Weight Management: State of the Science and Opportunities for Military Programs.
The appropriateness of using weight-loss drugs in the military population requires careful consideration. On average, a 5 to 10 percent weight loss can improve comorbid conditions associated with obesity, but it is not known if this degree of weight reduction by itself would improve fitness or if it could be expected to improve performance in all military contexts. The side effects that are sometimes encountered might also restrict the use of weight-loss drugs in some military contexts. On the other hand, the military is losing or is in danger of losing otherwise qualified individuals who cannot “make weight.” Such people might be able to keep their weight within regulation if they are allowed to take weight-loss drugs for the remainder of their term in the military. The frequency of known side effects of current weight-loss drugs is sufficiently low that the potential for adverse events would not seem to be a reason to avoid the use of these drugs by military personnel.
The use of available dietary supplements and herbal preparations to control body weight is generally not recommended because of a lack of demonstrated efficacy of such preparations, the absence of control on their purity, and evidence that at least some of these agents have significant side effects and safety problems. The occurrence of potential adverse effects (e.g., dehydration, mood alterations) would be of particular concern for military personnel.
Although it would be expected that very few active duty military personnel would qualify for consideration for obesity surgery, a review of weight-management programs would not be complete without a discussion of this option.
For massively obese individuals (those with a BMI above 35 or 40), the modest weight losses from behavioral treatments and/or drugs do not alter their obese status. For these individuals, obesity surgery may produce massive, long-term weight loss. Recent studies have shown dramatic improvements in the morbidity and mortality of those who are massively obese, and surgery is being recommended with increasing frequency for these individuals (Hubbard and Hall, 1991). Table 4-5 presents the rationale and results of all forms of obesity surgery.
Surgical Procedures Used for Treatment of Obesity in Humans.
Individuals who are candidates for obesity surgery are those who (1) exhibit any of the complications of obesity such as diabetes, hypertension, dyslipidemia, sleep disorders, pulmonary dysfunction, or increased intracranial pressure and have a BMI above 35, or (2) have a BMI above 40.
Obesity surgery is, however, considered the treatment of last resort because of the short- and long-term complications associated with the surgery. Perioperative mortality is small but significant (about 0.3 to 2 percent) and appears to vary inversely with the experience of the surgeon (Kral, 1998). Other potential side effects include vomiting, diarrhea, electrolyte abnormalities, liver failure, renal stones, pseudo-obstruction syndrome, arthritis syndrome, and bacterial overgrowth syndromes.
Apart from the obvious need to increase energy expenditure relative to intake, none of the strategies that have been proposed to promote weight loss or maintenance of weight loss are universally recognized as having any utility in weight management. The efficacy of individual interventions is poor, and evidence regarding the efficacy of combinations of strategies is sparse, with results varying from one study to another and with the individual. Recent studies that have focused on identifying and studying individuals who have been successful at weight management have identified some common techniques. These include self-monitoring, contact with and support from others, regular physical activity, development of problem-solving skills (to deal with difficult environments and situations), and relapse-prevention/limitation skills. However, an additional factor identified among successful weight managers, and one not generally included in discussing weight-management techniques, is individual readiness, that is, strong personal motivation to succeed in weight management.
Institute of Medicine (US) Subcommittee on Military Weight Management. Weight Management: State of the Science and Opportunities for Military Programs. Washington (DC): National Academies Press (US); 2004. 4, Weight-Loss and Maintenance Strategies.
