Copyright by

Alexandra Katarina Paez 2018 The Report Committee for Alexandra Katarina Paez Certifies that this is the approved version of the following Report:

Some Soldiers Carry Weight of Army Regulations

APPROVED BY SUPERVISING COMMITTEE:

Robert W. Jensen, Supervisor

Robert B. Brenner Some Soldiers Carry Weight of Army Regulations

by

Alexandra Katarina Paez

Report Presented to the Faculty of the Graduate School of The University of Texas at Austin

in Partial Fulfillment of the Requirements for the Degree of

Master of Arts

The University of Texas at Austin May 2018 Dedication

To my husband who opened my eyes to a whole new world. To my mom and Toby, who have always been my cheerleaders. And to the U.S. military members and their families.

Acknowledgements

Thank you to my readers, Bob Jensen and R.B. Brenner, for your guidance on this report. Thank you to Professor Kathleen McElroy, who assured me that my gut can be trusted. Also, a special thank you to Mr. Wayne who took care of everything else so I could write.

v Abstract

Some Soldiers Carry Weight of Army Regulations

Alexandra Katarina Paez, M.A.

The University of Texas at Austin, 2018

Supervisor: Robert W. Jensen

According to Army standards, many soldiers are , but this isn’t only a problem with current soldiers, it has become a major recruiting challenge. Weight and is determined by methods prescribed by the Department of Defense.

Many service members take issue with these programs because of unattainable weight requirements and outdated methods used to measure body fat in soldiers. With current methods, soldiers with larger body frames can be mistaken for having high body fat content and can be separated from the military.

vi Table of Contents

Text ...... 1

References ...... 20

vii On a crisp South Korean morning, Cameron Guest, a 23-year-old U.S. Army Intelligence specialist, marched through Dragon Valley, where roads are steep and deteriorating.

Mountains surround the edges of his destination, the shooting range at Camp Casey.

Guest and his team were on a ruck march from Camp Hovey, carrying all their gear along seven miles of gravel road, steep hills, and dangerous drop-offs. As Guest turned a corner, a chunk of gravel broke off the side of the road and tumbled down the hill into a creek. Loaded up with gear, his body landed on the road while his lower leg plunged toward the creek.

“I felt something snap in my knee, and I knew I hurt something,” he recalled.

Over the next few days it became harder to move his knee, and when he saw the unit’s physician assistant she handed him a bottle of ibuprofen. Guest thought his knee would get better.

That was in October 2015. Over the next year the injury was misdiagnosed, he said, and the pain and the reduced mobility got worse. In September 2016, he took the Army test. His knee gave out as he crossed the finish line and he barely completed the test.

1 Soldiers take the physical fitness test twice a year. They must complete three events: two minutes of sit-ups, two minutes of push-ups, and a timed two-mile run. In February 2017,

Guest’s weakened knee prevented him from completing the test.

But it turned out that something else put Guest’s military career in jeopardy: his weight.

The injury in South Korea limited his ability to ; he could no longer run, jump, bike, or swim. He could lift weights and do stationary , but those wouldn’t help keep him trim. Along with the Army physical fitness test, all soldiers are weighed to make sure they are staying within the allotted weight range for their height and age.

Failing to meet the Army’s weight requirements could put a soldier’s career at risk. A commander can decide to separate the soldier from the Army.

Cardiovascular exercises, which burn the most calories and fat, were no longer an option for Guest. Running is a common activity in Army training to help soldiers keep fit, build endurance, and promote comradery. Unit runs, where large groups of soldiers run in formation, are a military tradition. “Cardio went out the window,” Guest said.

Guest was sent to an orthopedic specialist and told he needed surgery, but his unit was set to deploy to South Korea again. He decided he would get the surgery while on his next deployment there. Until then, the orthopedic specialist at Fort Hood in Central Texas gave him a steroid shot to relieve the pain. 2 Since his knee injury, Guest’s exercise options grew limited. He went to the gym during his lunch breaks and after work to lift weights, but still gained 28 pounds.

