Anthropometric surveillance and obesity prevalence in Armed Force personnel: A cross-sectional study

INTRODUCTION

Obesity has emerged as a global health challenge, with current estimates from the National Centre for Disease Control indicating that approximately 880 million adults are affected worldwide.^[1] Within the Indian context, a large-scale study involving over 100,000 adults reported a striking obesity prevalence of 40.3%.^[2]

This growing health concern is not confined to the civilian population alone. A study among active Indian Army personnel reported obesity rates nearing 30% across all ranks.^[3] Similarly, a 2011 analysis of the Indian Air Force (IAF) personnel from five distinct geographic regions revealed a progressive increase in overweight and pre-obesity with advancing age, as measured by body mass index (BMI).^[4]

Recognizing the implications of these trends on operational readiness and long-term health, the Indian Armed Forces have implemented stricter fitness protocols, including revised promotion policies and elevated benchmarks in physical fitness assessments.^[5] These measures aim to cultivate a robust and mission-ready force. Despite the above, there remains a notable gap in the literature concerning the direct correlation between rank, age, and anthropometric measures among Armed Forces personnel. In this context, it becomes pertinent to investigate how variables such as age and rank influence key health indicators such as weight, BMI, and abdominal girth, among service members. This study seeks to bridge that gap by systematically evaluating these parameters and identifying contributing factors, to support targeted interventions and effective health policies within the Armed Forces. The unique demographic structure of the Armed Forces, characterized by a standardized lifestyle and controlled environment across geographic locations, allows for a relatively uniform health profile, potentially making data from one geographical area broadly representative of others.

MATERIAL AND METHODS

RESULTS

Of the 12,899 personnel stationed in the selected study area across nine data collection centers, a representative sample of 1,388 (10.8%) was assessed for body weight, height, and abdominal girth. Among participants, 70.24% met the service’s permissible weight standards. An additional 28.46% exceeded limits by 10–20% and 1.30% surpassed them by over 20%. The average height, weight, and abdominal girth were 171.4 cm, 71.2 kg, and 84.9 cm, respectively.

BMI

The mean BMI was 24.18 kg/m². The distribution as per BMI classification is depicted in Figure 1. A significant majority (70.17%) fell within the normal BMI range (18.5–24.9 kg/m²). 21.90% were in Class I Overweight (BMI 25–27.9) and 6.56% were in Class II Overweight (BMI 28–29.9). Obesity (BMI ≥30 kg/m²)was present in 1.3% with a significant distribution (χ² = 151.0566, P < 0.00001). Only a very small fraction (0.07%) was in the underweight category (BMI <18.5kg/m²).

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Figure 1:

Proportional distribution of the study population as per their body mass index status.

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The only underweight individual was a non-combatant. Officers had the highest prevalence in Overweight-I (26.12%), Overweight-II (9.70%), and obesity (1.49%). The age-wise distribution of overweight and obese is given in Table 1. Most participants were aged 28–37 years, with this group also showing the highest prevalence of Overweight-I (54.93%) and Overweight-II (50.55%). For obesity, the 28–37 years of age group remained most affected (61.1%), followed by those over 47 years (22.2%).

Table 1: Age-wise distribution of overweight and obese study personnel.

Age (years)	Overweight–I (n=304)	Overweight–II (n=91)	Obese (n=18)	Total (n=413)
<28	39	9	0	48
28–37	167	46	11	224
38–47	76	24	3	103
>47	22	12	4	38

Abdominal girth distribution

The average abdominal girth was 84.9 cm. In the <85 cm cohort, 73.99% were under 28 years. Among those with larger girths (86–105 cm), the highest prevalence was in the age group more than 47 years. The largest girth group (>105 cm) included nine participants, mostly aged 38 and above [Figure 2].

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Figure 2:

Age wise distribution of abdominal girth at umbilicus.

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DISCUSSION

The present cross-sectional point prevalence study of Armed Forces personnel provides valuable insights into the prevalence of overweight and obesity among serving personnel, and its correlation with rank, age, and abdominal girth. Although the study employed non-random convenient sampling, its credibility is strengthened by the large sample size (1388 participants) and multi-data collection centers involvement, despite limitations in generalizability.

