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SAN DIEGO -- Nearly a decade after retired American military brass warned that the obesity epidemic threatened national security, data show that about 70% of active-duty service members had overweight or obesity in 2021, thanks in part to a sharp jump during the early months of the COVID-19 pandemic.

From 2014 to 2021, the number of service members with overweight or obesity increased from 66.3% to 69.2% (P<0.0001), reported Michael Dore, MD, of the Uniformed Services University of the Health Sciences in Bethesda, Maryland, during a presentation at the Obesity Week annual meeting.

After several years of slow but steady growth, 22.1% were found to have obesity in 2021, up from 19.8% in 2020.

"The data show a significant acceleration in obesity within the service member population following the COVID-19 pandemic," Dore noted. "This trend is concerning, and obesity was already a risk to national security prior to the pandemic."

Meanwhile, as the rate of obesity keeps rising, the percentage of overweight service members has fallen from 50.2% in 2014 to 47.1% in 2021, possibly because people in this category gained enough weight to be considered obese.

In a 2012 report called "Too Fat to Fight," retired military leaders sounded the alarm about obesity in young people, claiming that 27% of those ages 17 to 24 were too overweight to serve. They called on Congress to take actions, such as cracking down on vending machines selling junk food at schools.

A by the Congressional Research Service estimated that "19% of U.S. adults ages 18-24 would not meet standards for accession to the U.S. military due to obesity."

"For the military in particular, I think one of the reasons that we have been so unsuccessful at decreasing rates of obesity is largely because we focused only on lifestyle modifications," said study co-author Richele Corrado, DO, MPH, of Walter Reed National Military Medical Center in Bethesda, Maryland, during an accompanying Obesity Week presentation.

"We know from meta-analyses that only about 25% of people are able to lose and maintain upwards of 10% total body weight loss with lifestyle alone," she added. "It's important to look beyond just lifestyle modifications alone and focus on efforts beyond that, including training providers in how to diagnose and treat obesity, particularly with the use of anti-obesity medications."

According to Corrado, the military health plan Tricare covers weight-loss medications, but "long-term use is not allowed by all branches of service for our active-duty service members." Moving forward, she said, "we need more studies to examine the safety and efficacy of these medications in our active-duty service members in particular as they try to maintain medical readiness and have to be deployed to potentially austere environments where the continued use of these medications may or may not be safe."

She also suggested that the military focus on hunger among active-duty service members. "There are studies that suggest that rates of food insecurity are higher in active-duty service members who have a family home in comparison to their civilian counterparts," she noted. "There is a lot of data suggesting that the active-duty population has higher rates of disordered eating and PTSD, which all have been linked to increased rates of obesity."

A reported that military bases were pushing salads, walkable spaces, and wellness centers. However, a weekly galley menu at Naval Base San Diego featured beef potpie, turkey à la king, and chili conquistador, not traditionally low-calorie meals.

For the current study, Corrado and Dore used the Military Health System Data Repository to retrospectively track service members from the Army, Air Force, Navy, and Marine Corps who were screened from 2014 (n=758,494) to 2021 (n=593,396). Overweight was defined as a body mass index (BMI) ≥25 and <30, while obesity was defined as a BMI ≥30.

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