He was facing a potential problem all too common in the Army. According to Army standards, many soldiers are overweight, but this isn’t only a retention problem. Over the last decade, it has become a major recruiting challenge.

One third of young adults ranging in age from 20 to 39 are obese, according to “The State of ,” an annual report by Trust for America’s Health, a nonprofit organization that focuses on disease prevention. About 40-percent of military recruits come from Southern states, including Texas, which have increased rates of obesity and decreased physical activity. Six of the top 10 states with the most active duty and reserve soldiers are

Southern states.

A study conducted by The Citadel, a military college in South Carolina, found that 10 states from the South and Southeastern regions produce significantly less fit male and female recruits.

The Department of Defense Physical Fitness and Body Fat Programs require that all military branches have physical fitness programs to develop and maintain the readiness of soldiers. All branches must submit a report to the Department of Defense that assesses physical fitness, body fat, and health promotion programs. 3 But, many service members take issue with these programs because of unattainable weight requirements and the “cheap” method used to measure body fat in soldiers. With current methods, soldiers with larger body frames can be mistaken for having high body fat content.

The Army aims to maintain soldiers at a high level of physical fitness, measured by two methods: the physical fitness test and a regular body fat screening. The physical fitness test is the first measurement to ensure that the soldier is ready to deploy. Then soldiers must pass the body fat screening. Soldiers are weighed and have their height measured, and they must fall within the Army body weight range. If they do not, then soldiers must

“get taped.”

“Getting taped” means that male soldiers will have their neck and their abdomen measured. In addition to those measurements, female soldiers have their buttocks measured at the largest point.

According to the Army’s Body Composition Standards, Guest is overweight for his 5’9” frame and should weigh no more than 179 pounds. When he joined the Army in 2014, he weighed 235 pounds. Despite high intensity training and a rigorous regiment during nine weeks at Basic Training, Guest did not meet Army weight standards at his lowest weight in his adult life, 207 pounds.

4 The Army uses the Weight for Height chart to screen soldiers to expedite the body fat screening process. If they weigh less than the maximum weight on the chart, then they do not need to have their bodies measured by tape measure. The Army uses “body circumferences” to determine a person’s body fat percentage. Soldiers commonly refer to this as the “tape test.” Because Guest does not meet weight standards, he is taped every time the soldiers are screened.

In October 2017, Guest was set to get his knee surgery during his second deployment in

Korea. The day before his surgery, his commander had him taped. His abdomen was measured, and his neck was measured. He failed by one-percent body fat.

According to the Army regulation, commanders can order a “tape test” for any soldier they think does not appear fit, regardless of whether the soldier exceeds the weight in the screening table. Soldiers can be exempt for a period, if there is a temporary medical reason preventing the loss of body fat.

Guest was flagged, a notice to the entire Army that he wasn’t meeting expectations.

When a soldier is flagged he cannot be promoted, qualify for any special schools, or move on to his or her next station. Guest had orders to go to the Defense Language

Institute in Monterey, Calif. after returning to Fort Hood from Korea, but after failing the tape test, his orders were put on hold.

5 The surgeon wrote a note preventing Guest from getting kicked out of the Army if he didn’t pass tape because he was still recovering from the knee surgery. A month after the surgery, November 2017, Guest was back in the gym. He lost four pounds, but also lost inches in his neck. The next tape test, his neck was measured. His abdomen was measured. He failed by two-percent body fat. The next month, he had lost another four pounds, but still had not lost any body fat according to the tape test.

By the time he returned to Fort Hood in February 2018, Guest had lost 23 pounds since the surgery and still had not passed the tape test.

“I knew I had to do something because I wasn’t passing the tape test and I was worried about my job,” he said.

And so was I. Guest is my husband.

I never put much thought into the Army physical fitness standards and body fat screening policy until it hit so close to home. I would learn just how a soldier’s fear of being separated from the Army can lead to desperate measures.

