Slideshow: All-female U.S. Marine team in Afghanistan

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The biggest hurdle to women serving in combat roles is the same obstacle for men, experts say. They need to be fit, not fat.

Launch slideshow

Women don’t have enough upper-body strength. They can’t run as fast. Their monthly cycle will interfere with being on the front lines. All the arguments against letting women serve in the military are being made again as Defense Secretary Leon Panetta lifted restrictions on women serving in direct combat roles.

But experts on fitness and on women in the military say the past two decades have shown that being female is not the biggest barrier to serving on the front lines. Being fat is.

“I don’t think gender is a factor at all,” says retired Navy rear admiral Jamie Barnett, who is now at the Potomac Institute for Policy Studies. “I do think there are physical requirements and not all men or women will be able to meet those physical requirements. Those physical requirements should be tied specifically to making sure the job gets done.”

Just as with men, women selected to combat roles will be “a select few”, says Edward Archer, an exercise physiologist at the University of South Carolina. “When it comes to physical capacity, I think without any question there will be females who will be able to exceed and excel and to perform as well as the average male, in that setting.”

The various branches -- Air Force, Navy, Army and Marines -- already have differing requirements for physical fitness, by branch and by gender. All have a minimum standard, calculated using three exercises that include running, either pull-ups or push-ups, and sit-ups. Women's requirements are lower in some cases, but the Marines doesn’t give females a break at all when it comes to minimum physical fitness.

Scott Olson / Getty Images file

Marine Corps recruit Megan Shipley (C), 17, of Kingston, Tennessee lets out a yell during hand-to-hand combat training at the United States Marine Corps recruit depot June 23, 2004 in Parris Island, South Carolina. Marine Corps boot camp, with its combination of strict discipline and exhaustive physical training, is considered the most rigorous of the armed forces recruit training.

Barnett notes that these are general fitness measures that may mean little when it comes to completing a specific task or mission. “You can be a football player and if you go out with your mom on a half marathon and you haven’t trained for it (and she has), she’ll kick your butt,” Barnett said.

There is a problem with fitness that affects the military, but it doesn’t reflect on women alone. It reflects on Americans in general, says Barnett, who as a member of a group called "Mission: Readiness" signed a report on the dangers posed by obesity to U.S. security.

“We are too unfit to fight, is the term. We are definitely an unfit society,” Archer added in a telephone interview. “They need basic training to get ready for basic training. This is true of both males and females,” Archer said.

“Already we see only one in four Americans between ages of 17 and 24 who can join the military,” Barnett said in a telephone interview. “The single biggest reason is that they are overweight.”

More than two-thirds of American adults are overweight or obese, and experts agree that both poor diet and a lack of exercise is to blame. The military needs men and women alike who are in the best possible shape, argues Barnett.

“Once you establish objective criteria for what the requirements are for a military job, then I say let women compete for those and let the best man or woman get the position,” says Barnett, who served in Iraq and who was deputy commander of the Navy Expeditionary Combat Command, with sailors serving in Iraq and Afghanistan.

“I think what we’ll find is there will be a lot of women who will be able to meet even the hardest positions.”

Experience shows this happens, says Lorry Fenner, a retired Air Force lieutenant colonel who is now at the Institute for National Strategic Studies at the National Defense University.

“Example after example can be found of women exceeding the expectations of their physical capabilities, finding work-arounds for heavy tasks, or teaming with their co-workers to complete their assignments to best effect,” Fenner writes in her book, “Women in Combat”.

“Obviously, not all women are strong enough for all jobs -- just as not all men are,” Fenner adds -- then describes how women recruits mastered tests to show whether they could scale walls and carry heavy equipment.

“When we study history, we find that women have coped with every aspect of war. Women have demonstrated the emotional courage to withstand the brutality of war, including during lengthy imprisonment as POWs under very harsh conditions in the Pacific and in European work and death camps; in very dangerous and stressful resistance fighting; in the face of rape and mutilation; and at the moments of their deaths,” Fenner writes.

The average woman is indeed weaker and has less heart, lung and blood oxygen capacity than the average man, says Archer. “But an elite female athlete can outperform the average male soldier easily in many ways,” he adds.

Fenner and Barnett say the U.S. military needs to be able to pull from a pool of the best recruits for all jobs, including front-line combat.

