identified childhood obesity as an issue that could adversely affect the future strength of America’s military. Military strength often is measured in terms of ships, tanks, and weapons systems. But “the most important asset in our military is and always will be the person in uniform,” announced retired Rear Admiral James “Jamie” A. Barnett, Jr. With that emphasis, Barnett shared from a military leadership perspective how the childhood obesity epidemic is seen as a threat to national security.

Barnett serves on the Executive Advisory Council of Mission: Readiness. The goal of the organization is not to steer young people into military service, said Barnett. It is to provide all young Americans with a full range of career opportunities, which may include service to the nation.

In 2009, Mission: Readiness released a report on what Barnett called a “shocking reality”: according to Department of Defense (DoD) data, an estimated 75 percent of all Americans between the ages of 17 and 24 are unable to join the military for three reasons: (1) they lack a high school diploma, (2) they have a criminal record, or (3) they are physically unfit (Mission: Readiness, 2009). “Military service is now out of reach for mil-

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1For more information on Mission: Readiness, see http://www.missionreadiness.org/.

Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
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lions of Americans,” said Barnett, and Mission: Readiness is “troubled by the likely impact this will have on our future military preparedness and on the success of our upcoming generation.”

TOO FAT TO FIGHT

Barnett shared evidence that obesity is “inexorably linked” to America’s future military strength. Obesity is the leading medical reason why applicants fail to qualify for military service, he said. Approximately one in four young Americans is too overweight to join, and between 1995 and 2008, the military turned away more than 140,000 otherwise qualified recruits for being overweight (Mission: Readiness, 2010; Niebuhr et al., 2010). In addition, approximately 1,200 enlisted members must leave the military every year because of their weight, at an estimated cost of $61 million (Dall et al., 2007).

Beyond its effect on recruitment and retention, obesity imposes a significant financial burden on the military for medical care. DoD spends about $1.1 billion annually on medical care associated with excess weight and obesity for active-duty personnel, their dependents, and veterans (Dall et al., 2007).

The lack of physical fitness that often accompanies obesity also has a negative effect on military readiness. Today’s recruits have the highest body mass indexes (BMIs) on record, Barnett stated. As a result of the shrinking number of young people eligible for service, the military has created waivers for slightly overweight young adults who can pass the fitness test. These heavier recruits are 47 percent more likely to have a sprain, a stress fracture, or some other overuse injury than those who are not overweight (Cowan et al., 2011). These types of injuries can force recruits to repeat boot camp or leave the military altogether. These injuries also are responsible for almost one-quarter of all medical evacuations from Iraq and Afghanistan to medical facilities in Germany, compared with 14 percent of medical evacuations due to combat injuries (Cohen et al., 2010). In other words, said Barnett, “soldiers are 71 percent more likely to be evacuated out of Iraq or Afghanistan for a serious sprain or stress fracture than they are for a combat wound.”

CHANGING FOOD INTAKE

DoD has identified obesity, particularly childhood obesity, as a major issue for the military and has begun taking steps to remedy the problem

Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
×

in its own installations. It has formed a childhood obesity working group2 that is considering changes to military bases, school menus, and the general environment designed to encourage more physical activity in children. Half of youth in military families join or consider joining the military, so addressing the problem begins with the families of active-duty personnel. Military officials are leading an effort to create standardized menus for child development centers to ensure that the centers are meeting children’s nutritional needs. DoD also is working to offer more healthy choices in vending machines, schools, dining facilities, its clubs, and other on-base locations that offer food.

The civilian sector can help the military solve the obesity problem by considering a range of options to combat childhood obesity, said Barnett. Schools are a good place to start, he suggested. Children may consume more than half of their daily calories during school hours, so improving the nutritional value of the foods and beverages served in schools can have a major effect on health (IOM, 2010).

Barnett pointed out that the military’s interest in school nutrition is not new. During World War II, 40 percent of rejected recruits were turned away for reasons related to poor nutrition (U.S. Congress, 1945). That issue became an important part of the conversation after the war when Congress established the National School Lunch Program. “Today we face a similar crisis and threat to our national security interest,” said Barnett.

Mission: Readiness strongly supported the Healthy, Hunger-Free Kids Act of 2010,3 which provided a framework for changing the foods that are served and sold in schools. One provision of the act gave the U.S. Department of Agriculture (USDA) the authority to update 15-year-old nutritional standards for school breakfasts and lunches to reflect the latest science on the subject. In turn, USDA’s proposed guidelines adhere closely to recommendations made by the Institute of Medicine to improve the nutritional quality of school meals (IOM, 2007, 2010).4

Barnett stressed that schools need the proper support to meet these higher nutritional standards. Many schools across the country lack the kitchen equipment needed for healthier cooking methods. For example, many school cafeterias still use antiquated ovens and deep fat fryers, and too few have salad bars. School food service employees need to be trained in

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2For more information on the DoD childhood obesity working group, see http://www.defense.gov/news/newsarticle.aspx?id=62753.

3Healthy, Hunger-Free Kids Act of 2010, Public Law 111-296, 111th Cong. (December 13, 2010).

4In the months following the workshop, Congress voted on an agriculture spending bill (Consolidated and Further Continuing Appropriations, 2012, H.R. 2112, 112th Cong., 1st Session, November 1, 2011) that limits USDA’s use of funds to carry out some of the proposed revisions.

Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
×

healthy food preparation techniques. The need for equipment and training is well documented, Barnett observed. The last time Congress appropriated funds for equipment assistance grants, school districts around the country submitted almost five times as many requests as could be funded.

IMPROVING FITNESS

Maintaining a healthy weight requires exercise in combination with a proper diet. In particular, regular exercise from an early age can help young people improve their fitness and control their weight. Being physically active and maintaining a healthy weight also reduce the risk of injuries.

In addition to its work to get unhealthy foods out of schools, Mission: Readiness is promoting opportunities to get physical activity back into schools. Years, not months, are needed to build a strong body, Barnett emphasized, and the foundation for good fitness is laid in childhood and young adulthood, not right before a recruit reports to boot camp. Surveys show that parents overwhelmingly agree on the importance of providing opportunities for physical fitness in school, but parents currently have no standardized way of obtaining information on how much physical education their children are receiving. Enhanced reporting from schools on the quality and quantity of physical education would empower parents to decide whether their districts are doing enough to combat childhood obesity, Barnett said.

INVESTING FOR THE FUTURE

Investments need to be made up front to ensure the health of future generations, Barnett concluded. The military, businesses, communities, and individuals will pay the price of having too many young adults unprepared to do the work of the nation. “We all share responsibility, as parents, citizens, and leaders,” he said, “to make sure that our children are fit and healthy.”

Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
×
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Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
×
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Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
×
Page 9
Suggested Citation:"2 Mission: Readiness." Institute of Medicine. 2012. Alliances for Obesity Prevention: Finding Common Ground: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/13305.
×
Page 10
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Many organizations are making focused efforts to prevent obesity. To achieve their goals, accelerate their progress, and sustain their success, the assistance of many other individuals and groups--not all of them with a singular focus on obesity prevention--will be essential. In October 2011 the Institute of Medicine held a workshop that provided an opportunity for obesity prevention groups to hear from and hold discussions with many of these potential allies in obesity prevention. They explored common ground for joint activities and mutual successes and lessons learned from efforts at aligning diverse groups with goals in common.

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