My husband had practically cut his calorie intake in half to get back some sense of job security. He needed to lose a couple inches to pass the Army’s tape test and to get his career back on track. I spent my nights at the computer looking for any solutions we 6 hadn’t thought of yet. I had seen the commercials on TV for Cool Sculpting, a procedure for people who want to get rid of stubborn fat, and I mentioned it to him. He immediately dismissed the idea, or so I thought.

People often associate cosmetic procedures with Hollywood. Models and actresses tout the latest and greatest in the procedures they use to stay looking great. Reality TV stars

Khloe Kardashian and Kris Jenner have said they use Cool Sculpting. In 2016, Cool

Sculpting was even featured on their show, “Keeping Up with the Kardashians.” Since then the procedure has gained popularity. It is an elective procedure, but for some it can feel like a necessary step to keep their jobs.

One soldier’s military retirement was at risk when he failed the Army’s tape test. He had spent 14 years in the South Carolina National Guard and had deployed to Afghanistan serving under Command Sergeant Major Edward Guest. Edward Guest has served in the

Army National Guard for 32 years and is Cameron Guest’s uncle. “At a reunion event, one of my old soldiers told me he was getting lipo and I was shocked,” he said.

With six years left until he was eligible for retirement, the soldier wanted to re-enlist, but did not meet the Army standards for height and weight. He decided his only option was to go under the knife to secure his job, his benefits, and his financial security. The soldier underwent , passed tape, and retired six years later.

7 While still in Korea, my husband did some searching online and found that Beleza

Medspa in Killeen, Texas was using Cool Sculpting to help soldiers pass the tape test. In

2016, Beleza Medspa, which has offices in Austin and three other Texas cities, published a press release making that claim.

The owner of the medical spa, Dr. Lawrence Broder, said he understands the stress soldiers experience from the tape test because he served in the Army.

We went to a Beleza Medspa location in Round Rock for a Cool Sculpting orientation the same week my husband returned home from Korea.

Cryolipolysis, better known as Cool Sculpting, is the freezing of fat cells. In 2009, the

Dermatology, Laser and Cosmetic Center of Massachusetts General Hospital came out with a study that showed the reduction of fat cells with localized cooling. The development of that study came from an observation of children who eat popsicles. At

Harvard, doctors Dieter Manstein and R. Rox Anderson noticed that children who eat popsicles tend to develop dimples because they are losing small pockets of fat in their cheeks. Since then the Cool Sculpting brand and procedure has grown.

Cool Sculpting is an FDA-cleared non-invasive fat-reduction procedure that uses cold to get rid of stubborn fat pockets. In the last year, Cool Sculpting and procedures like it have grown by tens of thousands, according to the American Society of Plastic Surgeons. 8 There has been a 7-percent increase in the amount of non-invasive fat reduction procedures from 2016 to 2017, but these numbers only reflect the procedures performed by ASPS certified plastic surgeons. In addition to plastic surgeons, medical spas with accredited staff can perform the procedure.

There are some side effects that can be caused by the procedure. Research conducted by the Washington Institute of Dermatologic Laser Surgery in Washington, D.C. says that skin can bruise or swell from the procedure for up to two weeks. A serious side effect is paradoxical adipose hyperplasia, which is when the fat cells grow instead of shrink; it occurs mostly in men and does not go away on its own.

Many medical spas in Central Texas area offer Cool Sculpting and are courting soldiers.

Medical spas and plastic surgeons offer military discounts for this procedure, knowing that soldiers have strict physical standards placed on them.

Novita Spa and Medical Rejuvenation Clinic in Georgetown, Texas advertises a 10- percent military discount on its website, next to before-and-after-pictures and below the headline “Make Tape.” The spa’s owner, Megan DiMartino, said she has advertised in the Fort Hood Sentinel to reach out to more soldiers after helping one pass the tape test in

2015. The soldier, identified only by the first name Michael, is the person pictured in the before-and-after-pictures. “I want to help whatever the need is,” DiMartino said, “and we were able to help him attain change.” 9 Novita Spa has done more than 1,000 Cool Sculpting procedures since 2015. DiMartino said many soldiers go to her spa, and about a dozen soldiers have come in and disclosed that they got the procedure to pass the tape test.