“My view is you can get the job done better if you can draw on the best talents that America has to offer, regardless of gender,” Barnett said. “If you have to be able to swim 3 miles in a certain amount of time, then it doesn’t matter what gender you are.”

Critics of the new policy also raise the issue of feminine hygiene -- something women in the military will hoot at. Women worried about monthly cycles can use oral or injected hormonal contraceptives to suppress ovulation and bleeding and studies show there is no additional danger to health from using birth control in this way.

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• Pentagon lifts ban on women in combat
• Critics: Women distract on front lines

Don’t miss the latest health news on NBCNews.com

Roll up a sleeve for the blood pressure cuff. Stick out a wrist for the pulse-taking. Lift your tongue for the thermometer. Report how many minutes you are active or getting exercise. 

Wait, what?

If the last item isn't part of the usual drill at your doctor's office, a movement is afoot to change that. One recent national survey indicated only a third of Americans said their doctors asked about or prescribed physical activity.

Kaiser Permanente, one of the nation's largest nonprofit health insurance plans, made a big push a few years ago to get its southern California doctors to ask patients about exercise. Since then, Kaiser has expanded the program across California and to several other states. Now almost 9 million patients are asked at every visit, and some other medical systems are doing it, too.

Here's how it works: During any routine check of vital signs, a nurse or medical assistant asks how many days a week the patient exercises and for how long. The number of minutes per week is posted along with other vitals at the top the medical chart. So it's among the first things the doctor sees.

"All we ask our physicians to do is to make a comment on it, like, 'Hey, good job,' or 'I noticed today that your blood pressure is too high and you're not doing any exercise. There's a connection there. We really need to start you walking 30 minutes a day,'" said Dr. Robert Sallis, a Kaiser family doctor. He hatched the vital sign idea as part of a larger initiative by doctors groups.

He said Kaiser doctors generally prescribe exercise first, instead of medication, and for many patients who follow through that's often all it takes.

It's a challenge to make progress. A study looking at the first year of Kaiser's effort showed more than a third of patients said they never exercise.

Sallis said some patients may not be aware that research shows physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. As recently as November a government-led study concluded that people who routinely exercise live longer than others, even if they're overweight.

Zendi Solano, who works for Kaiser as a research assistant in Pasadena, Calif., says she always knew exercise was a good thing. But until about a year ago, when her Kaiser doctor started routinely measuring it, she "really didn't take it seriously."

She was obese, and in a family of diabetics, had elevated blood sugar. She sometimes did push-ups and other strength training but not anything very sustained or strenuous.

Solano, 34, decided to take up running and after a couple of months she was doing three miles. Then she began training for a half marathon — and ran that 13-mile race in May in less than three hours. She formed a running club with co-workers and now runs several miles a week. She also started eating smaller portions and buying more fruits and vegetables.

She is still overweight but has lost 30 pounds and her blood sugar is normal.

Her doctor praised the improvement at her last physical in June and Solano says the routine exercise checks are "a great reminder."

Kaiser began the program about three years ago after 2008 government guidelines recommended at least 2 1/2 hours of moderately vigorous exercise each week. That includes brisk walking, cycling, lawn-mowing — anything that gets you breathing a little harder than normal for at least 10 minutes at a time.

A recently published study of nearly 2 million people in Kaiser's southern California network found that less than a third met physical activity guidelines during the program's first year ending in March 2011. That's worse than results from national studies. But promoters of the vital signs effort think Kaiser's numbers are more realistic because people are more likely to tell their own doctors the truth.

Dr. Elizabeth Joy of Salt Lake City has created a nearly identical program and she expects 300 physicians in her Intermountain Healthcare network to be involved early this year.

"There are some real opportunities there to kind of shift patients' expectations about the value of physical activity on health," Joy said.

NorthShore University HealthSystem in Chicago's northern suburbs plans to start an exercise vital sign program this month, eventually involving about 200 primary care doctors.

Dr. Carrie Jaworski, a NorthShore family and sports medicine specialist, already asks patients about exercise. She said some of her diabetic patients have been able to cut back on their medicines after getting active.

Dr. William Dietz, an obesity expert who retired last year from the Centers for Disease Control and Prevention, said measuring a patient's exercise regardless of method is essential, but that "naming it as a vital sign kind of elevates it."

