"Making weight,” the informal term for the twice yearly military assessments of body mass index and other markers of physical fitness, can spur stress that leads to disordered eating patterns including severe calorie restrictions, bingeing and purging, and excessively exercising.

"Service members will not be able to keep up their body processes and could suffer musculoskeletal injuries, cardiac issues or bone density issues that make them unable to perform their jobs to the maximum level,” said Army 1st Lt. Anna Smith, a dietitian at Walter Reed National Military Medical Center in Bethesda, Maryland. “These practices can affect force lethality."

And these types of behaviors go against the nutrition tenets of Total Force Fitness, the concept that proper nutrition fuels service members’ bodies so that they can perform optimally, remain uninjured, or heal from injury more quickly because of what they eat.

The active duty service members Smith sees usually are not making weight. “People come to their first meeting with me and tell me they will do ‘whatever it takes’ to pass those assessments,” Smith said. Sometimes, their military careers depend upon it.

It is her first job to get her patients to understand that the notion that “whatever it takes” is not in their best nutritional and overall health interests.

“People think they’ve done everything wrong nutritionally and physically, creating a very dissatisfactory body image,” Smith said. “Patients say to me, ‘I could look like a better military soldier.’ We need to change that attitude, take the weight stigma out of the equation.”

Her next task is a thorough assessment of the patient’s nutritional, social, financial, physical, and psychological factors (some of the eight TFF domains): “Do they live with five roommates but have no kitchen? Do they not have the financial means to purchase higher nutrition foods? Do they not have a car to get to the grocery store? What is their mental state now? What was their psychological profile before joining the military?"

She looks at a detailed diet history and at the patient’s diet the day before the first appointment. “Was it typical dietary habits or was it the Super Bowl?” She said patients’ comments about what they ate and why are often illuminating.

Smith also looks at lab work and medical history for underlying factors such as prediabetes, high cholesterol, bulimia, or anorexia nervosa.

She rounds out her assessment with the creation of nutrition-focused goals.

“A goal shouldn’t be ‘I’ll lose 15 pounds.’ It should be small, obtainable goals like eating another piece of fruit per day or decreasing my dinner portion size,” Smith said. “This nutrition-focused goal plan is designed to build the habits, change their way of living and keep those changed habits over a lifetime."

Her goal in the end is to help patients in the military pass their body composition assessments, but “we want to try to prevent disordered eating or eating disorders in the future."

Alicia Weaver, a dietitian at Naval Medical Readiness Training Command Beaufort in South Carolina, provides support to the Marines & sailors at  Marine Corps Air Station and Marine Corp Recruit Depot Parris Island, said the primary goal of her duties is “getting it into the mindset of patients.”  She furthered that, “there are no good or bad foods, that there is moderation and a variety of foods that help us fuel our body to do what we need to do."

"Nutrition is the one thing we get to choose every day,” Weaver concluded. “We can’t change our age or our body type, but we can change our nutrition."