The association between obesity related health risk and fitness test results in the British Army personnel

Cardiometabolic risk stratification using a novel obesity phenotyping system based on body adiposity and waist circumference

BACKGROUND

The estimation of obesity-associated cardiometabolic risk does not usually take into account body composition or the distribution of adiposity. The aim of the present study was to assess the clinical usefulness of a novel obesity phenotyping system based on the combination of actual body fat percentage (BF%) and waist circumference (WC) according to the cardiometabolic risk estimation.

METHODS

A classification matrix combining BF% and WC as measures of both amount and distribution of adiposity establishing nine body phenotypes (3 BF% x 3 WC) was developed. Individuals were grouped in five different cardiometabolic risk phenotypes. We conducted a validation study in a large cohort of White subjects from both genders representing a wide range of ages and adiposity (n = 12,754; 65 % females, aged 18-88 years).

RESULTS

The five risk groups using the matrix combination of BF% and WC exhibited a robust linear distribution regarding cardiometabolic risk, estimated by the Metabolic Syndrome Severity Score, showing a continuous increase between groups with significant differences (P < 0.001) among them, as well as in other cardiometabolic risk factors. An additional 24 % of patients at very high risk was detected with the new classification system proposed (P < 0.001) as compared to an equivalent matrix using BMI and WC instead of BF% and WC.

CONCLUSIONS

A more detailed phenotyping should be a priority in the diagnosis and management of patients with obesity. Our classification system allows to gradually estimate the cardiometabolic risk according to BF% and WC, thus representing a novel and useful tool for both research and clinical practice.

Prevalence of obesity and associated health risks in soldiers of the German Armed Forces

BACKGROUND

Obesity rates are rising in the armed forces of Western democratic countries, impacting military readiness and health. This highlights the need for preventive health risk assessments and countermeasures.

METHODS

Using mandatory health examination data from 2018 to 2022, we analyzed the prevalence of obesity, health risks, and associated specific military risk factors (rank and unit) in 43,214 soldiers of the German Armed Forces. Statistical methods included χ2 contingencies and binary logistic regressions.

RESULTS

The prevalence of obesity (BMI ≥ 30) was 18.0%. Male soldiers (OR = 3.776) and those with an officer's rank (OR = 1.244) had an increased chance for obesity. Serving in a combat unit reduced the chance of being obese (OR = .886). Considering BMI and waist circumference, 2.4% of the total sample faced extremely high cardiovascular and metabolic health risks, while 11.0% and 11.6% had very high or high health risks, respectively.

CONCLUSIONS

Our data underscore the importance of targeting obesity-related health risk factors in soldiers to ensure their well-being and deployment readiness.

Trends of physical fitness related to weight status: An analysis including over 412,000 Swiss young male conscripts from 2007 to 2022

Objective

The high prevalence of obesity among young adults in the civilian population pose challenges in recruiting physically fit soldiers. We assessed the trend of physical fitness related to weight status among Swiss male conscripts.

Methods

Cross-sectional data of medical examination data during mandatory conscription for the Swiss Armed Forces, 2007-2022 (N = 412,186). The conscription physical test (CPT) assessed five aspects of physical fitness, each aspect scoring 0-25, one component being an endurance test (ET). CPT and ET categories were defined as per military guidelines: "Insufficient", "Sufficient", "Good", "Very Good" and "Excellent". Weight status was based on body mass index (BMI).

Results

Conscripts with obesity (BMI ≥ 30 kg/m2) and overweight (BMI 25-29.99) had significantly (p < 0.001) lower CPT and ET scores compared to normal weight [multivariable-adjusted mean: 54.7 ± 0.1 and 66.5 ± 0.1, vs. 73.6 ± 0.1 for CPT; 8.8 ± 0.1 and 12.5 ± 0.1, vs. 15.3 ± 0.1 for ET] and a higher likelihood to be categorized as "Insufficient" [weighted relative-risk ratio and (95 %CI): 70.4 (63.7-77.7) and 2.35 (2.16-2.55) for CPT; 77.1 (71.0-83.7) and 3.05 (2.91-3.20) for ET] or "Sufficient" [7.67 (7.38-7.97) and 2.02 (1.99-2.06) for CPT; 8.93 (8.37-9.52) and 2.02 (1.98-2.06) for ET]. Compared to normal weight conscripts, the CPT and ET scores decreased over the conscription years for conscripts with obesity (multivariable-adjusted mean yearly change: -0.11 ± 0.02 for CPT; -0.032 ± 0.007 for ET) and overweight (-0.16 ± 0.01 for CPT and -0.044 ± 0.004 for ET).