Figuring out how to get people to be more active is the important next step, he said, and could have a big effect in reducing medical costs.

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Thomas Barwick / Getty Images Stock

Can you get up off the floor without using your hands, arms or knees to help you?

A simple test that looks at how easy -- or difficult -- it is for you to sit down on the floor and then get back up may help predict how long you’re going to live, a new study shows.

Middle-aged and elderly people who needed to use both hands and knees to get up and down were almost seven times more likely to die within six years, compared to those who could spring up and down without support, Brazilian researchers reported Thursday in the European Journal of Preventive Cardiology.

Doctors have long used the chair test -- where a person stands up from a sitting position -- to determine leg strength and lower body fitness of seniors. But the new test is more difficult and can be used with a younger group, said cardiologist Dr. Kathryn Berlacher, an assistant professor at the University of Pittsburgh Medical Center.

While the most important factor controlling the ease of getting down and then up is the ratio of muscle power to body weight, there are “other very relevant issues including body flexibility, balance, and motor coordination,” said Claudio Gil Soares de Araújo, a professor at Gama Filho University in Rio de Janeiro who worked on the study.

Ultimately the test gives a quick window into a patient’s ability to function from day to day.

“Moving, for the average person, especially those who are older, and the ability to rise from the floor is very much relevant for autonomy,” Araújo said. “Imagine if your glasses went below the bed. You would need to sit on the floor to reach then and then you would need to rise.”

The researchers followed 2002 adults aged 51 to 80 for an average of 6.3 years. Sixty-eight percent were men. At the outset, each study volunteer was asked to sit down on the floor and then get up, using the least amount of support from hands, knees and other body parts.

The volunteers could score five points if they could sit down without touching their knees, legs, hands, or arms on the floor and another five points if they could get back up unaided.

They lost a point for each body part that was leaned on while getting down or up. So, people who could get down touching the floor with just one knee scored four points. If they needed to touch a hand and a knee on the floor as they were rising, they would lose two points for a score of three. If the volunteers looked wobbly on the way down or up, they lost half a point.

The most agile ended up with a combined score of 10 while those who couldn’t get down or up at all were scored with a zero.

During the course of the study 159 of the volunteers died, with the majority of the deaths in the group that had the most trouble getting up and down.

A person’s score matched well with risk of death. People who scored zero to three were 6.5 times as likely to die during the course of the study, compared to people who scored from 8 to 10. Those who had scores of 3.5 to 5.5 were 3.8 times as likely to die as the high scorers -- and those who scored 6 to 7.4 range were 1.8 times more likely to die than those with the highest scores.

“Just two subjects that scored 10 died in the follow-up of about six years,” says Araújo. If  someone between the ages of 51 and 80 scores 10, “the chances of being alive in the next six years are quite good,” he said.

The test may be most valuable as a tool for primary care physicians to show patients they need to work on their health, Berlacher said. “These days most don’t exercise and if you ask them whether they walk up stairs they tell you about knee and ankle pain. So it’s hard to truly assess them.”

More health news from NBCNews.com:

• Caregivers neglect own health to look after others
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CDC.gov, Preventing Chronic Disease

Sit-stand devices used in the Take-a-Stand Project in Minneapolis, Minnesota, 2011.
The Take-a-Stand Project was a partnership with a sit-stand device manufacturer, Ergotron, Inc, Eagan, Minnesota.

Office workers who spent an hour or so a day at stand-up workstations felt more energized, productive and even happier, researchers reported on Thursday. And if they keep it up, they may help reduce the damage done by sitting at a desk all day.

Study after study has shown that sitting all day long is bad for you. People risk developing lower back problems, kidney disease, heart disease and other ills – even if they exercise outside of work.

“If you go out for a 30 minute run , and then sit for eight hours at work, you could still have health problems because you are sitting all day,” said Nicolaas Pronk, a vice president at Minnesota-based HealthPartners, a non-profit health care organization that provides clinics, health insurance and does health care research.

Pronk decided to test special workstations on the organization’s employees.

They recruited 34 volunteers to test some of the commercial workstations on the market that allow users to sit or stand, as they like, without having to move all their stuff.  They tried models made by Ergotron, Inc. of Eagan, Minnesota.

