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Supplemental Issues

Supplement to Military Medicine
Volume 175, No 8

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Supplement sponsored by Samueli Institute (www.SamueliInstitute.org)

On Total Force Fitness in War and Peace

“Fitness” is a commonly used word in our society today but within the military it has a particularly deep meaning. Conventionally, being fit means being adapted to a particular condition or circumstance. In war, militaries and their individual combatants must adapt to the chaos and complexities of battle. As these militaries return from war, they must maintain a state of vigilance while also peacefully coexisting within the civil society that produced them. Their fitness is not just something that is merely physical; it is holistic.

Fitness for an individual, family, or organization, is a state of adaptation in balance with the conditions at hand. An individual fit for marathon running may be perfectly unfit for mountain climbing. A family adapted to the state of having the soldier-parent gone may suddenly find themselves poorly suited for the sudden return of a battle-hardened warrior. An organization having spent the past decade in counterinsurgency warfare may find the role of conventional armor warfare too restrictive or mundane to perform well on the tank gunnery range.

In a static world, perfect fitness is achievable. However, in the real world being fit is a dynamic state of being. Optimal fitness may be more dependent on our state of mind than on the frequency of trips to the gym. I believe the secret to optimal fitness lies in the constant awareness of the changing environment and the continuous pursuit of flexible adaptation to the inevitable shifts. For the warrior, this necessity for “awareness” is encapsulated in the quotation from Sun Tzu “Know the enemy and know yourself; in a hundred battles you will never be in peril. When you are ignorant of the enemy but know yourself, your chances of winning or losing are equal. If ignorant both of your enemy and yourself, you are certain in every battle to be in peril.”¹ This sounds so simple and yet it is very hard. Hearing about our strengths is easy. Finding out that we are vulnerable requires integrity in our assessments. Nowhere is this more true than in our unit readiness reporting.

Fitness is often used interchangeably with the term “readiness.” Are you fit, are you ready? As I see it, readiness is all about being capable of being able to accomplish something you are called to do. A unit of troops may be ready to load onto airframes and deploy to a distant land. How many troops are leaving behind families that are falling apart? How many are flagged for unresolved drug or alcohol issues. How many are being loaded onto these aircraft while we in leadership remain oblivious to these problems that do not show on a readiness report? I, for one, want to know not only that a unit is ready but also that it is in a state of what I would call “total fitness.”

Total fitness is a state where mind and body are seen as one. It is a state where people, their families, and the organizations in which they serve are connected and thriving. I see total fitness as a point of balance between readiness and well-being, where each of these two conditions are mutually supporting and in complete balance. A total force that has achieved total fitness is healthy, ready, and resilient; capable of meeting challenges and surviving threats. Achieving that begins with the way we treat our people.

In the discussions of deployment we often talk about “boots on the ground” or “numbers of bodies.” When a soldier is medically evacuated from theater we “requisition” a replacement. Our current language bespeaks the idea that we are moving around an inanimate object. We cannot forget that a mind occupies the body of every person we deploy.

From Aristotle and Plato through Descartes and Kierkegaard, philosophers have debated the mind–body duality. Regardless of one's beliefs in a mind–body duality, a growing body of scientific evidence, as I read it, certainly links the general health of the body with the state of one's perceptions of well-being.² Scientists have also gathered ample evidence that one's attitudes toward wellness influence how one maintains one's physical health.³^,⁴^,⁵ Even if one still believes that success in war is all about boots on the ground, one has to concede that being concerned about the state of a soldier's mind is just as important as the state of his or her weapons system.

It is also true that what we put into our bodies has just as much importance as how we prepare our minds and bodies. The emerging science behind the positive effects of omega-3 fatty acids on mood indicate that diet is not simply a matter of maintaining ideal body weight. Fitness cannot be separated completely from nutrition.⁶^,⁷ Stress eating may just be compounded by the fact that we present so many “comfort foods” in deployed settings—where the ability to expend calories is ever present; yet upon return, individuals with much lower calorie requirements continue to ingest these high-fat and high-carb diets.

It would be a mistake to fix a discussion on fitness in a military at war only in the negative. It is, in fact, not at all uncommon for people to achieve a higher level of physical and emotional fitness following difficult events like battles and wars. This is what Richard Tedeshi and others have called “post-traumatic growth.” Many of the principles described under the rubric of post-traumatic growth can be found in the Army's pioneering efforts in comprehensive soldier fitness.⁸^,⁹ The key seems to me to be the ability to maintain a balance both emotionally and physically under a variety of rapidly changing demands.

In this edition of Military Medicine, scientists will explore what fitness really means to warriors and their families. I have charged them to think hard, to apply science, and to help me understand how I can make sure that warriors and their families can lead their lives to the fullest. I have challenged the scientists to think holistically and to provide our 21st century leaders with 21st century definitions of fitness, health, and resilience.

Inevitably in war, some men and women pay the ultimate sacrifice. For those surviving members of their families and those who have served beside them I am obligated to provide opportunities for them to meet whatever challenges they face in the future. For those who continue to serve, I must make sure they stand fit and ready to face whatever missions they are called to execute. For those who move into the civilian world, I believe we owe them our full support for a successful transition toward a life that is as rich and fulfilling as it can possibly be. Most importantly, for the families who have sacrificed so much, I fully embrace my role as a defender of their rights.

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Supplement to Military Medicine
Volume 176, No 7

Assessing Potentially Hazardous Environmental Exposures Among Military Populations

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Supplement to Military Medicine
Volume 176, No 8

2008 Department of Defense (DoD) Recruit Oral Health Survey

EXECUTIVE SUMMARY
This report presents the findings from an oral health survey of DoD Recruits at time of entry into all nine armed services’ recruit training sites from December 2007 to November 2008. Clinical data on oral health status, dental treatment needs, and DoD Dental Readiness Classification were collected along with data from a recruit questionnaire regarding oral hygiene and nutritional habits, dental utilization, perceived need for dental care, and tobacco use. Prior to analysis, the sample (n = 5,835) of DoD Recruits was weighted to represent the estimated total number of DoD Recruits attending basic training (N = 300,418) during this time frame. Weighting factors included Military Service, recruit training location, gender, and Military Service status or Component thus allowing for comparisons among the Regular (Active Duty), Reserves, and National Guard of each appropriate Service. The distribution of the recruits by Service was 57.1% US Army, 15.2% US Marines, 15.1% US Navy, and 12.6% US Air Force and by Component, 66.0% Regular, 20.1% National Guard, and 13.9% Reserves. Males represented 82.1% of the recruit population across all Services. Oral health findings were compared to results from the 1994 and 2000 Tri-Service Oral Health Recruit Surveys when data were available.ⁱ Figures and tables in the “Findings” section illustrate the specific findings reported in the Executive Summary.