Congress Needs to Weigh Obesity as a National Security Concern
From Eastern Europe to the Taiwan Strait, the global geopolitical situation is increasingly unstable, and our long-term alliances and friendships are coming into focus. Nowhere is that clearer than in Europe, where it’s reassuring to see our allies firmly in alignment and stepping up to meet their NATO commitments. As a retired Army officer who served in West Germany, a longtime US representative to the NATO Parliamentary Assembly, and an outspoken champion of this critical alliance, I’m thrilled to see the West united in this uncertain time.
But after some in Washington spent years lecturing NATO members about their treaty obligations, I’m concerned that the United States may soon be unable to fully meet our own commitments, particularly as it matters most: the ability to put boots on the ground if needed. That’s because the United States is facing a growing, and mostly unaddressed, crisis of military readiness. We have the best weapons and men and women in the uniform, but too many Americans in the cohort most likely to enlist – those 17 to 24 years of age – are unable to do so.
The largest medical disqualifier for people interested in military service is obesity: One in four young adults cannot serve due to this chronic disease. That statistic may even be further exacerbated by the fact, per a 2020 Congressional Research Service report, that recruits are largely drawn from regions with the highest prevalence of obesity, including the South and the Midwest.
Put another way, our obesity epidemic is coming home to roost. More than 42% of Americans are living with obesity. But for too long, we have viewed it as a personal choice, or the result of one’s lifestyle, even as our scientific understanding of the disease and treatment options have evolved. Most notably, in 2013, the American Medical Association officially recognized obesity as a disease “requiring a range of interventions to advance obesity treatment and prevention.” When we talk about our military readiness crisis, we must propose solutions that acknowledge the truth about obesity: a chronic disease, like arthritis, diabetes, or hypertension – requires full continuum of care.
Too often, though, proposed treatments for obesity fixate on fad diets and exercise on the one hand, or bariatric surgery on the other. And prescriptions for our obesity-fueled readiness crisis are similarly inapt, focusing on childhood nutrition and school-age physical education. These are obviously important and shouldn’t be discounted, but they’re also proposals that we’ve tried for years to no avail and do nothing to address the crisis of readiness that we’re facing today.
Those prescriptions also overlook something that could help to address that crisis in the short-term, namely anti-obesity medications (AOMs) approved by the Food & Drug Administration (FDA). These aren’t the bottles, powders, or pills found in the drug store supplements section, nor are they hyped as providing miraculous results on late-night cable. They’re also not the “phen-fen” of 25 years ago, that negatively affected perceptions of treating obesity through medication. Rather, these new drugs are partly the result of the FDA’s publication in 2007 of guidelines to address those safety concerns and encourage innovation, and we are now able to reap the benefits of decades of research & development spending and scientific studies.
As a former member of the House Energy & Commerce Committee, which oversees the pharmaceutical industry, I fully appreciate the ways in which innovative pharmacotherapies can improve our quality of life, but those drugs are only as good as the access that patients in need have to them. And in the case of AOMs, too many Americans – including those potential recruits looking to lose weight and meet the military’s recruiting standards – have little or no access.
The single biggest step that Congress could take to improve access, and help to address our readiness challenge in the near-term, is an overdue reform to Medicare Part D. The original Part D law, which I proudly supported, was a product of its time. The law prohibited Congress from covering drugs for cosmetic purposes, including “weight loss” drugs, because at that time our understanding of treating the disease of obesity was limited. But since then, Congress has acted to permit Medicare coverage of various classes of drugs – and they should do so again in this case.
How, though, does Medicare coverage affect military readiness? Because Medicare serves as a benchmark for insurers across the country, including the commercial insurance that millions of Americans receive from their employer, state employee plans, and state Medicaid plans. In other words, until Medicare covers this class of drugs, access will be limited for potential recruits who may be able to use them to lose weight and get into uniform.
In a bit of irony, TRICARE, the Pentagon’s insurance plan for active-duty military and their families, already covers these drugs. Once someone is in uniform, they have access to the tools that they need to best manage their weight. And even more ironically, Congress and Washington officials – the same people that are limiting coverage to these drugs for millions of Americans – will soon have access themselves.
It’s time to get would-be recruits this same access, and it’s time for those members of Congress to act. My friends in Washington should move, this year, to grant Medicare the authority to cover safe, effective, FDA-approved anti-obesity medications, and in doing so help to expand access to these drugs for all Americans. It’s not only a matter of fairness and an improved quality of life for our senior citizens: it’s one of the best tools we have to improve our military readiness and national security now.
John Shimkus is a former Congressman and retired Army officer.
