Assessing Readiness in Military Women The Relationship of Body, Composition, Nutrition, and Health (1998) / Chapter Skim
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A Workshop Summary, Agenda, Participants, and Abstracts
A Workshop Summary, Agenda, Participants, and Abstracts
Pages 173-252
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held a workshop in Irvine, California, on September 9-10, 1996, entitled "Assessing Readiness in Military Women: The Relationship to Nutrition." The purpose of the workshop was to gather information from military personnel and civilian researchers on issues related to body composition, fitness, nutrition, and pregnancy as they pertained to active-duty servicewomen and to identify areas where further research is needed. This is a brief summary of the data presented and issues discussed.
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. Although the majority of women still occupy support, administrative, and health care roles, more and more military women are accepting assignments to physically demanding jobs.
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Military Active-Duty Women Quoted by Speakers at the Workshop Speaker Survey Cited Sample Drake Eating Disorders Inventory U.S. Naval Academy cadets Baker-Fulco Total Army Injury and Health Army active-duty personnel Outcomes Database Baker-Fulco, King Eating Attitudes Feelings and Selected Army personnel Behavior Study Baker-Fulco, King Army Food and Nutrition Survey Selected Army personnel Baker-Fulco; King Brief study-unique questionnaires Selected Army personnel, U.S.
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FriedI, USA (1996) , the origin of military body fat standards can be traced to a report on the physical fitness of the services (DoD, 1981)
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A 1995 update of the original directive (DoDD 1308.1, "Physical Fitness and Body Fat Programs") now states that the maximum allowable limit for men is 26 percent and for women 36 percent, although each service maintains its own standards.
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measurements, particularly for assessment of body fat loss or change in women. He also recommended more research on the time course and magnitude of changes in postpartum body composition and on the possibility that a lower minimal limit of body weight be set for women, in response to evidence that Tower-weight women are at a significantly greater risk for early attrition.
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These self-reported data show clearly that female soldiers experience more difficulty meeting the weight standards than do male soldiers and that the higher ranked officers and enlisted women experience the greatest difficulyv. ~ a, , As age increased, the difficulty for both men and women increased, but a greater percentage of female soldiers self-reported difficulty in meeting weight standards than did older male soldiers (Table A-21.
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, 47 percent of the sample perceived themselves as overweight, and 60 percent were aTrempl1ng to lose weight. more non-~;aucastans Earl Caucasians exceeded the body fat standard, yet there was no difference in the percentages who were trying to lose weight.
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The goal of the study was to provide baseline anthropometric and strength characteristics and blood pressure. The most significant finding of this study was that, according to self-report, 46 percent of Navy women exceed the 30 percent body fat standard.
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also described two additional studies comparing circumference-based percentage body fat assessment with hydrostatic weighing or DXA (Beckett and Hodgdon, ~ 987; Jette et al., ~ 9901. These studies indicated that anthropometrically based classification of body fat in military women is not significantly better than BMI.
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Army Physical Fitness School at Fort Benning, Georgia. Each year, this school trains 2,000 to 3,000 trainers who then work with the troops to assist them in developing ongoing, personal, physical fitness programs.
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Although the pass rate is 92 percent, Hernandez presented data showing the number of individuals who were separated from the Navy in 1995 due to repeated failure to pass the PRT (either the body fat portion or the PRT) : 494 enlisted personnel and ~ officer.
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Several of the workshop presentations indicated that a significant proportion of military women report dissatisfaction with their current body weight and a desire, as well as attempts, to lose weight. Thus, the survey data discussed at the workshop suggested a high prevalence of behavior aimed at meeting appearance and body weight standards; this behavior might affect overall nutritional status.
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suggested that field conditions, extreme environment, and type of ration served all contributed to the Tower food intake. In addition, it was noted in the workshop discussion that some military personnel desire to lose weight during field operations and may restrict food intake during this period.
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, in an overview of eating disorders among military women, emphasized that eating disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-TV, 1994) are uncommon in the military.
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First, he emphasized the presence of many known risk factors for eating disorders among the military population: gender, restrictive dieting, weight and shape dissatisfaction, the crucial role of appearance in judgments of readiness, and prior history of weight problems. He cited the following observations as bases for his recommendation that the body weight and appearance standards should give way to performance-based standards: apparent lack of strong association between body weight and physical performance (fitness)
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The difficulty in meeting calcium requirements from military rations as well as reports of stress fractures among young military women have raised concerns about bone health. COL Bruce H
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Small increments in weight loss are not associated with loss of total body BMD in adult women. However, larger increments in body weight loss are associated with loss of BMD.
