A Cohort Study of BMI Changes Among US Army Soldiers During the COVID-19 Pandemic in 2020-2021

ABSTRACT

Background: The increasing number of individuals with obesity is a healthcare concern in the US population;the men and women who serve in the Army are no exception, with 17.3% of soldiers categorized with a body mass index (BMI) of obese in 2017. The COVID-19 pandemic profoundly disrupted life around the globe. In response to the pandemic, broad sweeping regulations were put into place for the US Army, limiting movement and restricting regular military activities. We strive to assess what effects these changes may have been on the BMIs of soldiers during this time. Methods: We conducted a retrospective cohort study of active-duty US Army soldiers using data from the Military Health System Data Repository. BMI was calculated and categorized before (February 2019 - January 2020) and during the pandemic(September 2020 - June 2021). Women who were pregnant or delivered during and one year prior to the study periods were excluded. Statistical analyses included paired t-tests evaluating on mean BMI, percent change, and the Stuart-Maxwell test for marginal homogeneity. Results: 191,894 soldiers were included in the cohort. T-test and Stuart-Maxwell test indicated significant differences and changes in BMI across the categories;especially in the obese category, with a 5% growth and 27% percent change. Significant absolute changes were observed during the pandemic, with 26.7% shifting from health to overweight and 15.6% from overweight to obese. In those with obesity, absolute increases were observed across every demographic category, with the most impacted groups being female, younger, White, and lower-ranking soldiers. The pre-pandemic obese category represents 18.2% of the cohort, and that group grew by nearly 10,000 soldiers resulting in an overall 5% growth in obesity over the short study period. Conclusions: Higher rates of obesity may result in decreased health of the force. The specific needs of younger and more junior enlisted soldiers need to be further addressed, with a focus on special intervention programs by the US Army.