Soldiers often call plastic surgeon Adam Tattelbaum in a panic. They need liposuction — fast.
Some military personnel are turning to the surgical procedure to remove excess fat from their waists in a desperate attempt to pass the Pentagon's body fat test, which relies on measurements of the neck and waist and can determine their future prospects in the military.
"They come in panicked about being kicked out or getting a demerit that will hurt their chances at a promotion," the Rockville, Md., surgeon said.
Service members complain that the Defense Department's method of estimating body fat weeds out not just flabby physiques but bulkier, muscular builds.
Fitness experts agree and have joined the calls for the military's fitness standards to be revamped. They say the Pentagon's weight tables are outdated and do not reflect that Americans are now bigger, though not necessarily less healthy.
Defense officials say the test ensures troops are ready for the rigors of combat. The military does not condone surgically altering one's body to pass the test, but liposuction is not banned.
The Pentagon insists that only a small fraction of service members who exceed body fat limits perform well on fitness tests.
"We want everybody to succeed," said Bill Moore, director of the Navy's Physical Readiness Program. "This isn't an organization that trains them and says, 'Hey, get the heck out.'"
The Defense Department's "tape test" uses neck and waist measurements rather than the body mass index, a system based on an individual's height and weight that is widely used in the civilian world.
Those who fail are ordered to spend months in a vigorous exercise and nutrition program, which Marines have nicknamed the "pork chop platoon" or "doughnut brigade." Even if they later pass, failing the test once can halt promotions for years, service members say.
Failing three times can be grounds for getting kicked out.
The number of Army soldiers booted for being overweight has jumped tenfold in the past five years from 168 in 2008 to 1,815. In the Marine Corps, the figure nearly doubled from 102 in 2010 to 186 in 2011 but dropped to 132 last year.
The Air Force and the Navy said they do not track discharges tied to the tape test.
Still, service members say they are under intense scrutiny as the military trims its ranks because of budget cuts and the winding down of the Afghanistan war.
Dr. Michael Pasquale of Aloha Plastic Surgery in Honolulu said his military clientele has jumped by more than 30 percent since 2011, with about a half-dozen service members coming in every month.
"They have to worry about their careers," the former soldier said. "With the military downsizing, it's putting more pressure on these guys."
Military insurance covers liposuction only if it is deemed medically necessary, not if it is considered cosmetic, which would be the nature of any procedure used to pass the test. The cost of liposuction can exceed $6,000.
Some service members go on crash diets or use weights to beef up their necks so they're in proportion with a larger waist. Pasquale said liposuction works for those with the wrong genetics.
"I've actually had commanders recommend it to their troops," Pasquale said. "They'll deny that if you ask them. But they know some people are in really good shape and unfortunately are just built wrong."
Jeffrey Stout, a sports science professor at the University of Central Florida, said the tape test describes the body's shape, not its composition, such as the percentage of body fat or the ratio of fat to muscle.
"I wouldn't want my career decided on that," he said.
A more accurate method, he said, would be to use calipers to measure the thickness of skin on three different parts of the body.
"That way these guys are not hurt by a bad measurement," said Stout, who has researched the accuracy of different body composition measurements.
Strength-and-power athletes and those who do a lot of twisting that builds up the muscle tissue over the hips would likely fail the Defense Department test, he added.
Marine Staff Sgt. Leonard Langston, 47, blames himself for weighing 4 pounds over his maximum weight of 174 pounds for his 5-foot-7 frame.
"I think we've gotten away with keeping ourselves accountable. Especially the older Marines have let things go," he said after sweating through 75 crunches with others ordered to the exercise program. "And unfortunately, I'm an example of that."
Military officials say the tape test is still the best, most cost-effective tool available, with a margin of error of less than 1 percent.
Air Force Gen. Mark Walsh noted only about 348 of 1.3 million airmen have failed the tape test but excelled otherwise.
Even so, his branch heeded the complaints and modified its fitness program in October. The Air Force obtained a waiver from the Pentagon so airmen who fail the tape test but pass physical fitness exams can be measured using the body mass index.
Marine Staff Sgt. Jeffrey Smith applauded the move. Smith said he has received five Navy achievement medals but has not been promoted since failing the tape test once in 2009.
"They call you names like 'fat bodies,'" Smith said. "They talk a lot of trash to you and put you down quite often."
He launched an online White House petition this summer to talk to leaders about the tape test.
The 1,700 signatures fell short of the 100,000 needed to get a response, but Smith said the Air Force gives him hope other branches might also heed the complaints.
"There's got to be something better for Marines who are working hard but just born like a tree stump," Smith said.