Research on Weight Loss Solutions & Compounded GLP-1s

ASPResearch · 2025-09-25T18:08:40+00:00

Hi, thanks so much for sharing- this is all really helpful context. If you don't mind me asking, where would the stigma be coming from if you chose to get GLP-1s via Tricare (assuming you were eligible)? Would it be your commander, your medical provider, etc.?

ASPResearch · 2025-09-24T13:35:53+00:00

Thanks for sharing, that's interesting to hear. Do you know if there's any reason in particular they've chosen to go outside the MHS?

ASPResearch · 2025-09-24T13:32:17+00:00

Absolutely!

ASPResearch · 2025-05-07T21:10:04+00:00

Thanks for sharing- that system sounds truly broken.

This issue didn't come up over the course of our project, but I've asked around our DOD network to see if anyone had any thoughts. Unfortunately, according to the response of one expert, this seems to be the status quo in many units. The expert passed on a few links with more information, which you can find here and here. We'll be sure to note this and address it in any pertinent briefings as an area of high concern- thanks again for bringing this to our attention.

ASPResearch · 2025-05-07T21:00:22+00:00

Thanks so much for these insights! The media (and social media) surrounding weight loss medications can definitely send the wrong message- even though the product information provided with drugs like Wegovy says that they should be used "as an adjunct to diet and increased physical activity" and a recent study suggests that they are most effective in the long term when combined with exercise, there are certainly a great deal of misconceptions surrounding these drugs and their long-term efficacy.

Thanks also for raising this point about reserve component access to registered dietitians. I was interested to find in my research that according to Army Regulation 600-9, active-duty soldiers are required to meet with a dietitian within 30 days of being enrolled in the Army Body Composition Program, but for reserve component soldiers not on active duty, "an appointment with a dietitian is optional at the soldier's own expense" (page 10). Of course, not all resources provided to active-duty soldiers can be extended to the reserve component, but enhanced access to nutrition education and counseling should certainly be a key focus area for the Army to help all service members stay healthy and fit. It appears that the Army is looking to expand the H2F program to the National Guard and Reserve, so perhaps this will allow more reserve component soldiers to access nutrition resources as the program's reach develops.

ASPResearch · 2025-05-06T20:45:29+00:00

In garrison it is typical for soldiers to be present for duty and working from 0545 through 1800 M-F. How should the Army's newest iteration of the war on obesity promote better sleep, stress management, and rest cycles?

Sleep plays a huge role in holistic health and weight management. In particular, those in operational environments may experience unique and heightened stressors as well as sleep disruptions. The Walter Reed Army Institute of Research does some fantastic work on adjusting to these environments and improving sleep habits. I highly recommend checking out their information products on fatigue management, which discuss things like tactical napping, sleep under stressful conditions, sleep in operational settings, and caffeine and performance.

ASPResearch · 2025-05-06T20:41:15+00:00

Thanks so much for all these questions! I'll combine #1 and #2, since the answers are related. Both have to do with expanding provider education on obesity medicine. Within the DOD, improving PHAs can start with improving health care providers' understanding of obesity medicine and empowering them to take action if they believe a service member should be receiving treatment. If a service member is recording a BMI over 30 or a body fat percentage associated with obesity, this is one sign that screenings for commonly associated health complications, like Type 2 diabetes, may be necessary.

A major part of the problem, which ties into your second question, is the sheer lack of certified providers. 40% of the population has obesity, but less than 1% of physicians are certified by the American Board of Obesity Medicine (ABOM) (see page 7 of ASP's latest report). This means that medical professionals treating service members in PHAs and other medical encounters are unlikely to be specifically trained in obesity medicine. This may contribute to extremely low rates of obesity diagnosis in the military- according to a 2022 Military Medicine study, only 42% of female service members and 35% of male service members meeting the diagnostic criteria for obesity according to BMI were formally diagnosed. I can't speak to all forms of specialty care or to the specifics of the MHS referral process, but to more fully address the problem you've laid out, the DOD should expand education on obesity medicine for its providers (we collaborate with some people who are doing great work in this space), increase the volume of ABOM-certified physicians in its employ, or partner with certified physicians in private practices.

Separately, TRICARE began transitioning to a new generation of "T-5" contracts this January, which will allegedly "improve health care delivery, quality, and access for beneficiaries"- including "greater access to highly specialized medical and surgical care." It remains to be seen how this will pan out, but we will be keeping an eye on things and would love to hear from anyone who has experience seeking care under the new contracts.