“There are different devices out there. The ones we tested, you clamp them onto the desk. It has a keyboard tray and you push up or push down as you want to sit or stand,” Pronk said. “Ergotron is located in the same town as we are. So we partnered with them.”

The question is, will people use them and if they do, do they stand up for enough of their days to make a difference. And if so, how does that affect them?

Over seven weeks, 10 workers stayed at their usual desks, while 24 used the new workstations, Pronk and colleagues report in this week’s issue of the journal Preventing Chronic Disease.

To be scientific, Pronk’s team checked in with workers several times a day to see whether they were standing or sitting and to see how they felt. “We provided all participants a prepaid cellular telephone and sent text messages at three random times throughout the course of the work day. Immediately upon receiving a text message, participants responded to the question, ‘Tell us what you are doing right now: sitting, standing, or walking?’ by using 0, 1, or 2 for sitting, standing, or walking, respectively,” the researchers wrote.

They also surveyed the workers more thoroughly three times during the study, once at the end of the seven weeks.

People really liked them, Pronk said. “People felt happier. They felt more confident. They were more productive. Across the board, the feedback was very positive.”

The workers who used the devices were lavish in their praise – 87 percent felt more comfortable,  87 percent felt energized, 75 percent felt healthier, 71 percent felt more focused, 66 percent felt more productive, 62 percent felt happier, and 33 percent felt less stressed.

“Not a single person in the intervention group indicated that they did not like the device,” Pronk said. In fact, HealthPartners now offers them to all employees.  “Around 30 percent have them. There are about 2,000 people today who have one at their station,” Pronk said.

People sat, on average just over an hour less every day. While standing didn’t help lower back pain, it reduced upper back and neck pain by 54 percent, Pronk found.

Research is piling in that that shows just the act of sitting most of the day can cut years off your life. Researchers reported in July that cutting the time that people spend sitting to less than three hours would increase the U.S. life expectancy by two years. And reducing the time spent watching TV to less than 2 hours daily would increase life expectancy by 1.4 years.

Last month, British researchers found that people who spent the least amount of time sitting were also the least likely to have chronic kidney disease.

Pronk is himself sold on the idea. “I don’t think this is a fad. It’s a new way of doing your work,” he said. He uses one now. “I probably stand about 80 percent of the time when I am in my office. I leave it up when I leave at night so it’s up when I come in in the morning,” Pronk said.

Part of the appeal may be that employees can control the device themselves. “You literally can push this device up with your hand and you can stand up,” he said.

“It has an impact on their work while they at work. The fact is that sedentary job tasks will end up making people sit for such long periods of time that it truly, literally, affects their longevity, so this is a very important area of intervention. The entire work force can go home more energetic and energized than they came in in the morning. That makes a huge difference from a work-life balance perspective.”

Related links:

• Less sitting would add two years to Americans' lives
• All that sitting is killing you 
• Stand up, for the sake of your kidneys

Image Source / Getty Images file

In the 13 heaviest states, 60 percent of residents will be obese in less than two decades if current trends continue, finds a new report.

Think Americans are fat now? After all, a third of us are overweight and another 35 percent are obese. But a report out Tuesday projects 44 percent of Americans will be obese by 2030.

In the 13 worst states, 60 percent of the residents will be obese in less than two decades if current trends continue, the report from the Trust for America’s Health projects. That’s not chubby or a little plump – that’s clinically obese, bringing a higher risk of heart attacks, strokes, diabetes, several forms of cancer and arthritis.

“The initial reaction is to say, ‘Oh it couldn’t be that bad’,” says Jeff Levi, executive director of the Trust for America’s Health. “But we have maps from 1991 and you see almost all the states below 10 percent.” By 2011 every single state was above 20 percent obesity, as measured by body mass index (BMI), the accepted medical way to calculate obesity. Those with a BMI or 30 or above are considered obese.

In August, the Centers for Disease Control and Prevention reported that 12 states have an adult obesity rate over 30 percent. Mississippi had the highest rate of obesity at 34.9 percent. On the low end, 20.7 percent of Colorado residents are obese. CDC projections for obesity resemble those in Tuesday's report - it projects 42 percent of adults will be obese by 2030.

The problem isn’t just cosmetic. “The number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis could increase 10 times between 2010 and 2020 — and then double again by 2030,” the report projects.  “Obesity-related health care costs could increase by more than 10 percent in 43 states and by more than 20 percent in nine states.”