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Stress Fracture Risk The factors just described are important for bone health of all women, regardless of whether they are in the military. Specific questions about bone health for female military personnel have focused on the potential impact of training activities as well as actions taken by women to remain in compliance with body weight and body composition standards.
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, the curve is ~ shaped, with a small increase in risk for those with the fastest times and increasing risk for those with slower run times. Neither body fat nor BM} show strong associations with stress fracture risk in this population.
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A study by Sandstead and coworkers to determine the impact of zinc supplementation, with or without iron or other micronutrients, on neuropsychological function in healthy women aged ~ 9 to 40 years is currently under way. In summary, results from a number of surveys of eating practices and preferences among military personnel show that active-duty women are concerned about body weight: prefer fruits and vegetables to meats and dairy foods, but are no more likely to consume them than are men; and frequently skip meals.
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Military Women (%) Army Navy Marine Corps Air Force Total DoD Never been pregnant 37.5 44.6 38.4 41.7 40.9 May currently be pregnant 2.2 1.4 0.9 0.9 1.5 Pregnant in the past year 17.4 16.4 21.6 19.2 18.0 Pregnant in the pest 1-2 years 7.7 6.7 8.4 7.3 7.3 Pregnant in the past 2-5 years 13.2 13.1 14.8 12.6 13.0 Pregnant more than 5 years ago 22.0 17.8 15.7 18.2 19.3 SOURCE: Szl~vey of Health-Related Behaviors among Military Personnel (Bray et al., 1995)
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About 3 percent of pregnant military women drank several times a month or more often. About 84 percent of military women who were pregnant in the past 5 years reported no cigarette use during their most recent pregnancy, about 16 percent reported some cigarette use, and approximately 3 percent reported heavy cigarette use.
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Rates of weight loss during lactation have been studied in healthy, well-nourished populations (Boardley et al., 1995; Brewer et al., 1989; Butte et al., 1984; Dewey et al., 1993;
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Military Concerns Military attendees at the workshop emphasized the need for scientifically based recommendations regarding appropriate weight gain, how much time to allow active-duty women to return to their prepregnancy weight, and whether these recommendations should consider individual factors such as total pregnancy weight gain and whether or not the woman is breastieeding. Several speakers questioned whether active-duty women should receive more encouragement to breastfeed, given the beneficial effects on the infant and influence on postpartum weight loss.
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· What percentage of personnel are separated from service each year for body fat or fitness violations? Minimum Lean Body Mass Body Composition and Fitness What levels of minimum lean body mass, and/or maximum body fat, are compatible with readiness (health, physical and cognitive performance, appearance)
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· What is the rate of weight loss postpartum? · Do military women attain weight, body fat, and fitness standards by 6 months postpar · What is the incidence and duration of lactation?
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1989. Postpartum changes in maternal weight and body fat depots in lactating versus nonlactating women.
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1989. Estimation of body fat in healthy Swedish women during pregnancy and lactation.
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1996. The impact of physical fitness and gender-integrated training on risks of stress fractures and other injuries among women in Army basic training.
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1990. 1988 active Army physical fitness survey.
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"Physical Fitness and Body Fat Program." July 20. Washington, D.C.
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Presentation at the workshop on Assessing Readiness in Military Women: The Relationship to Nutrition. September 9-10, Irvine, Calif.
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Schneeman, Chair, Committee on Bocly Composition, Nutrition anal Health of Military Women Presentations are 15 minutes in length followed by a 5 minute discussion period 8:45 a.m.-9:05 a.m. Military Readiness of Women: An Overview from the Command Perspective CDR Susan B
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Ethnic Differences in Body Composition: Application to Active Military Women Lisa M Stolarczyk University of New Mexico, Albuquerque 1:50 p.m.-2:10p.m.
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~ P~fc~/ ~ ~( 3:50 p.m.~:10 p.m. Physics Readiness Program: U.S.
