Best Defense

Thomas E. Ricks' daily take on national security.

Unfit for battle: America’s military is growing tired, injured and overweight

By Jim Gourley Best Defense military health columnist In 2010 the national security organization Mission: Readiness grabbed headlines with a report stating that obesity and other weight-related health conditions were the reason why nearly one-third of American youth were ineligible for military service. Titled "Too Fat to Fight," the report concluded that if American schools ...


By Jim Gourley
Best Defense military health columnist

In 2010 the national security organization Mission: Readiness grabbed headlines with a report stating that obesity and other weight-related health conditions were the reason why nearly one-third of American youth were ineligible for military service. Titled "Too Fat to Fight," the report concluded that if American schools did not reform diet and exercise programs, the diminished pool of recruits might constitute a national security crisis. Though Mission: Readiness released a follow-up report in 2012, changes in American schools have been slow and sporadic, and the growth of obesity in Americans continues apace. During that time, the American military has had to recruit from the available population while facing other extraordinary challenges: continued operations in Afghanistan and the Horn of Africa even as new conflicts develop in Europe and the Middle East, fiscal austerity and emerging threats in west Africa and Asia.

In the meantime, the American national security establishment hasn’t offered much in response to the warnings of Mission: Readiness. Depending on which top Defense Department official you ask, the greatest threats to America’s safety range from the national debt to global warming. Despite the variety of their fears, the majority of these leaders appear to have a common language when they discuss how to keep the military prepared. They speak in terms of maintaining an edge in technological capabilities and a force large enough to respond to multiple simultaneous events around the globe while faced with the crushing effects of tightened budgets. But while the Army, Navy and Air Force have fought tooth and nail to preserve the Ground Combat Vehicle, Littoral Combat Ship, and the F-35, recent events and reports strongly indicate they have neglected what they all proclaim is their greatest weapon: The individual service member.

The most spectacular evidence of increasing health problems within the military was this year’s discovery of the Veterans’ Affairs hospital scandal, in which the death of several patients revealed extraordinary wait times to be seen by VA physicians. A common response among V.A. officials during questioning was that the volume of new beneficiaries had increased exponentially as a result of the wars in Iraq and Afghanistan. Figures indicate that more than 50,000 service members have been wounded in combat since 2001. But combat wounds are not the only injuries sustained by those deployed. A 2013 study by the Watson Institute for International Studies at Brown University estimated that more than 30,000 uniformed personnel were evacuated from theater for disease and/or non-battle injuries between 2001 and 2013. Another study by the Army found that there were 743,547 musculoskeletal injuries among non-deployed active duty soldiers in 2006 alone. The study cited the predominant region of injury to be in the lower spine and joints of the leg and ankle. The Army and Marines have already done significant research concluding that there is a strong correlation between running and such injuries. In a briefing to Congress in 2011, the American Physical Therapy Association presented data indicating that the number of medically retired service members with musculoskeletal injuries had increased ten-fold between 2003 and 2009, and that the VA was paying $500 million annually to treat them. For those who consider this sum a drop in the bucket, another study found that the V.A, issues another $5.5 billion each year in direct payments to veterans whose disabilities are specifically marked as a result of musculoskeletal injuries. This does not account for losses in productivity. It further estimated that musculoskeletal injuries result in 400,000 medical profiles issued each year. One light infantry unit accrued enough to average 7.1 lost or limited duty days per man annually. Add up the real dollar value of those lost duty days, the payouts, x-rays, MRIs, physicians and medications, and there’s possibly enough money on the table to save the entire GCV or LCS programs, or at least buy a few more F-35s.

These non-combat musculoskeletal injuries, especially those due to rigorous physical activity, suggest a diminishing physical fitness within the armed forces. This is exactly what has been documented by the most recent Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel. Its findings on weight management and physical exercise routines among service members are disturbing. Only 35.7 percent of active duty personnel are classified as being a healthy weight. 51.2 percent of uniformed personnel are overweight; 12.4 percent are obese. Responses to the Army survey foreshadow of further problems in the future. Ten percent of service members who responded said that they had to lose between 5-20 pounds just to be eligible to join the military. Yet only 3.2 percent of service members reported they were enrolled in a mandatory weight control program and 90 percent of service members passed their most recent physical fitness test.

This should offer little comfort. When researchers at the Army Physical Fitness School administered the Army’s 1946 version of the physical fitness test to soldiers in 2000, they were surprised by modern soldiers’ abysmal performance. The Defense Department’s survey offers some explanation for this decline in fitness. Less than a third of active duty personnel engage in five hours of moderate physical activity per week. Instead of exercise, many are turning to expensive and sometimes costly surgical procedures to avoid being "flagged" for weight. However successful these procedures are at helping service members pass body fat measurement tests, they do nothing to catalyze the kind of muscular and skeletal adaptations necessary to maintain a body that is resilient against injury during rigorous physical activity.

Maybe the gravest prognostication of emerging threats to the military came from former Defense Secretary Robert Gates in 2011. He said then that health care was "eating the department alive." Yet the Defense Department’s solution to this problem took the opposite approach of a nuts-and-bolts weapons system. Instead of telling Congress of the dire threats that would face America if the budgets did not sustain it like the F-35, military leaders moved to cut costs and force military members to pay increased Tricare fees. At no time was there a discussion of how to make service members healthier such that they didn’t experience problems and require medical care in the first place.

The U.S. armed forces entered wars just as American healthcare researchers began alerting the country that it was reaching a dangerous peak in a 20-year-long trend of declining physical fitness. That trend among American citizens and soldiers continued unabated in fourteen years of combat. The soldiers, sailors, Marines, and airmen of today have some of the most highly advanced personal protective gear and weaponry in the world. But the individual war fighter himself may represent a step backward in development. It’s debatable if he’s as good as his ancestors of 70 years ago. It is incontrovertible that he’s not as trim, strong, fast, or resistant to injury as he could or should be. When asked about the state of protective gear supplied to soldiers in 2004, former Defense Secretary Donald Rumsfeld responded that "you go to war with the army you have." He was widely castigated for that remark. Since then, the military has moved with prodigious effort and expense to improve its weapons and equipment in order to be all it can be before the next war. The military has similarly become all too familiar with the physical toll of war in the last decade, but has been much less agile to adapt the human weapon. Our approach remains to go with what we’ve got, and the figures indicate that what we’ve got is getting progressively worse than what we used to have.

Jim Gourley is an author, journalist, and former military intelligence officer.

Thomas E. Ricks covered the U.S. military from 1991 to 2008 for the Wall Street Journal and then the Washington Post. He can be reached at Twitter: @tomricks1