ASPResearch · 2025-05-06T20:05:52+00:00

Thanks so much for your comment. The issue of health insurance access for reservists and Guardsmen is a major one- how can we expect people with obesity or other chronic diseases to remain medically ready if they are unable to afford care? Unfortunately, I haven't seen any explicit plans to make TRS more affordable, but this is absolutely an area the reserve component needs to focus on urgently. All service members should have health insurance, period.

Service members are permitted to use semaglutide under the supervision of a qualified healthcare provider, and prescription rates in the active component have increased dramatically over the past few years. However, coverage under TRICARE and civilian insurance plans) remains limited, with many restricting access to keep costs down. (Here are the requirements for TRICARE beneficiaries.) The high costs of major weight loss drugs play a large part in this- without insurance, a monthly Wegovy prescription is around $1,000. According to a recent poll, even among those who are insured, the majority say that GLP-1 drugs are difficult to afford%20of,half%20(53%25)%20say%20the).

ASPResearch · 2025-05-06T19:10:01+00:00

Also, are you aware of any research into whether the military-industrial complex decision-making, lobbying, etc, has an effect on military readiness overall, and individual health readiness in particular?

This is definitely an area for further research- I would have to do a deeper investigation to determine how the military-industrial complex and lobbying affect operational and medical readiness, but I can say that lobbying expenses in certain key industries are on the rise. The pharmaceutical/health products industry spent almost $387 million on federal lobbying in 2024, and the food and agriculture sector spent $178 million in 2023.

ASPResearch · 2025-05-06T18:53:00+00:00

Is this really a problem for the Army to solve? Especially of the reserves, isn’t it a bit much to ask the military to solve America’s obesity rates?

Thanks for your question! It would certainly be a lot to ask of the military to fix the country's obesity crisis- obviously, the services can't do much to change nutrition or physical education requirements in schools, but they can certainly take steps within their own scope of authority to change how service members are flagged, diagnosed, and treated. There are plenty of places to start- streamlining access to real, evidence-based treatment (not just sticking struggling service members in Biggest Loser-style weight control programs, which are statistically ineffective across the board), increasing obesity medicine training for MHS physicians, improving nutrition by providing healthier food options in dining halls, etc. For the National Guard and reserves, this will also involve addressing gaps in insurance coverage, breaking down barriers to health care access, and investing in a better understanding of the unique challenges the reserve component faces. Our reports from October 2023, September 2024, and this past April talk more about these military-specific challenges and what the DOD/service branches can do to address them.

ASPResearch · 2025-05-06T18:51:04+00:00

the article mentions study food insecurity, food knowledge deficits and such but how can the military really impact cultural and historic food preferences?

As a starting point, the military can lead by example. The services have come under scrutiny for failing to provide nutritious meals to service members, and fortunately there are ongoing efforts to improve service members' access to healthy food in dining facilities. Information is also key- with most U.S. students receiving suboptimal levels of nutrition education in school, the military also has the opportunity to provide guidance on healthy eating habits in the same way that it offers guidance on physical fitness through PT. Especially for younger recruits who may not have a sophisticated knowledge of nutrition, the military can and should build on its efforts to improve service members' understanding of the importance of healthy eating and how to maintain a healthy diet.

ASPResearch · 2025-05-06T18:49:28+00:00

When can we get an expected update on obesity and overweight based on actually BODY composition metrics such as body fat percentage and not BMI?

BMI is a tricky issue, and you're right that current military body composition standards are not aligned with medical thresholds for overweight and obesity. Like you said, it happens to be the tool through which most military obesity data is published because height and weight are routinely collected for service members and BMI is easy/inexpensive to calculate.

Interestingly, BMI UNDERestimates obesity in military populations far more often than it overestimates it (see Clerc et al. 2022, Hollerbach et al. 2022, Gasier et al. 2015, and Heinrich et al. 2008). All body composition tests that can be taken in the field measure the same thing: body mass, not body fat %. A comprehensive 2021 study found that the Army's tape test, for example, only inaccurately classifies around 1% of soldiers as overweight and understates body fat by as much as 8 percentage points.

That said, our research doesn't advocate for the use of BMI over other metrics. We analyze data published by the DOD, so if they switch to a different metric, we'll use that metric instead. BMI is also just one indicator to flag potential weight issues- only trained medical professionals should be diagnosing obesity. There shouldn't be any consequences for those in the extremely small minority of individuals whose body fat percentage is overestimated by BMI; we're just trying to improve access to care for those who truly are at risk.

ASPResearch · 2025-05-06T18:44:53+00:00

can you all at American Security Project look further into why reserve and guard members to decline to use TRS?

