It's about weight gain, obesity and the best way to handle a problem that plagues airmen at the massive military installation as well as people across Middle Georgia and the nation.
According to the Air Force surgeon general, about 55 percent of all airmen are overweight based on their body mass index. About 12 percent are obese. Body mass index, or BMI, calculates a number based on height and weight ratios.
The problem is worse outside the military, where 64 percent of Americans are overweight or obese, according to the federal Centers for Disease Control and Prevention in Atlanta.
But that's no consolation at Robins, where the goal is to develop and sustain a fighting force with the physical conditioning, stamina and energy necessary to support the global war on terror.
Air Force Materiel Command, the parent agency for Robins, took the lead in January among Air Force elements, instituting a revised wellness program for its military members with specific goals, a structured approach - and one with teeth should standards not be met.
Civilian employees - the bulk of the AFMC work force - are not directly involved, although they have a separate program that emphasizes counseling and cardiac risk profiles.
"The huge difference is that we cannot mandate anything for our civilians," one official confirmed, "although we are committed to a healthy civilian and military work force. We can just do a lot more arm twisting with our military."
The AFMC mandate for its personnel is to reduce obesity by 10 percent in six months and 20 percent by December. The idea is for airmen not only to lose weight and meet fitness standards, but also develop a mindset and culture emphasizing healthy living and eating.
"Gen. (Bruce) Carlson is looking at the health of our airmen, and he gave commanders flexibility to develop programs that work best," said Chief Master Sgt. Carol Dockery, the command chief master sergeant at Robins. Carlson is the AFMC commander.
"(The general) asked us to engage our medical treatment facilities so that we went about this in a safe and effective way," she added. "We did not want fad diets or overexercising. That was the platform AFMC gave us to get started."
AFMC has about 2,000 military personnel at Robins, about a third of the military population on base. The other 4,000 - not included in the program - are assigned to non-AFMC units.
The initial check of AFMC airmen at Robins showed 14.5 percent were obese with a BMI of 30 or greater. Under BMI guidelines, a rating less than 20 is underweight, 20 to 25 is normal and 25 to 30 is overweight.
"Those people were referred to their commanders who did the eyeball test," Dockery said. "They were reweighed to make sure they still fit the parameter, and the ones that remained went into a 90-day, healthy living workshop that included counseling, mental health support and exercise."
The number initially was 279, but several factors cut the final total to 122. Those deployed were exempted. So were pregnant women and people with certain medical problems. Athletes with a low body fat percentage but a high BMI also were taken off.
BMI is a useful, but imperfect screening tool, said Lt. Col. Michael Bledsoe, chief of occupational medicine at Robins.
"We're really looking at individuals to determine if their appearance and body fat measurement are consistent with someone who is obese," the board certified physician said. "Since something like this can affect a person's career, we want to make sure excess BMI reflects obesity and not just high muscle mass."
After the first 90 days, commanders were required to weigh their airmen again. "Some did it on a monthly basis," Dockery reported. "Those who progressed are being monitored for an additional 90 days to make sure they remain below a 30 BMI."
Airmen who did not progress were enrolled in a body composition improvement program that carries more stringent guidelines.
"They are more closely monitored," Bledsoe said, "with monthly weigh-ins, monthly meetings with health and wellness center staff and they're given individual dietary and exercise instruction."
At some point, punitive measures will kick in, with a range of options - including separation from the Air Force.
"But we won't get to the punitive aspect unless the individual fails to make progress," Dockery emphasized. "It's not cut and dried so that if you do 'A' then the impact is 'B.' Commanders have a range of tools. If airmen are progressing - although still obese - the likelihood of punitive action is minimal."
The new approach is part of an evolutionary change in Air Force fitness and wellness programs, according to Dockery. The first was a one-size-fits-all focus on height and weight. Next came an emphasis on fitness criteria - running, sit-ups, crunches.
"(In that latter program) we took our eye off the weight piece and relied on commanders to do the eyeball test," she explained.
The new program looks not only at weight but physical conditioning and the ability to perform assigned jobs.
"It will promote the long-term fitness of our force by ensuring commanders encourage - sometimes force - their airmen to exercise at least three times a week as well as look at their BMI," Dockery said. "That will get us to a place where people are watching their weight as well as exercising. That will lead to a more fit force."
Bledsoe remembers the old "weight focused" program and the problems it gave him. "At the mass weigh-ins - the cattle calls - there would be people with arms and legs the size of toothpicks but with big bellies," he recalled. "They smoked like chimneys, but were 20 pounds under their max weight. ... A lot of those people would not have a prayer of passing today's fitness test."
Robins has some unique issues that may not be true of other bases. The AFMC military force tends to be older and statistically more likely to have weight problems. The condition of mid-level non-commissioned officers - the staff and technical sergeants - was particularly disturbing: About 80 percent of the males were overweight or obese.
Also, many of the personnel assigned to the base are from the Southeast, a region of the country with the highest prevalence of overweight and obesity according to a recent Johns Hopkins Bloomberg School of Public Health report.
"So regionally and ethnically, we have those dynamics that feed into our numbers," Dockery said.
Bledsoe confirmed that the new program includes a healthy dose of reality. "Weight loss is difficult, and sustaining weight loss can be extremely difficult," he conceded. "I hope commanders will be sensitive to this and sympathetic to airmen who are struggling. I also hope airmen will not give up, not get frustrated. It's often two steps forward and one step back. It can be done, but it's not easy."
Dockery said commanders and senior enlisted leaders will be key to the new program's success.
"They must make sure standards - although a little loose - are applied across the board," she stressed. "They also have to lead by example. And if we do it just right - with the proper mix of pressure from the carrot and stick - we'll come out with a more fit force that's more aware of health concerns."
To contact writer Gene Rector, call 923-3109, extension 239.