That’s bad news when states are already strapped to pay for public health programs such as Medicaid and the federal government is struggling to fund Medicare.

Over the next 20 years, more than 6 million patients will be able to blame obesity for their diabetes, 5 million will be diagnosed with heart disease and 400,000 will get cancer caused by obesity.

And some of them are frighteningly young.

"Now I am seeing 25-year-olds weighing 350 pounds who present with chest pain or shortness of breath," says Dr. Sheldon Litwin, a cardiologist at Georgia Health Sciences University. “Everything from the heart disease process to its diagnosis and treatment are affected by obesity. We see it every day. This really is the number-one issue facing us," added Litwin, who worked on one of a series of obesity studies published in this week’s issue of the Journal of the American Medical Association.

The trend is not inevitable, according to the report, entitled “F as in Fat.” Some programs are beginning to make a dent in the rising rates.  “We certainly see, in some communities, the beginning of some changes,” says Levi. “We know what some of the answers are.”

Convicted killer: I'm too obese to be executed

For instance, making it easier for people to exercise day in and day out, and making it easier to get healthy food. “A large-scale study of New York City adults found that increasing the density of healthy food outlets, such as supermarkets, fruit and vegetable markets, and natural food stores is associated with lower BMIs and lower prevalence of obesity," the report reads.

What about initiatives like New York’s controversial ban on the largest sodas? “Every community is going to experiment with different approaches. It is going to be very interesting to see what happens in New York and whether this makes a difference,” Levi said.

New York’s health commissioner, Dr. Thomas Farley, defends the move in the medical journal’s obesity issue. "How should government address the health problems caused by this successful marketing of food? To do nothing is to invite even higher rates of obesity, diabetes, and related mortality,” he wrote.

Trust for America's Health

Many studies have also shown that people who live in big, walkable cities such as New York and Washington D.C. are thinner than their rural and suburban counterparts, and it’s almost certainly because they walk more and use public transportation instead of sitting in cars.

If everyone lost just a little weight, the savings would be enormous, the study predicts.

“If we could lower obesity trends by reducing body mass indices (BMIs) by only 5 percent in each state, we could spare millions of Americans from serious health problems and save billions of dollars in health spending —between 6.5 percent and 7.8 percent in costs in almost every state,” the report says.

Education can’t hurt, either. The more educated people are, the less likely they are to be obese. Higher-earners are also thinner. “More than 33 percent of adults who earn less than $15,000 per year were obese, compared with 24.6 percent of those who earned at least $50,000 per year,” the report notes. And several studies have shown that people who eat more fruits and vegetables are thinner, as well as healthier. “Seven of the 10 states with the highest rates of obesity were also in the bottom 10 for fruit and vegetable consumption,” the report says.

Levi believes it’s worthwhile targeting kids the hardest. New nutritional guidelines for schools will help, he said, as will initiatives to restore recess and physical education classes. Beverage makers have agreed to replace sugary sodas in vending machines with water and other low-calorie drinks. “It is as simple as an hour a day less of screen time and one less sugar beverage,” Levi says.  “Just 120 calories can make a big difference as to whether a kid crosses over from being normal weight into overweight and obesity.”

Another study in the Journal of the American Medical Association showed that kids who exercised 20 minutes a day lowered an important measure of diabetes risk by 18 percent. Exercising 40 minutes a day cut the risk by 22 percent. The researchers also noted it’s important to make exercise fun for kids

"Regulation sports tend to have kids standing around a lot waiting for the ball. We had enough balls so everyone was moving all the time," said Dr. Catherine Davis of Georgia Health Sciences University. "It had to be fun or they would not keep coming.”

For some people, drastic measures remain an option. One study in the Journal shows that gastric bypass surgery is a viable option. And two doctors present opposing views over whether the Food and Drug Administration holds obesity drugs to an unreasonably high standard. On Tuesday, one of the newest obesity drugs hits the market - Qsymia, made by Vivus.

Are you obese? The National Institutes of Health has a BMI calculator here. http://www.nhlbisupport.com/bmi/

If you’re 5 feet 6 inches tall, you become overweight at 160 pounds (a BMI of 25.1) and obese at 192 pounds, when your BMI grows to 30.1.

Trust for America's Health

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