Fat chance
Policy change on medication

Exercise is crucial to keeping weight under control.

Photo by AB Kade Rogers

OVERWEIGHT and obese ADF personnel may be prescribed some of the newer weight loss drugs that until recently they have not been allowed to use.

However, people on weight loss medication will generally be considered temporarily nondeployable. According to the last health survey, the 2000 Health Status Report, about 53 per cent of Air Force personnel – 57 per cent of men and 32 per cent of women – were overweight or obese.

About 55 per cent of Navy personnel – 57 per cent of men and 42 per cent of women – were overweight or obese. No data exists for Army personnel.

In August, the Defence Health Service Branch modified its policy on weight loss medication. Previously, ADF personnel were only able to use three medications to control their weight: Duromine, Modifast or Xenical.

Now, Defence medical officers are able to choose any approved weight loss medication most appropriate or effective for a patient.

Colonel Glenn Wells, the Director Clinical Policy, said the new policy of not listing specific drugs, but instead allowing the use of any weight loss medication registered by the Therapeutic Goods Authority, would “avoid exclusion of new drugs which may possibly be developed with better effects and allow more options for treatment to be better tailored to the individual”.

Medication will only be prescribed under certain circumstances (see panel). Personnel will generally be considered non-deployable while on weight loss medication because of the difficulty of correct food selection while deployed, the need to be on a formal weight loss program and the need to be regularly monitored to assess weight loss or side effects to the drugs.

COL Wells said if personnel had tried to lose weight through diet and exercise, but were not successful, they should seek further advice and support from their medical officer, but the use of weight loss medication was not the first step to manage obesity and its use alone had consistently shown not to result in permanent weight loss.

“Weight loss medication is not a ‘cure all’,” he said.

“The use of such medication does not obviate the need to make changes to diet and to increase physical exercise. The role of the medication is to support the member in adhering to an appropriate weight loss program.”

He said the weight loss attributable to medication was “modest”.

“Compared with weight lost using a placebo, the extra amount lost is usually not more than 4kg. However, this degree of weight loss can be associated with important health benefits,” he said.

“Medication is only effective while it is being taken. Weight is often regained after drug therapy is stopped. The crucial factor in preventing weight regain, or in maintaining continuing loss, is longterm behaviour modification. Individuals who return to a previous, unhealthy lifestyle upon cessation of medication will regain lost weight.”

AT A GLANCE

The policies

Health Directive (HD) 206 outlines the current ADF policy on the management of weight. HD 242 provides education and advice on maintenance of a healthy lifestyle, including nutrition. HD 246 provides guidelines for healthy eating, safe levels of alcohol intake, and recommended modes and volumes of exercise.

How the new policy works

Members must see their MO for full assessment and management of their weight problem. The MO is only authorised to prescribe weight loss medication for ADF members who: - Have a Body Mass Index (BMI) > 30, or a BMI > 27 with a co-morbidity (a complicating condition relating to being overweight or obesity); and - Have failed to lose weight after an adequate trial of a program combining dietary modification, exercise and behavioural (psychological) therapy.

The impact on deployment

Personnel of a normal weight (BMI up to 25) and overweight personnel (BMI up to 30) are deployable. Personnel are still deployable with a BMI = 30 (obese), as long as they have no complicating conditions and have maintained the required fitness level. However, personnel with a BMI = 35 are generally not considered deployable, although Navy does not apply the HD 206, in this respect, as strictly as Air Force and Army. There are specific single-Service requirements for weight for certain occupational or trade groups due to the demands of the jobs and/or due to the need to safely operate or wear specific equipment, as well as to safely exit vehicles, airframes or vessels, in emergency situations.

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