At the Cool Sculpting orientation, my husband was in an unfamiliar environment.

“The presenter explained that women handle the procedure better than men and a lady in the corner said, ‘Men are whimps,’ not realizing that I was a soldier,” he said.

After the presentation, he went with a nurse to an exam room.

“The nurse is doing her assessment and she’s grabbing my love handles and my stomach and she says to me, ‘You’re a big guy. You’re not fat. I can feel the muscle underneath.’

The entire time it was very awkward.”

She explained the procedure. If he decided to get Cool Sculpting, my husband would return to the office and have six applicators placed on his abdomen. The applicators use suction to grab and hold any loose tissue. Then the cold treatment would start. The fat cells under the skin would freeze and over the next few weeks the body would get rid of them naturally.

“It was really awkward the entire time she was touching and feeling my body, not that

I’m not used to that for the tape test, but this was just awkward.” 10

The Cool Sculpting procedure would cost us about $8,000. It could put my husband in a position where he would no longer have fat in the area the Army measures for the tape test. He would never have to worry about failing the tape test for the rest of his career, but it would come at a price.

“I will always have to take the tape test, but at the end of the day I didn’t feel comfortable with going through with getting Cool Sculpting or putting myself in that kind of debt,” he explained.

If soldiers don’t meet the Army body composition standards they can be discharged and lose their job. When a soldier fails tape, he or she is required to complete the Army Body

Composition Program. Staff Sergeant Daniel Penano is a Master Fitness Trainer in the 1st

Cavalry Division at Fort Hood. He is one of many Master Fitness Trainers who have the extra responsibility to create an individualized training program for soldiers within their units who are not meeting the physical fitness or height/weight standards. “Normally, the soldier will be chaptered. I have only seen two or three soldiers who were able to stay in because they were so close to that passing mark,” Penano said.

The Body Composition Regulation has remained largely the same for the last 30 years, but the Army has given units more flexibility to make exceptions. Traditionally soldiers had to take the physical fitness test and then get height and weight recorded right after. 11

The earliest form of Army policy in the United States began in 1775 when the

Continental Congress was recruiting “able-bodied men” between the ages of 16 and 50.

Army weight standards go back to the Civil War, but they don’t look anything like they do today. The first height and weight tables were created in 1887.

In the 1920s, industries screened for employees using weight to see who was fit to work.

As for the Army, a draftee was considered “normal,” “overweight,” or “.”

Before World War II, weight-for-height tables were predominantly used to exclude people who were seen as unfit because they were underweight.

During the Vietnam era, the demand for soldiers was high and weight standards were relaxed. Relaxing the standards will be seen again during other conflicts. Minimum and maximum weights were published, for the first time, for both men and women in the regulation, Standards of Medical Fitness (AR 40-501). In 1976, the Army Physical

Fitness and Weight Control Program (AR 600-9) was first proposed. This was the closest regulation to what is used to assess soldiers today. At the time it was generally accepted that BMI was an accurate measurement of body composition.

Over the years, body fat content became the focus of weight control programs. That remains especially true when obesity is more common today than it was 40 years ago. In the late 1970s, the Department of Defense mandated that body fat percentage is the only 12 measurement that can be used to separate heavy from unhealthy. Modification of the allotted body fat percentage because of age and sex wasn’t addressed until about a decade after the DOD mandate.

In 1985, Colonel James Kirkpatrick of the Office of the Army Surgeon General proposed a revised weight control program that included a new way to estimate body fat percentage. With few variations, that method is still widely used today, the tape test.

After about three decades, controversy and ethical questions still surround the reliability of the Army Body Composition Standards.

