Christine Lang

Project title: Weight at Enlistment Predicted Enrollment in the Army Weight Control Program 15 months later

Degree: MPH | Program: Occupational and Environmental Medicine (OEM) | Project type: Thesis/Dissertation
Completed in: 2008 | Faculty advisor: William E. Daniell


Background: As the percentage of Americans who are overweight or obese continues to climb, the pool of eligible recruits who meet the military’s stringent age-specific height-weight entrance standards has begun to shrink.  The ARMS (Assessment of Recruit Motivation and Strength) study was conducted by the Walter Reed Institute of Research (WRAIR) as a means of objectively assessing physical fitness in recruits through a series of fitness tests, thereby providing a means to enlistment in some who might otherwise have been disqualified.  This study compared enrollment rates in the non-voluntary Army Weight Control Program (AWCP) in those who passed fitness testing and were granted enlistment waivers for overweight compared to those who met the entrance standards.  

Hypothesis: To determine if overweight recruits can successfully lose weight and meet Army retention standards.

Methods: A prospective cohort study was conducted with 8,208 men and women 18-39 years of age who enlisted in the Army and remained on active duty for at least 15 months.  An overweight recruit for the purposes of this study was defined as one who did not meet accession standards as per Army Regulation 40-501.  Subjects enrolled into the ARMS protocol from February 2005 through September 2006 at any of six of the participating Medical Examination Processing Stations (MEPS).  Each participant was administered the ARMS fitness test.   Overweight recruits were required to pass the fitness test in order to obtain a waiver for enlistment.  A total of 990 overweight recruits had waivers.  The cohort was followed for outcomes through December 2007.

Results: Of male recruits, 25%  of those who were overweight ultimately enrolled in the AWCP within 15 months compared to just 2.3% of those who met entrance stands (p<0.001).    For women, AWCP enrollment occurred in 16.8% of those who were overweight compared to just 5% in those who met the standards (p<0.001).  Overweight male recruits had 13 times the odds (95% CI 10.30, 17.22; p<0.001), while overweight female recruits had nearly 4 times the odds (95% CI 2.29, 6.24; p<0.001) of AWCP enrollment compared to those who met enlistment standards after adjusting for age, smoking status, race, and time of enlistment.

Conclusion: Overweight recruits granted enlistment waivers had significantly higher rates of mandatory enrollment in the AWCP at 15 months regardless of gender.