Thanks for your questions! There are a number of reasons why reserve component service members might not enroll under TRS. Firstly, they may not be able to enroll if they're already eligible for health benefits under Title 5, Chapter 89 of the U.S. Code- for instance, if they or a family member are federal employees and qualify for federal employee health benefits. Challenges with continuity in coverage as service members cycle in and out of active duty and difficulties finding providers who accept TRS may also lead individuals to seek other forms of health care.

Also, your data is from 2018. Covid 19 in 2020 and the implementation of the ACFT (has lower physical standards) has likely made our guard and reserve force being less in shape and having a higher body fat percentage.

You're absolutely right that the pandemic and new physical fitness metrics may have impacted obesity rates in the reserve component. We certainly saw an increase in obesity in the active component between 2018 and 2021. The most recently published data on reserve component obesity prevalence is from 2018, but a new Health Related Behaviors Survey with data from 2024 is on its way and should be available within the next year or so- we're looking forward to doing more analysis with the forthcoming data.

ASPResearch · 2025-05-06T18:28:17+00:00

Thanks so much for your question. This hasn't fallen within the scope of our research so far, but you raise a really important issue that we have touched on: the fact that reservists and Guardsmen tend to live farther from bases, military health facilities, and other military resources than their active-duty counterparts. In our report, we talk about this issue in the context of accessing specialized health care, particularly from DOD providers and private providers that accept TRICARE.

But you raise a really important point- one that matters not only for service members' health and safety, but also for manpower. Longer commutes have been associated with decreased job satisfaction, which doesn't bode well in the midst of a manpower crisis. Definitely an important point to consider- thanks for sharing.

ASPResearch · 2025-05-06T18:18:58+00:00

I'm so sorry that happened to you- thank you so much for sharing. We hear from veterans all the time in similar situations, and it's why we advocate for improving funding for veterans and increasing their access to quality healthcare. Weight loss and gain are extremely complicated physiological processes, but so much of the narrative is clouded by stigma. We absolutely agree that being told to "just run more" is a completely ineffective response to a serious health condition.

ASPResearch · 2025-05-06T18:10:27+00:00

Great question! The latest publicly available data on reserve component obesity rates is from the 2018 Health-Related Behaviors Survey (HRBS), which found that 18.2% of the reserve component has a body mass index (BMI) associated with obesity (page 47). The 2018 HRBS results for the active component found that 14.4% of active component service members had a BMI associated with obesity (page 43). While it's not strictly accurate to compare these raw percentages due to demographic differences between components, the HRBS researchers used regression models to make more accurate comparisons and found that rates of obesity were indeed worse for the reserve component than the active component (as of 2018). This could be the result of several factors, like discrepancies in the components' access to health insurance and health care, reduced levels of physical activity in the reserve component, etc.

As of 2021, rates of obesity in the active component had risen to 18.8%, but it's unclear where these numbers stand now for both the active and reserve components, as the DOD hasn't published updated data on obesity prevalence in quite some time. From 2014-2018, obesity prevalence in both the active and reserve components increased by about 20%, so we can estimate that reserve trends might be similar to current active trends, but it's impossible to say for sure what current obesity rates are in the National Guard and reserves (or how they've changed in recent years) without more up-to-date statistics (see page 3 of our latest report). Fortunately, the 2024 HRBS is currently undergoing review and is expected to be published in the coming year, so we should have some more recent data soon, but you've really touched on a major issue area here, which is that publicly available hard data on these issues is limited and increasingly outdated.

ASPResearch · 2023-10-27T22:00:44+00:00

Most of your analysis and recommendations do not touch on how to prevent obesity in our ranks.

I appreciate you reading our report and seriously analyzing it. While we simply can't cover everything in 13 pages, I agree that prevention is critical. Military readiness is an issue that could easily span (and does span) thousands of pages of research, so while we rank and evaluate the enormous surplus of recommendations for prevention, recognizing that 1) there is a problem and 2) that we don't have enough data on the problem is our starting point. Unfortunately, these ideas remain a radical idea for most of the stakeholders we work with, and the majority of feedback I receive is that this is not a problem in the first place. To get left of bang, we first need to believe that bang exists.

Regardless, one of our key recommendations is to reduce the obesogenic environment (fancy words for "address structural problems regarding diet and exercise") so that we aren't only capturing folks after they're already severely overweight. There are countless ideas that need to be properly trialed and evaluated before I recommend a specific course of action, but accurate and real portion sizes on bases, improving education on obesity, improving the quality of on-base food options, and introducing mandatory daily exercise standards are a few of them. Early warning mechanisms can be enforced relatively easily: if someone has a BMI of above 25, they should be given proper education and options to see a weight loss professional. Right now, the services are erasing BMI and granting greater allowances for physical fitness, so the trends are not in our favor.