The Army Body Composition Program was changed a few years ago so a unit’s commander could decide if height and weight would be done separately from the physical fitness test to prevent health problems and injury in soldiers. Army schools like

Air Assault remain strict and stick to tradition and conduct height and weight right after the physical fitness test.

“Sometimes you have soldiers who will not eat or drink anything before the [Army physical fitness test] because they want to pass tape,” Penano said. “We give it a little time, so the soldiers aren’t starving themselves.”

All branches measure their soldiers’ height, weight and body fat percentages using the same methods prescribed by the Department of Defense. Physical fitness tests used to 13 measure muscular endurance and aerobic ability are conducted differently in each branch.

The Air Force Physical Fitness test consists of a one minute of sit-ups, one minute of push-ups and a 1.5-mile run. The Marines have pull-ups, crunches, and a 3-mile run.

In the Army, no matter your military occupational specialty (MOS), the Army physical fitness test, weight requirements and body fat percentage requirements are all the same.

In 2017, the Army introduced the Occupational Physical Assessment Test, or OPAT.

This test is taken by anyone entering the Army to see if their fitness level matches what is required for certain jobs. For example, recruits must score high to qualify for a combat arms branch, like infantry, that must lift more than 99 pounds frequently. A recruit does not need to score as high for a branch like cyber, which requires lifting weights up to 40 pounds, but only on occasion.

The South Carolina National Guard is taking a different approach to helping its soldiers.

Coaches are provided to soldiers who enroll, free of charge, in the Warrior Fitness

Program. It helps soldiers become more successful in meeting Army physical fitness standards, both the Army physical fitness test and the body fat assessment by creating programs for the units and the individual soldiers. Coordinator Ron Doiron took over the program in August 2016 and shifted the focus from general health and wellness to a strength and conditioning program.

14 His focus is to train soldiers proper mechanics and movement patterns. Most people in the military have injured knees because of improper training, Doiron said. In fact, 55 percent of soldiers have musculoskeletal injuries per year, and 76 percent of those soldiers are non-deployable because of those injuries, according to the Army’s 2015

Health of the Force Report.

“Most people only aim at their flagged personnel, but you’ll be chasing flags forever just waiting for more people to get flagged,” Doiron said.

Doiron said the Army should approach unit training like professional athletics, focusing efforts on the team, not on separating the flagged soldiers from the rest of their unit. “Do you see professional sports coaches separating their team?” Doiron asked. “That is what the military is doing, and it is the wrong way to do it.”

The Warrior Fitness Program is averaging a 6 percent reduction of soldiers with flags per month.

Currently, the Warrior Fitness Program is only available to the South Carolina National

Guard, but Doiron hopes to expand it. The state of South Carolina is funding the cost of the program. Doiron is presenting his program to the Department of Defense in June. If it were to expand to the entire Army, it would need federal funding. Participation in the

15 Warrior Fitness Program is required for soldiers who fail the body fat screening but is also available to any soldier who wants to take advantage of it.

Command Sergeant Major Edward Guest of the South Carolina National Guard said it’s harder for the National Guard to stay on top of , but the program helps. The

Army weight scale sets unrealistic expectations for many soldiers, he said. Edward Guest is a strong proponent of the idea that if soldiers can pass their physical fitness test, then their weight shouldn’t matter. “I have more soldiers on the weight control program than I have soldiers who are APFT failures,” he said.

In 2016, the Marines implemented a new regulation that allows soldiers to be exempt from the body composition standards if they meet a certain threshold on their physical fitness test, according to the Marine Corps body composition regulation.

Edward Guest explained that out of his 30 years of service, he has been taped for 25. But now in a leadership position in the Guard, his concerns run deeper than his own measurements. “Muscular guys are being pushed out because they can’t pass the weight standards,” he said.

Army Regulation 600-9 says that soldiers who fall within the Army’s prescribed body fat percentages are more likely to be most effective at their jobs, but soldiers have taken

16 issue with the tape test for decades. Soldiers say that bodybuilders, people with thin necks, and people with wide hips can be at risk of not passing tape.

