Implications

In this document, the term “readiness” is used to describe the preparedness of a Soldier for combat or in the case of medical readiness, to describe a Soldier being in a state of health that does not hinder the Soldier from being fully mission capable

(“Readiness,” n.d.). One of the goals of Army medicine is to improve Soldier readiness (Army Medicine Campaign Plan, 2017) which is threatened by a reduced pool of

physically fit young men and women to recruit from and by the development of undesirable health outcomes during a Soldier’s career.

The 2017 Army Medicine Campaign Plan (the strategic document that outlines the ways in which the Army envisions meeting its organizational objectives) identified that a key process in meeting objectives was to “Improve Healthy Behaviors,

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Communities and Environments”(Army Medicine Campaign Plan, 2017). A key method identified under this objective was to move to a “predict and prevent” model that would work in partnership with the individual Soldier to improve health (Army Medicine Campaign Plan, 2017). In 2015, the Army began to train health professionals and commanders to use an innovative system called the Medical Readiness Assessment Tool (MRAT), which uses a Soldier’s individual health data to identify those at higher risk for undesirable health outcomes that threaten readiness (“Medical Readiness Assessment Tool (MRAT),” n.d.). Developed by Dr. D. Alan Nelson and others, the MRAT utilizes the same data sources that were used in this research to identify Soldiers whose BMI or history of injury (among numerous other predictors) puts them at increased risk for becoming MNR (“Medical Readiness Assessment Tool (MRAT),” n.d.). The methods that drive the MRAT were based on published studies on predicting readiness outcomes among soldiers (A. D. Nelson & Kurina, 2013; D. A. Nelson, Wolcott, & Kurina, 2016). The MRAT has shown promise for interventions that prevent musculoskeletal injuries (“Latest Army medical innovation to keep soldiers ready for the fight,” 2016), but there is no equivalent tool in the military health system for other health outcomes (such as

cardiovascular disease) or a mechanism for identifying when Soldiers have experienced stressful life changes.

A tenet of Army leadership is to care for the well-being of Soldiers (Department of Defense, 2017). The Army recognized that stressful life changes, among other concerns, can distract Soldiers from the mission, thus the Army has made efforts to provide greater instrumental support to Soldiers and their families (“Army Family

How Each Service Is Organized | DoDLive,” n.d.) in which commanders are reliant on lower levels of leadership to know their Soldiers and be aware what is going on in their lives. In many cases, leadership may know about the stressful life changes Soldiers are experiencing because they may request leave or need time off for medical appointments. In other cases, such as when a Soldier relocates and is assigned to a new unit, leadership has no mechanism to know about the stressful life changes a Soldier has experienced. This research established that stressful life changes do have an effect on Soldiers’ health. Similarly to or in conjunction with the MRAT, the Army could use information on stressful life changes to help identify Soldiers who have had stressful exposures and employ existing resources to mitigate the risk of developing undesirable health outcomes. Expanding the capabilities of the MRAT to identify Soldiers who have experienced stressful life changes could enhance the applicability of the MRAT by furthering its usefulness in identifying those at higher risk for undesirable health outcomes that are related to stressful exposures.

The Army has resources and existing programs specifically aimed to improve the ability of Soldiers to adjust and adapt (Casey, 2011). The Comprehensive Soldier and Family Fitness (CSF2) program mandated resilience training to all Soldiers, with the primary aim of enhancing Soldiers’ “psychological strength” (Casey, 2011;

Comprehensive Soldier and Family Fitness, 2014). Evaluation of the CSF2 program showed reduced odds of mental health diagnosis for those who received resilience training (Harms, Herian, Krasikova, Vanhone, & Lester, 2013). A further step in

proactively addressing Soldier health could be to use the MRAT to identify Soldiers who have recently experienced stressful life changes and then employ proven resources at

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critical transitions in a Soldier’s life-course to help the Soldier adjust and adapt to the consequences of stressful life changes.

Soldiers are often young and active, but as shown by this research and previous studies, they are not free of cardiovascular risk factors nor are they insulated from substantial weight gain that threaten readiness. The Army represents the largest known population that consistently self-monitors weight, and – as indicated by the over 60% of Soldiers with a constant or declining BMI trajectory – this appears to be effective for the majority of individuals. The Army’s mandatory bi-annual weight and body composition checks and the inconvenient and career-threatening ramifications when Soldiers do not comply with weight standards are reinforcing factors in a Soldier’s motivation to self- monitor and self-manage weight (“Overweight,” n.d.; United States Army, 2013). Even with standards for physical fitness and body composition, over 30% of Soldiers were in a BMI trajectory group that had a high percentage of individuals who exceeded weight standards. A possible way to leverage existing processes that promote and reinforce weight self-monitoring is to increase the frequency of annual mandatory weight

assessments, which may help motivate Soldiers to maintain a weight that complies with regulations and minimizes weight fluctuations.