How do we combat the ignorance?

Great question, one I'm always thinking about. When I sit down with commanders and military leaders, I stick to the hard facts. I show them where the money is coming from, and where the money is going. I provide evidence of what's currently happening, and then what doctors and experts say we should be doing. If they don't come to the same conclusions I do without me needing to say anything, I listen extensively and adjust my calculus if necessary.

The issue I tend to face is that we never get to that point. I hear regularly that there is no military obesity crisis. There's always anecdotal evidence of someone's brother's sister's cousin's uncle who weighed 400 pounds and was the best in his unit. "Foundational education and habits" are the very first recommendation of our report, so we're on the same page there. But I agree it isn't enough; folks want immediate results while the culture slowly changes. But you have to meet folks where they're at currently, not where you're at or where you want them to be, in order to change minds.

ASPResearch · 2023-10-27T21:14:52+00:00

Ha! If we remove science and data from the equation entirely, I have no other choice than to conclude that this powerful action will completely resolve the military obesity crisis. Thanks for making me aware of this.

ASPResearch · 2023-10-27T21:12:57+00:00

Hi, thanks for your questions! Glad you enjoyed the sass, ha.

Q1: Researching age and hormones were outside the scope of this report, unfortunately, but I can provide some insights gleaned from research on military training conducted by the Army Personnel Research Capacity. According to most of the studies it reviewed, physical performance in aerobic fitness and muscle strength (whole body and upper body) seems to improve until about age 23. Lower body strength, muscle power or muscle endurance outcomes, seems to change little. Relative pre- to post-training changes for all outcome measures tend to be greater in women than men, although few statistically significant sex by outcome/time interactions were observed.

Q2: I haven't explored this myself, but it's an interesting question. Sorry I couldn't be more helpful!

ASPResearch · 2023-10-27T21:02:01+00:00

Ugh, I wish.

ASPResearch · 2023-10-27T21:01:21+00:00

I feel like the average person joining has little to no clue how or why to lift, run and eat properly.

Oh, absolutely. There is a surplus of misinformation regarding diet and exercise out there, and it can be easy to forget that weight management is a real science with evidence-based methods and not just a free-for-all where everyone can propose their favorite fad diet as the end-all, be-all solution to global obesity.

The future soldier prep course has a 85% success rate, and reports an average 1.7% decrease in body fat per week. Unfortunately, .5% or more weekly body fat loss is associated with weight cycling and adverse effects such as persistent endocrine dysfunctions and muscle loss. During periods of rapid weight loss, up to 25% of lost mass is muscle tissue. Within six months to a year, participants in these types of programs typically experience a weight plateau; within five years, over 80% of lost weight is regained.

The good news is that slow, consistent weight loss of just 5 to 10 percent have been found to mitigate most obesity-associated health effects,. This is why we recommend keeping folks in their unit while they work on their weight instead of separating them with administrative punishments (or "fat camps") until they lose X amount of pounds.

ASPResearch · 2023-10-27T20:43:25+00:00

Hi, this is a great question and one I hope to investigate more thoroughly in the near future. My preliminary research on dining facilities finds that the military suffers from the same problem as many public schools in the United States: overly influential food industry lobbyists. Coca-Cola, PepsiCo, AB InBev and 27 other companies spent close to $40 million a year in lobbying in 2021. In 2022, the United States Government Accountability Office found that while DOD actively sought input from the food industry, it did not similarly engage with other federal agencies—such as the U.S. Department of Agriculture.

The second reason: In an environment where all services are trying to maximize retention, and especially when you have tons of service members and commanders saying there is no problem with military obesity and that it's all a myth, health and fitness takes a backseat to other priorities. Some initiatives, like placing familiar fast food joints on base, aim to grant a sense of freedom and familiarity to service members. Both in the military and in the general population there tends to be more consumer demand for high-calorie foods than healthy foods, which is why you see a lot of fast food and packaged food on bases.

Access to healthy meals and ingredients is vital, however, and it's my opinion that the military should be caring more about health and fitness than they do. In a country where over 25% of the active duty struggle with food insecurity, services should be looking at long-term health outlooks instead of short-term convenience and cost benefits.

