Cardiovascular Crisis in the United States

After years of watching airmen of all ranks struggle with diet and nutrition, it is apparent to me the Air Force has a preventive health problem. Our men and women enter the service in great health, but we then fail to give them any deliberate preventive dietary or nutrition guidance. In parallel, every day I read yet another scientific or medical article linking proper diet with physical and mental health and longevity. If our airmen and their families are our top priority, why do we refuse to make the tough calls required to change the diet and nutrition environments our airmen live in every day and educate them for long, healthy lives? You can walk into any Air Force dining facility, installation franchised fast food location, MWR facility, or AAFES food court and immediately see the standard American diet – the same one that’s giving our fellow citizens heart disease and killing hundreds of thousands of them each year – is the easy choice for our airmen.

The thousands of men and women in the Air Force Health Promotion and medical system go above and beyond every day to make an impact on the diet and nutrition front for our airmen and their families.

Until we make preventive diet and nutrition health promotion a priority for the health of our airmen and give our health and medical professionals the resources and staffing they need to get this right, the Air Force should not be surprised to see trends in airmen cardiovascular disease and risk factors continue to move in the wrong direction.

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I thank my family for their stalwart support during this project and throughout my career. I also thank the Air Force’s health promotion coordinators, dieticians, nutritionists, and medical providers for continuing to work hard every day to change the status quo and keep our airmen healthy. Lastly, I thank the men and women of the U.S. Air Force, for protecting my family and the American way of life.

Abstract

The United States Air Force has been conducting continuous combat operations for over 27 years and there appears to be no reduction in this blistering operational tempo for the foreseeable future. To perform its mission, the service needs every airman mentally and physically fit and ready for combat. However, the source of the all-volunteer Air Force – U.S. citizens – is experiencing a heart health crisis as the prevalence of cardiovascular risk factors and diseases skyrocket, leading to increased national mortality and morbidity rates. While this troubling trend significantly impacts recruitment, airmen and their families are also at risk of developing these serious health issues once they enter the service. Even more concerning, heart disease and risk factors are largely preventable through proper dietary and lifestyle choices.

Statistically, cardiovascular disease will kill most airmen and their family members over a lifetime. It is the number one killer in the world, taking an American life every minute. About 90 Americans will die from heart disease and related complications in the time it takes the average person to read this paper. Heart disease and risk factors of obesity, high blood pressure, high cholesterol, abnormal glucose levels, and diabetes are serious health issues that drastically increase an individual’s chances of early death and chronic disease. Airmen are not immune –medical data on active duty airmen from 2006 to 2017 shows that while they are accessed with little to no prevalence of cardiovascular risk factors or diseases, incident rates of diagnoses significantly increase as their careers progress. Alarmingly, airmen 30 years of age and older experience a 240 percent increase in obesity diagnosis and an almost 1,500 percent increase in high cholesterol diagnosis when compared to younger airmen. Further, there is an almost ten-fold increase in the diagnosis of cardiovascular diseases themselves when airmen turn thirty. When airmen are diagnosed with these health conditions, combat readiness is impacted as they are sidelined with medical treatments and face further evaluation and subsequent separation. Additionally, these issues place a significant time and cost burden on the military health system.

There is now no question that cardiovascular diseases and risk factors are largely preventable with proper diet and lifestyle choices, yet significant gaps and seams exist in preventive diet and nutrition guidance the Air Force provides for airmen and their families. This shortfall is apparent from the moment they enter the service – there is little to no deliberate, preventive diet and nutrition training from the time of accession, in both Basic Military Training and across all officer commissioning sources, and throughout their careers. Equally important, instead of a preventive system shaping the airmen’s dietary and nutrition environment and arming them with current, evidence-based information to posture them for success, the system is reactionary…triggered by physical fitness test failures or disease diagnosis. In essence, the system intervenes when it is already too late.

The Air Force spares no expense to organize, train, and equip its airmen to accomplish the missions. It cannot afford to have any airman sidelined or separated with cardiovascular risk factors or disease, especially since they are preventable with proper diet and lifestyle. Thus, the Air Force must consider taking immediate, focused action to remedy the deficiency in initial and continual preventive dietary and nutrition health promotion. Recommended steps include increased resources and staffing for the Air Force Health Promotion system, educating commanders and supervisors at all levels and giving them the tools to create a health promotion culture for their airmen, and consolidating web-based information for airmen’s ease of use, among many others. The Air Force needs all airmen healthy…dietary and nutritional health must be a top priority for leaders at all levels in their efforts to establish and maintain a combat-ready force.