It’s not just guys that are affected. Females are measured at the neck, the smallest part of their waist and around the largest part of their buttocks. “For females it is harder to pass the tape test,” said Sgt. 1st Class Michael Bernquist of Delta Company, 8BEB, 2ABCT of

1st Cavalry Division at Fort Hood, Texas.

While stationed in Germany, Sgt. 1st Class Bernquist had a female soldier in his unit who scored high on the Army Physical Fitness Test. She was 5’2” tall, had a thin waist and was all muscle. “She rocked the [physical fitness] test, but she had large buttocks and she was flagged for being overweight,” Sgt. 1st Class Bernquist said.

Bernquist oversees collecting soldier physical fitness results in his company and recording them into the Digital Training Management System. The results are collected at every organizational level.

In his company of 112 soldiers, about half of the soldiers do not meet the Army weight standards. They are all taped. But only three of them failed the tape test. Of all the soldiers in the Company, 14 failed the Army Physical Fitness Test. These results come from his Company’s most recent physical fitness test and body fat screening in April

2018. 17 “The tape test is not an accurate description of how much fat a soldier actually has,”

Bernquist said. “I can suck in my stomach and instantly lose 5 percent body fat.”

There are more accurate ways to measure body fat percentage, Bernquist said, but the

Army is looking for the quickest, easiest and cheapest way to measure soldiers. The

Army Wellness Center at Fort Hood has a BOD POD, an air displacement machine that measures body composition, but soldiers cannot use this machine for an official body fat screening. In an official capacity, the BOD POD would cost hundreds of dollars for each soldier; the tape measure used for the tape test can be found for $1.

BOD POD is within about 3 percent range of error for most people, according to Lisa

Farr, Exercise Physiology Lab Manager at the University of Virginia. She is trained in the different ways to measure metabolic response and body composition for research at the

School of Medicine. BMI and waist circumference measurements can give people an idea if they are overweight or obese. “If a person is super muscular and weighs more they could be classified as overweight even if they are not,” Farr said.

After my husband decided he would not go through with Cool Sculpting, he got a personal trainer. The pain in his knee had dulled after the surgery and he was able to ride the stationary bike in the gym. He did a juice cleanse right before his tape test in March

2018. He lost six more pounds.

18 The night before the test, he used an “old Army trick” that one of his sergeants recommended. It is rumored to temporarily reduce waist size. He lathered hemorrhoid cream onto his abdomen and wrapped himself up in saran wrap. “It was nasty and embarrassing to have to do that,” he said.

But he passed. According to the tape test, he was 19 percent body fat, 4 percent less than his last tape test in December.

“The Army encourages people to go to the gym to become super soldiers, but at the same time they aren’t adjusting Army standards to include muscular profiles,” he said. “You are putting soldiers that are huge assets to the team at risk.”

19 References

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Department of Defense. (2002) DOD Physical Fitness and Body Fat Programs

Procedures. Retrieved from www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/130803p.pdf

Department of the Navy. (2016). Marine Corps Body Composition and Military

Appearance Program. Retrieved from www.marines.mil/Portals/59/Publications/MCO%206110.3A.pdf?ver=2017-01-04-

071352-610

Friedl, Karle E. (1990). Body Composition and Military Performance: Origins of the

Army Standards. Institute of Medicine (US) Committee on Military Nutrition Research.

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Governing. (2017). Military Active Duty Personnel, Civilians by State. http://www.governing.com/gov-data/military-civilian-active-duty-employee-workforce- numbers-by-state.html

20 Johnson, CPT Niel A. (1997). The History of the Army Weight Standards. Military

Medicine, Vol. 162, August 1997.

Keaney, Terrence C. MD; Gudas, Amber Tario MHS, PA-C; Alster, Tina S. MD. (2015).

Delayed Onset Pain Associated with Cryolipolysis Treatment: A Retrospective Study

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