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New York O , en, _,, ~ :20 a.m.-l ~ :40 a.m. The Impact of Physical Fitness and Gender-Tntegrated Training on Risks of Stress Fractures and Other Injuries Among Women in Army Basic Training COL Bruce H
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, Tacoma, WA 1:20 p.m.-1 :40 p.m. The Impact of Pregnancy Weight Restriction, Postpartum Exercise and Weight Loss on Lactation Megan McCrory, University of California, Davis 1:40 p.m.-2:00 p.m.
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Army Research institute of Environmental Medicine Military Nutrition Division Natick, MA LTC Alana Cline, Ph.D., R.D. Research Dietitian U.S.
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Bray, Ph.D. Senior Research Psychologist Research Triangle Institute Research Triangle Park, NC ASSESSING READINESS IN MILITARY WOMEN Kirk I
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Commandant U.S. Army Physical Fitness School Ft.
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Wood, Ph.D. Laboratory Chief, Mineral Bioavailability Lab USDA Human Nutrition Research Center Boston, MA ASSESSING READINESS IN MILITARY WOMEN Guests LTC Margaret Applewhite, Ph.D.
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Indeed, African American females comprise the majority group among female enlisted in the Army. The percentage of African American and Hispanic women enlisted recruits
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There is a higher percentage of racial and ethnic minorities among military women than among military men. Female recruits tend to be a little younger and slightly more educated than their male counterparts, with fewer women having less than a high school diploma.
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While 9 percent of the women exceeded the Navy's percent body fat standard (cutpoint = 30% fat for women) , 47 percent of the sample perceived themselves as being overweight, and 60 percent were attempting to lose weight.
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We continue to focus our efforts on delineating the contribution of the constellation of various stressors on menstrual dysfunction, bone mineral, and eating disorders or "female athlete triad." Using our study data on menstrual dysfunction and BMD and that of the Eating Disorders Inventory, we are pursuing the development of a female stress triad risk mode! for stress fracture injury.
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~ 2. Stress fractures of the tibia are associated with decreased BMD of the spine and hip but not total bone mineral content.
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Although the prevalence of disordered eating among military women has not been thoroughly characterized, it is likely to be prevalent because the military culture place importance on factors that are known to be of etiological significance in the development of eating disorders. These factors include appearance, weight control, exercise, and perfectionism.
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The stated goals of the regulations vary across services, but all include some mix of physical fitness/job performance, long-term health, and military appearance. A DoD directive specifies that all services will use circumference-based equations to assess body fat in overweight servicemembers to enforce weight control regulations.
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Gender-appropriate body fat and/or body weight standards combined with an appropriate level of support to the individual (e.g., physical training programs, dietary counseling, and well-equipped fitness facilities) should enhance physical readiness of all soldiers.
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x 100) ' total body density from hydrostatic weighing can be converted to relative proportions of body fat (percent body fat)
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Comparison of Siri's two-component model and Friedl's four-component model that adjusts body density for body mineral and body water yielded significantly different estimates of percent body fat for the Hispanic women in this sample (26.9% and 30.6% body fat, respectively)
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Conclusions and Recommendations In summary, research clearly demonstrates that fat-free body composition is influenced by e~nicity. The average fat-free body-density for Native American, African American, Asian, and Hispanic women is greater than 1.100 g/cc; therefore, prediction equations based on twocomponent models will systematically underestimate the relative body fat of women in these ethnic groups by 2 to 4 percent body fat' on average.
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1989. Body fat from body density: Underwater weighing versus dual-photon absorptiometry.
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In comparing the weight standards for men with those for women, inconsistencies are noted. Using a regression formula to calculate an estimated percent body fat using height and weight, it was shown that the current standards allow many men and women to enter the military at weights that exceed the service-specific body fat percentage limits.
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The more we say women are "different," the harder it will be on the system. Tough, consistent battle-focused physical training is the key to weight reduction and body fat loss.
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"Physical Fitness and Body Fat Programs." August 30. Washington, D.C.
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These studies provide experimental evidence that strongly suggest that the relationships between body fatness and physical performance described in cross-sectional studies are cause and effect. In addition, several of the studies attempt to directly determine the extent to which the sex difference in certain physical performances is related to the sex difference in percentage fat.