Conclusion

Male Swiss conscripts with overweight and obesity have lower physical fitness than normal weight conscripts, and this condition tends to worsen over the conscription years.

BMI Alterations and Prevalence of Overweight and Obesity Related to Service Duration at the German Armed Forces

The aim of this study was to assess body mass index (BMI) and the prevalence of overweight and obesity at entry and release of service at the German Armed Forces and related associations to service duration. In a cohort study, 85,076 paired BMI data sets (entry and release of service) of German soldiers (5.4% females) between 2010 to 2022 were analyzed retrospectively to assess BMI alterations and the prevalence of overweight (BMI ≥ 25) and obesity (BMI ≥ 30) after service durations of ≤2 years, 2−5 years, or ≥5 years. Between 2010 and 2022, we observed a trend for BMI increases of about 0.5 kg/m2 (X2 = 27.104, p = 0.007). BMI increases differed significantly (X2 = 7622.858, p < 0.001) after ≤2 years (0.0 kg/m2), after 2−5 years (1.1 kg/m2), and after ≥5 years (2.4 kg/m2) and were correlated to service duration (r = 0.34, p < 0.001). The prevalence of overweight increased from 33.0% to 39.5%. Obesity prevalence increased from 3.7% to 6.3%. The switch to obesity was more pronounced for longer service durations. Although secular trends for BMI increases among soldiers were in line with the general population, service duration was related to BMI increases. Especially, the service time depending on pronounced prevalence of obesity should be a matter of debate leading to counteracting measures at the German Armed Forces.

Much work remains to reach consensus on musculoskeletal injury risk in military service members: A systematic review with meta-analysis

Musculoskeletal injuries are the most common reason military service members cannot perform their military duties. Not only are they costly and associated with long-term disability, often long after completion of military service, but injuries also adversely affect the military readiness of a nation. This can be seen as a threat to national security and part of the impetus behind many efforts to better understand, predict, and mitigate injury risk in the military. A systematic review of the literature published between 1995 and October 31, 2020 was conducted to identify significant risk factors of musculoskeletal injury in military populations across the world. 74 out of 170 eligible studies addressed comprehensive injuries, providing 994 unique risk factors. 46 of these studies provided data that could be included in a meta-analysis, which was possible for 15 predictor variables. Seven predictors were significant in meta-analysis: female sex(RR=1.46;95CI 1.30,1.64), high body mass index(RR=1.36;95CI 1.21,1.53), functional movement screen pain (RR=1.70;95CI 1.55,1.87) or scores ≤ 14(RR=1.42 95CI 1.29,1.56), prior injury(RR=1.54;95CI 1.32,1.80), slower running performance(RR=1.33;95CI 1.18,1.51), and poorer push-up performance(RR=1.15;95CI 1.04,1.27). Low BMI, height, weight, smoking, physical activity scores, and sit-up and jump performance were not significant risk factors in the meta-analysis. Most studies had a high risk of bias. Lack of raw data and large heterogeneity in definitions of predictors and injury outcomes limited comparison across many studies.Highlights Female sex, high body mass index, pain with functional movement screen or a score of ≤ 14, prior injury, slower running performance and poorer push-up performance were all significant predictors of musculoskeletal injury.Low body mass index, height, weight, smoking, physical activity scores, and sit-up and jump performance were not significant predictors of musculoskeletal injury.Many other predictors were present only in single studies, but large heterogeneity in definitions of both outcomes and predictors limited comparison across studies.Overall, studies assessing risk factors to predict musculoskeletal injuries in the military were at high risk for bias, especially in regards to statistical approaches.

