Overweight BMI (25-29) in Active Duty Military: Excess Fat or More Lean Mass? A Look at the Evidence.

Many active duty service members and their health care providers feel that the current body mass index (BMI) standard for diagnosing obesity, BMI ≥30 kg/m2, may unfairly overclassify as obese those with higher muscle mass. Unfortunately, a closer look at the data available for service members repeatedly demonstrates the exact opposite: we are actually underestimating the rates of obesity in service members using current BMI cutoffs when compared with body fat mass as measured by either dual-energy X-ray absorptiometry or bioelectrical impedance analysis as the gold standard. Using a lower BMI threshold and refining positive results via history, exam, labs, and/or more specific measurements of body composition would more accurately estimate body fat percentage in active duty service members while remaining convenient and scalable. Given the current obesity epidemic in our nation, this suggests the critical need for new approaches to screening, as well as treatment, of overweight and obesity in our military to improve service readiness.