Introduction

In 2018, the United States finds itself amid an alarming cardiovascular health crisis. Rates of cardiovascular risk factors such as obesity, hypertension, high cholesterol, elevated blood glucose (prediabetes), and diabetes mellitus among Americans of all ages have exploded in recent decades. This has resulted in the unprecedented prevalence of actual cardiovascular disease (CVD) across the nation. CVD is the number one killer worldwide and now takes the lives of 610,000 people in the U.S. each year…more than one American each minute and about 25 percent of total U.S. deaths annually. Unfortunately, a vast majority of deaths related to CVD, as well as the numerous debilitating health issues that arise in individuals living with heart disease risk factors, are entirely preventable. It is now well-established in the international medical community that dietary and lifestyle choices overwhelmingly influence the chances individuals across all demographics will develop cardiovascular risk factors and subsequent heart disease in their lifetimes. While genetics impact cardiovascular risk in some way, diet and lifestyle choices have been proven to play the central role in preventing the development of heart disease risk factors and halting their progression into CVD. In their daily dietary and nutrition choices, Americans are making choices that determine whether or not they will increase their chances of developing heart disease and the increased morbidity and mortality rates that come with it.

As an all-volunteer force, the demographics of the men and women of the U.S. Air Force roughly mirror those of the society they serve. The impacts of these alarming national CVD trends on recruiting are already clear – more than one in four eligible Americans are unable to meet entry requirements for the U.S. armed forces due to excessive weight and obesity. More important, those Americans who enter as airmen into the Air Force are not immune from developing these heart health issues or the national nutritional trends that lead to them. Both officers and enlisted members enter the Air Force with incredibly low to no prevalence of CVD or its risk factors, but then live and work within their communities and are subject to the same lifestyle and dietary pressures experienced by their fellow Americans. Over time, poor diet and lifestyle choices put them at risk to develop the risk factors and CVD that are ravaging their fellow citizens across the nation. Unfortunately, preventive health training and dietary nutritional guidance for Airmen, both at the time of accession and throughout their careers, appears to be a low priority for the Air Force. Instead of a preventive health system leveraging diet and nutrition to keep airmen healthy, the system is primarily reactionary – based on triggers in physical fitness testing failures or medical diagnosis. In essence, the system responds too late…giving airmen medical or dietary solutions to manage their CVD and risk factor diagnoses instead of leveraging preventive dietary health solutions to preclude the problems from developing in the first place. This leaves airmen largely operating amid a self-help environment of dietary and nutritional guidance, placing them at risk for developing harmful dietary habits with long-term consequences. Equally important, a diagnosis of CVD or risk factors can lead to duty restrictions and loss of individual job qualifications (i.e. flight status) for members in certain duty specialties, or medical evaluation resulting in service separation depending on severity…Air Force combat readiness is impacted.

Therefore, this study is intended to:

1. Provide a broad assessment of risk factors and CVD incident rates within the U.S. Air Force, demonstrating that while airmen are accessed into the service with little to no prevalence of cardiovascular risk factors or CVD, their incident rates of diagnosis increase considerably in airmen as their careers progress.
2. Review the current state of dietary and nutritional education and training provided to airmen, both at the time of entry and throughout their careers, as diet has been proven in countless studies to be directly responsible for early death and disability related to CVD in the U.S.
3. Offer recommendations to improve initial and continual nutrition education for airmen of all ranks and generate further discussion to elevate diet and nutrition as a true combat readiness and health longevity imperative.

Due to the lack of access to detailed information in medical records, this study is not intended to provide a detailed epidemiological or medical assessment of the nuances of risk fa, actors, and CVD in the U.S. Air Force. Rather, it is intended to highlight that overall airmen tend to experience an increase in critical risk factors and CVD as their careers progress, which should not be a foregone result if they adhere to proper dietary and lifestyle choices. This study is also not intended to endorse specific diets or nutritional programs, but merely attempts to identify gaps and seams in nutritional and dietary guidance provided to airmen. They should be provided with consistent, evidence-based dietary training and guidance throughout their careers, so they can make informed choices to optimize health and readiness while establishing and reinforcing habit patterns that will enable longevity. The U.S. Air Force owes its men, women, and their families nothing less.