The findings bring forth both reassuring and cautionary trends that can inform policy and practice in the Armed Forces. Among 1,388 personnel assessed, 70.24% were within the normal weight range, and only 1.3% exceeded 20% of permissible standards. BMI analysis showed 70.17% had a normal BMI, while 29.8% were overweight or obese. This is notably lower than civilian obesity rates, estimated at 12% among men (NFHS-5),^[8] and far below the national prevalence of 40.3%.^[2]

The concentration of overweight and obese personnel in middle-aged groups is largely due to their higher numbers. Other ranks often retire around 38 years, reducing the representation of older individuals in the study.^[9] This distribution aligns with national and international research showing abdominal girth increases with age,^[10] though the study found these differences were not statistically significant. The study also highlights a higher prevalence of overweight and obesity among officers compared to other ranks and non-combatants, likely due to occupational differences, lifestyle, and age distribution, being associated with administrative roles and reduced physical exertion, mirroring trends from a 2011 IAF study on age-related weight gain.^[4] The highest prevalence of overweight/obesity was surprisingly observed in the age group of 28–37 years, which is alarming and definitely needs intervention by administrative authorities.

The average BMI of 24.18 kg/m² showed significant variation across age groups (Z = −1.960, P = 0.024998), though rank-based BMI differences were statistically insignificant, aligning with Indian Army studies on service roles³. Abdominal girth at the umbilicus, a strong indicator of weight gain and cardiometabolic risk, was found to have significant correlations with age (Z = 11.1996, P < 0.00001) and BMI (Z = 15.97776, P < 0.00001), supporting WHO and NIH recommendations for obesity surveillance.^[7,8] Similar findings of strong positive correlation between the BMI and abdominal circumference have also been reported in a cross-sectional study among Belgian and Nigerian adults.^[11,12] Overweight and obesity prevalence declined among personnel over 38 years, likely due to early retirements. Personnel record data supports this trend, showing most personnel retire before 38 years, keeping the active cohort younger.^[9] Despite a lower prevalence compared to civilian averages,^[1,2] the findings underscore the necessity of stringent fitness requirements. Armed Forces have responded with stricter fitness standards, promotion-linked health benchmarks, and comprehensive medical evaluations.^[5]

To enhance fitness standards among personnel, existing policies should be reinforced with routine BMI and abdominal girth monitoring across all ranks and age groups. Targeted wellness programs are particularly necessary for the 28–37year age group, where overweight and obesity are most prevalent. Nutritional education initiatives within messes and canteens should be strengthened to encourage healthier eating habits. In addition, structured physical training programs must be mandatory and tailored to varying fitness levels and age groups to ensure effective participation.

Establishing realistic weight reduction goals can be tough; however, visual materials demonstrating the health and wellness benefits of weight loss may be useful in setting realistic goals and motivating patients to sustain their weight loss. Methods such as motivational interviewing, which focus on addressing resistance to behavioral change in a supportive and hopeful manner, may assist individuals in integrating these changes so that they become part of regular daily life and aid in weight loss maintenance.^[13] Psychosocial counseling should be integrated to address stress, sedentary roles, and lack of fitness motivation, which are significant contributors to weight gain. Further studies should be replicated across all services to analyze broader trends and formulate holistic health strategies. There is ample evidence to suggest that abdominal obesity is a strong predictor of cardiovascular disease and type-2 diabetes. However, BMI is the most widely used measure of determining obesity in clinical and research settings. BMI measures an individual’s weight and height to classify them as normal, overweight, or obese. However, its diagnostic accuracy is debatable as it often leads to an inaccurate assessment of adiposity. Therefore, it is essential to incorporate additional indicators, along with BMI, to assess the risk of obesity-related diseases accurately.^[8] Thus, abdominal girth measurements should be standardized in annual medical check-ups to enable early detection of central obesity and mitigate associated cardiometabolic risks.

Future research should focus on longitudinal weight tracking over a 5-year period to analyze weight progression among serving personnel. Investigating cardiometabolic risks associated with obesity could provide valuable insights into its correlation with heart disease within this demographic. Comparative studies involving all sister services would help identify broader obesity trends across the Armed Forces. In addition, controlled trials assessing the efficacy of structured fitness interventions would be essential to determine their impact on weight management and overall health outcomes.

CONCLUSION

This study offers valuable insights into the prevalence and distribution of overweight and obesity among a representative sample of serving personnel. The analysis confirms a statistically significant correlation between increasing age and both BMI and abdominal girth, reinforcing the trend of progressive central obesity. However, rank did not significantly impact these metrics, suggesting that lifestyle and occupational factors associated with age play a more crucial role than hierarchical status.

By incorporating abdominal girth as a key metric, the study enhances understanding of adiposity distribution and associated health risks, aligning with global recommendations that recognize central obesity as a major concern. These findings highlight the growing need for continuous monitoring and preventive health strategies, even within a physically active and routinely screened population like the Armed Forces.