Help Military Bariatric Programs
Obesity has long been considered a major public health and economic threat. However, powerful voices inside and outside the military, including first lady Michelle Obama, say obesity has also become a national security issue.
Being overweight or obese is the leading medical reason recruits are rejected for military service. According to "Mission Readiness," a nonprofit organization of more than 300 retired generals, admirals and other military leaders, more than 9 million or 25 percent of all Americans ages 17 to 24, are too heavy to serve.
Military readiness and national security threats aside, rejection of potential recruits does not inoculate the military from the burdens of obesity. The Armed Services Health Surveillance Center reports that between 1998 and 2010, the number of active-duty military personnel deemed overweight or obese more than tripled. In 2010, 86,186 troops, or 5.3 percent of the force, received at least one clinical diagnosis of being overweight or obese.
The U.S. Department of Defense (DOD) spends about $1.1 billion a year on medical expenses related to obesity and obesity-related diseases. Only a small portion is spent on bariatric surgery, which according to DOD policy, cannot be performed on active duty military personnel. Their families and veterans, however, are benefitting from bariatric surgery.
According to data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), military bariatric surgeons perform between 600 and 1,000 bariatric procedures per year. Despite the challenges of frequent deployments amongst the military's bariatric surgeons, mortality and morbidity rates are comparable.
"ASMBS and ACS quality standards and programs have been an excellent model for us to follow," said Robert B. Lim, MD, FACS, Chief, Metabolic and Advanced Laparoscopic Surgery, Tripler Army Medical Center in Hawaii and chair of the newly formed ASMBS Military Task Force. "But security risks and concerns of maintaining privacy of patient data that could be included in a collective database, make it difficult to document protocols and outcomes to identify best practices in a military setting."
"But help is on the way." Several members of the ASMBS are serving or have served in the military. Among them, ASMBS past president and retired U.S. Army Colonel, Walter Pories, MD, the first to ask back in 1992, "Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus." Alan Wittgrove, MD, the surgeon who performed the first laparoscopic gastric bypass in the world 20 years ago, was a Navy surgeon for 10 years rising to the rank of lieutenant commander. Robin Blackstone, MD, the first female president of the ASMBS, was a major in the U.S. Army. There are many more.
Dr. Lim, who served two tours of duty in Iraq in 2003 and 2005 and two tours in Afghanistan in 2010 and 2012, is hoping to tap into former and current military surgeons and integrated health professionals to advance the care of obesity and related diseases in both the armed forces and civilian life.
"I am aware of a lot of ASMBS members who are current or ex-military, but there are probably many more whom I don't know," said Dr. Lim, who in addition to chairing the ASMBS Military Task Force, is chair of the military committee for Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).
The ASMBS Military Task Force hopes to change that during ObesityWeek 2013 in Atlanta. After a special reception honoring military members of the ASMBS, the task force will convene its first meeting where members can exchange "war stories." But not the ones you might expect. They will discuss bariatric and metabolic surgery cases, how to manage long-term follow-up among patients who are required to frequently relocate, research and education needs, and barriers to the care and treatment of obesity in the military. They will also look at ways to forge alliances between the military and civilian health care providers in areas of research, training and education.
"In a way, the military task force will be our state chapter and support group,” Dr. Lim said. "It will be a way for us to network, share best practices, improve access and have a stronger voice in shaping the national conversation around obesity and metabolic and
If you are an active duty service member or a retiree, please contact Dr. Lim at firstname.lastname@example.org to RSVP for the reception and task force meeting.
The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the
United States Government.