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When plasma zinc concentration was < 70 ,ug/dE, the disappearance of injected 67Zn was increased (p < 0.051. Regression analysis found that serum ferritin concentrations and the 30- to 60-min disappearance of injected 67Zn were inverselY and nonlinearlY related ~ ~ r ~ ~r~ ~ ___ _ A r~ ~ r~ ~ ~r~1 1 ~ J J _ _ _ __ _ _ ~ (N = 1d, K~ = U.lil, p < U.UUUJ)
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(Penland, 19971. The study we are doing that is of relevance to military women or young women is a 16-wk double-blind randomized controlled repletion trial of 30 mg iron or 30 mg zinc daily and/or selected micronutrients alone, with a crossover at ~ weeks, on neuropsychological functions of 60 nonanemic women, ages 19 to 40 years, who have serum ferritin concentrations ranging from 5 to 1 8,ug/Liter.
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This suggests that the nutritional problems of military women may not be different from those of their civilian counterparts. However, the nutritional problems of military women may be exacerbated by the physical performance demands imposed by military training and the need to meet weight
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Army Research Institute of Environmental Medicine. BODY WEIGHT SATISFACTION AND STATUS OF ARMY WOMEN Carol ~ Baker-Fuico, MS., R.D., Military Nutrition Division (currently Military Nutrition and Biochemistry Division9, U
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Women's desired body weights were well below the maximum allowable weights of the Army Weight Control Program. Only eight women (4%)
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The findings that desirable body weights were well below the maximum allowable weights of the Army Weight Control Program indicates that most women do not consider the screening table weights overly strict. Body weight goals seem to be driven more by societal pressures than by the weight control program, although actual weight loss attempts may be strongly influenced by the semis nual weigh-ins.
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Army Research Institute of Environmental Medicine. GENDER DIFFERENCES IN FOOD RATION PREFERENCES AND CONSUMPTION AMONG MILITARY PERSONNEL Edward Hirsch, Ph.D., An Dianne Engell, Ph.D., Behavioral Sciences Division, U.S.
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. HEALTH CONSEQUENCES AND ASSESSMENT OF DISORDERED EATING AND WEIGHT CONTROL BEHAVIORS David M Garner, Ph.D., Department of Psychology, Bowling Green State University and Toledo Centerfor Eating Disorders, Toledo, OH 43617 It is well recognized that there are significant health consequences to eating disorders and disordered eating.
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health. Concerns were reviewed related to the fact that Army Regulation 600-9 may lead to weight loss recommendations that are inconsistent with what is known about the feasibility of permanent weight loss and that also may inadvertently precipitate eating disorders.
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Moreover, dieting can lead to binge eating in individuals who have not experienced the symptom prior to attempting weight loss (Table A-~; it may also have other untoward psychological effects and can even precipitate serious eating disorders such as anorexia nervosa and bulimia nervosa. Instead, the focus of interventions should be on physical activity for health.
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Low bone mineral density is an important determinant of bone fracture risk in the elderly. At any point in time, absolute bone mass is the sum of the cumulative rates of bone formation and bone loss.
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Luke 's-Roosevelt Hospital Center, New York, NY 10019. Currently at Columbia-Presbyterian Medical Center, New York, NY 10032-3784 The female athlete triad, the triad of amenorrhea, osteopenia, and eating disorders, has been the source of much publicity in the athlete.
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THE IMPACT OF PHYSICAL FITNESS AND GENDER-INTEGRATED TRAINING ON RISKS OF STRESS FRACTURES AND OTHER INJURIES AMONG WOMEN IN ARMY BASIC TRAINING COL Bruce H Jones, USA, M.D.)
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. We concluded that integrated training did not increase the risk of injury among wooers in this population and that low levels of physical fitness were an important risk factor for men and women.
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TABLE A-12 Two-Mile Run Time arid Incidence (%) of Stress Fractures*
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~ . ~ ~ ~ ~ Pregnant soldiers are excused trom the Army Dody composition Program standards and trom physical fitness testing for the duration of the pregnancy.
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Soldiers who exceed body fat standards have favorable personnel actions suspended: nonpromotable, no command, no professional military schooling. The Army expends literally hundreds of thousands of manhours annually on the Army Body Composition Program.
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However, there was no difference in weight or body fat loss in the exercising group compared to the control group because the exercise group increased their energy intake. High intensity exercise has been shown to cause a transitory increase in breast milk lactic acid concentration (Wallace et al., ~ 992)
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1993. Breast-feeding reduces maternal lower-body fat.
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250 Cal o · _ At Cal CQ o o C)
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1992. Factors that influence weight loss in the puerperium.
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