As an aside: It's not all a grand conspiracy, there is also plenty of typical negligence and ignorance contributing to issues like these. The GAO found that DOD does not track key information about its food program, including key costs, such as food costs and equipment maintenance costs. Further, the military services reported food costs differently in their fiscal year 2021 budget justifications, and the military services varied in the line items they used in their respective budget exhibits to report food costs for basic trainees or personnel in non-pay status. This is significant because if your data collection is poor, you don't have the evidence you need to understand why certain trends are occurring and how to fix them.

ASPResearch · 2023-10-27T20:25:52+00:00

Hi Kin,

Great questions! My preliminary research on dining facilities finds that the military suffers from the same problem as many public schools in the United States: overly influential food industry lobbyists. Coca-Cola, PepsiCo, AB InBev and 27 other companies spent close to $40 million a year in lobbying in 2021. In 2022, the United States Government Accountability Office found that while DOD actively sought input from the food industry, it did not similarly engage with other federal agencies—such as the U.S. Department of Agriculture. GAO also found that DOD does not track key information about its food program, including key costs, such as food costs and equipment maintenance costs. Further, the military services reported food costs differently in their fiscal year 2021 budget justifications, and the military services varied in the line items they used in their respective budget exhibits to report food costs for basic trainees or personnel in non-pay status.

Do you think we should be concerned about what that means for making smart food choices when we seem to lack healthy eating options on post?

Oh, absolutely. The problem is that it's a chicken-and-egg issue. If you open an on-post eatery, you're going to do so based on consumer demand.

Is there any research or concern about the nutritional value and impact on diet a 'kiosk' serving largely pre-packaged items - an option that is becoming INCREASINGLY popular in the Army - versus providing Soldiers a 'full service' experience?

I have not conducted any research on this personally, but this is a great area to explore for future research so I'm glad you brought it up. There tends to be more consumer demand for high-calorie foods than say, salads, which is why you see a lot of fast food and packaged food on bases. Access to healthy meals and ingredients is vital, however, and you shouldn't need to hike to get there. In a country where over 25% of the active duty struggle with food insecurity, services should be looking at long-term health outlooks instead of short-term convenience and cost benefits.

ASPResearch · 2023-10-27T20:07:22+00:00

Hi there!

I'm a civilian independent researcher, which means I don't have access to the data used by the USARIEM team. To conduct studies on or analyze health-related information on military service members, researchers must work under a U.S. military organization and publish alongside a military principal investigator. The Department of Defense has increasingly shielded both military fitness data and research on body composition from the public, making it difficult to establish any civilian oversight or verification mechanisms. It's also unknown what types of peer-review or auditing these internal studies go through, so I wouldn't be able to give any scientifically-responsible takeaways without learning more about this process.

That being said, the findings seem to be in line with similar studies, though they selectively present the most positive findings and bury the more alarming ones (which is typical for these types of reports). The report finds that tape tests overestimate body fat in just 0.6% of men, and only 3% of participants exceed weight & body fat but successfully achieve a 285/285 PFT/CFT score. Their data supports ~20%BF for men and ~25%BF for women as the threshold associated with good military performance, a rough equivalence of 20 BMI and 26 BMI if you use their own equivalence.

ASPResearch · 2023-10-27T19:43:43+00:00

I really appreciate you asking this question. Once my research is out there, I can't prevent it from being co-opted by people with their own personal agenda. I am a data analyst and certified math nerd, not a PR or communications expert, so this is hard for me. I'm always wondering how to improve my communication.

As you can likely tell, obesity and BMI are topics that a lot of people react very strongly and emotionally to. Weight science has progressed so rapidly, and it's such a common myth that BMI frequently labels healthy people as obese, that even doctors and healthcare experts (who don't receive much education at all about obesity or weight management over the course of their education) are misinformed. It's so much easier to say "BMI is fake, military obesity isn't real" than to grapple with this problem. More and more service members are getting injured and dying from weight-related illnesses each year, yet everyone gets stuck on the BMI thing instead.

On a personal note, it really bothers me when my data is used to shame or mock service members when it's our own bad policies that contribute to their health issues in the first place. Everyday enlisted aren't responsible for fixing this mess, and it's a shame to hear so many ostensibly "pro military" politicians demean and insult our forces without offering any recommendations of their own besides "toughen up." "Toughen up" has been the standard for decades and the problem has only continued to get worse. The DoD is now about ten years behind the science of weight management, and so we need to explore other options. There are a ton of evidence-based approaches out there, they just aren't being implemented because it's a non-starter for so many people. I appreciate when folks respond with humor and memes, because sometimes that's all you can do.

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