Some things never change

PETERSON AIR FORCE BASE, Colo. -- It seems some things never change. On a recent trip through Wichita, Kan., I dropped in on McConnell Air Force Base where I had first been assigned many years ago. The KC-135s were still on the flight-line looking much as they had in the 1980s when I was there, and other than the engines, looking like they did when new in the late 1950s.

One thing you can bet on, however, is that the flight manual or "dash one" has been changed innumerable times as modifications of the aircraft have been made, and then changed again to correct the errors made in the prior changes, and so on, ad infinitum.

This is also true of how we tweak the Air Force Fitness Program AFI. The test I took as a new lieutenant back at McConnell was not much different from the one I have to take now; we did a run test, sit-ups, pushups, and had a body composition score, which in those days was based on a height to weight formula of some type. We would fall out as a squadron and go to a road where someone had placed a marker three-fourths of a mile from the start line. It was fairly informal compared to today. We would start in bunches of a couple dozen runners and run to the turn and meet or be met by the slower or faster runners on the way back.

On arriving at the finish line the fitness monitors would assign us a time, record it and that was that. Simple; no drama. The people that were overweight were put on the weight management program. They got the privilege of working out for an hour before the start of the duty day or after hours until the next scheduled squadron test date and were weighed and counseled by the squadron commander as often as the commander thought necessary. This usually had the desired effect. Naturally, there were a few guys that were muscular, or thought they were, and they sometimes got body fat measurements done but this was rare. Obesity was not nearly as common in those days as now.

As the local chief flight surgeon, I now chair a working group that hears requests for the waist circumference exemption to the fitness test. We seldom grant an exemption as there are very few legitimate medical reasons to explain a man having more than a 39-inch waist (35.5-inch for women) that are compatible with retention in service. Just as in the past, there are many that have an altered perception of their physique and can't believe the standard should apply in their case. As stated before, some things don't change. AFI 36-2905 has grown to 129 pages counting charts and modifying letters. The length of the AFI reflects the increasing difficulty the Air Force has in defining fitness (a subjective concept) and the difficulty of enforcing 'new tougher' standards which are essentially the same as 30 years ago. Occasionally, someone is actually separated from the service for failure.

As a profile officer, it is not my job to write the fitness program, but to try to be objective in our review of cases. This gets me to the leadership portion of this exercise in reflection. We are a fat nation and getting fatter - yet we military members are, or should be, held to a higher standard. This weight problem is due to multiple, complex factors which are the result of a rapidly changing society, yet all these factors result in the simple fact that we consume more than we expend in calories. We are to the point now that many obese people, currently defined as having a BMI greater than 30, do not see themselves as more than a little bit overweight. I often counsel patients on their weight and find that they are in denial; it seems we have reset our collective national baseline on what is fat and what is not.

What can the fitness 'challenged' member do? First, admit that the test is sooner than one thinks; after all, every six months comes around in just a few weeks. Take the test every day; by this I mean do the test as an exercise program daily. This way on the day of the real test there is nothing to fear (so far we have not recognized anxiety as legitimate medical reason not to test though some have requested consideration); many fail after never having done a rehearsal. Sleep seven or eight hours each night, the rest may be more beneficial than more workout time. Adequate sleep may improve hormone production helping to improve lean muscle mass and vigor. Eat three meals a day; people who are hungry eat snacks and wind up consuming more empty calories. Eat some fat as well; people who eat low fat diets consume more carbs, especially sugar, gain more and still feel hungry. All this fear of fat is highly overrated (trans fat is the exception and it is ubiquitous); sugar is probably more of a health risk. Don't eat for sport; find something else to do for entertainment.

Bring your lunch; if you live on base go home and eat, or if you are eligible for the Airman's dining hall go there. Stay out of the fast food joints except as a last resort; their motive is to make a profit, not to promote your health. Most salads as a meal are not satisfying unless they are laden with processed cheese, dressing and bacon bits and then you don't have a salad (watch people overload a salad bowl). Meat and fat, within reason, are part of a good diet; don't be afraid of them. Avoid processed foods if possible; they are more detrimental long-term than foods in their natural state. If you must eat substantial carbohydrates, eat the kind that is high in fiber (whole vegetables or bran); it may make you feel more satisfied (satiety value). At least you will be more regular and your colon may last longer. Learn to drink water and stop drinking sodas (packaged sugar water) for hydration. One pound of fat represents about 4,000 calories. A highly motivated person eating less than 1,500 calories per day and exercising an hour daily can lose a pound or more a week safely for a few weeks. If you are older you will take months to get back in shape once out; start running or get on a low impact aerobic machine now.

Lastly, avoid or learn how to deal with stress; stress may be the biggest health risk we face and is a contributor through cortisol hormone production to truncal obesity (failing the waist measurement) and altered metabolism among other bad things.

Like the size of the AFI (latest modification out this January), the girth of the population keeps increasing much to the detriment of our health and the image and effectiveness of the Air Force member. To have any significant effect on health risk, the healthy lifestyle must be maintained for a lifetime. Keep up the fight.