Body Mass Index and Measures of Body Fat for Defining Obesity and Underweight: A Cross-Sectional of Various Specialties in Montenegrin Army Soldiers

Background:

The body composition and physical fitness of members of the army is always a relevant topic for research, since the level of defense and security of people and material goods in a specific territory in many ways depends on the level of ability of the army. However, members of the armed forces are a heterogeneous group, typified by different abilities, characteristics, but also everyday needs, and the trend of changing body composition and reducing physical fitness is a current issue that has not bypassed this population either. Therefore, this study aimed to determine possible differences in body composition indicators that could appear between members of the Army of Montenegro of different military specialties.

Methods:

The sample of respondents included 240 Montenegrin male soldiers (32.5yr±9.5), who were measured at the sports dispensaries within the barracks of Montenegrin Army around the country in the spring of 2020, was classified into eight numerically equal subsamples according to their military specialty. The sample of variables included five anthropometric measures, which were necessary to calculate two derived body composition indicators: Body Mass Index (BMI) and Body Fat Percentage (FAT %). Using the one-way ANOVA and Post Hoc test with Taki’s model, the variables were analyzed.

Results:

It was determined that the body composition of Montenegrin soldiers shows a certain peculiarity compared to other national military corps, while there are differences in body composition indicators between members of the Montenegrin Army of different military specialties.

Conclusion:

This fact dramatically strengthens the issues of Montenegrin distinctive regarding body composition, both in general terms and in terms of distinctive within specific professional vocations.

Crowe M. Epidemiology of Exertional Heat Illness in the Military: A Systematic Review of Observational Studies

Exertional heat illness (EHI) is an occupational hazard among military personnel. This systematic review describes the incidence, risk factors, clinical manifestations, and biomarkers of EHI in the military. Six databases from inception to 28 May 2020 were systematically reviewed using the PRISMA guidelines. Forty-one articles met the inclusion criteria and the incidence of EHI ranged from 0.2 to 10.5 per 1000 person years, while the prevalence rates ranged from 0.3% to 9.3%. Intrinsic risk factors influencing EHI were gender, physical fitness, obesity, previous history of heat illness, and motivation, while the extrinsic factors included hot environmental conditions and service unit. Evidence suggests that loss of consciousness, absence of sweating and confusion were the common clinical features of exertional heat stroke (EHS). The mean core temperature ranged from 40 to 41.6 °C, while elevated levels of creatine phosphokinase, liver enzymes, and creatinine were common biochemical markers of EHS. The findings of the review suggest a variation in the incidence of EHI among military populations possibly due to the varying definitions used. Although some risk factors of EHI were identified, more analytical studies are needed to investigate the association between EHI and other important factors such as acclimatisation and occlusive clothing.

Regular strength training and baseline fitness in overweight infantry members of Slovenian Armed Forces

INTRODUCTION

The prevalence of overweight subjects in military cohorts increases despite the obligatory army physical fitness test (APFT) requirements and the negative consequences of possible test failure due to the increased body mass index (BMI). Studies that have examined the association of BMI with baseline fitness in the military are showing conflicting evidence. The primary aim of the study is to examine BMI effects on baseline fitness that was measured by APFT and additional functional performance tests (FT) (vertical countermovement jump with and without load, loaded prone plank, single-leg hamstring bridge test and pull-ups). Our secondary goal is to explore if regular strength training modifies the BMI effect on baseline fitness.

METHODS

A cross-sectional study on a sample of 118 male infantry soldiers that have performed APFT and FT was carried out. Body mass and body height measurements were used to calculate BMI, and to categorise participants into BMI ranks. Two independent categorical variables (BMI rank and strength training) were used to evaluate their influence on dependent variables of physical performance acquired from APFT and FT.

RESULTS

A significantly large size effect of BMI rank (F=1.69, p=0.037; effect size (ES)=0.15) and regular strength training (F=2.66, p=0.006; ES=0.21) on physical performance was found. It was shown that strength training had a medium ES on push-up and pull-up performance, as well as on the overall APFT score and loaded plank.

CONCLUSIONS

The importance of regular strength training and normal BMI for better overall baseline fitness in infantry members was highlighted. Most importantly, it was shown that performance is not affected in overweight soldiers who are performing regular strength training in addition to their daily physical training.

TRIAL REGISTRATION NUMBER

NCT03415464.