A new report estimates that obesity is costing the U.S. military $1.35 billion annually between direct care expenses and productivity losses — and the military’s approach to the growing problem isn’t working.

The American Security Project published a report that calculated the burden of obesity on the military health system for the first time since 2007.

Direct health care costs account for $1.25 billion, with lost productivity from obesity-related hospitalizations, injuries and illnesses coming to another $99 million.

Two-thirds of active-duty troops are overweight or obese — and obesity is a leading driver of the military recruitment crisis, with about 52,000 applicants disqualified based on their weight last year.

This is a serious readiness issue for the military, said Courtney Manning, the lead researcher on military recruitment and readiness at the American Security Project.

“It impacts manpower, health and combat effectiveness,” Manning said.

Obesity is keeping people out of the service, forcing troops to leave the service and raising the risks for those still in the service.

“The scale of the problem has risen just from 10% 10 years ago to 22%. Some studies even say 25% obesity rate in active duty,” Manning said.

The costs have risen as the scope of the problem has risen.

The health care burden was last estimated using 2006 data at $1.1 billion annually for military personnel, retirees and military dependents combined.

Obesity impacts all body systems, Manning said, and it’s associated with an increased risk for many serious diseases and health conditions.

The health effects of obesity can sneak up on people “like a frog in boiling water,” Manning said.

Obesity is defined as a body mass index of 30 or higher, according to the Centers for Disease Control and Prevention.

Obesity rates are lower in the military than in the general population, but the public isn’t tasked with defending the nation.

“So, pretty much anyone, if you’re deployed in a war zone, is going to struggle with the demands physically and emotionally of that role,” Manning said. “But if you’re a person with obesity, you have double, triple or even quadruple the risk of some of these conditions happening to you when you cannot reliably access health care, when you cannot reliably be lifted physically outside of the combat zone, and when you cannot reliably stay in that position.”

Manning said they found and evaluated the efficacy of 22 military weight-loss programs.

“None of them are able to keep weight off service members once they’ve reached that threshold,” she said.

Only around 3% of people in the military can successfully lose 5% of their body weight and keep it off for longer than 12 months, she said.

“The service members don’t tend to stay in service long enough to sustain that weight loss because they might be exceeding weight standards for 12 months, 24 months, and then they’re out before we even get to address the underlying reasons for why they’re gaining weight,” Manning said.

Around 30% to 50% of obesity is genetic, she said.

Environmental factors also come into play.

In the military, easy access to fast food or dining hall food without clear portion sizes can contribute to weight gain.

Manning said there are morale programs on bases that include comfort measures that can lead to obesity.

There’s also underutilization of the military health care system for obesity care management, she said.

Add in the stigma and possible adverse career impacts of obesity, and some service members aren’t getting the help they need to lose weight and improve their health, she said.

“If the best, most well-resourced and most highly controlled weight-loss programs don’t work, why are we continuing to impose them?” she said.