The Office of the Surgeon General/Medical Command hosted its Commander's Conference at the Defense Health Headquarters earlier this month. A major topic that the senior medical leaders discussed was transforming Army Medicine from a healthcare system to a system for health.According to Brig. Gen. Brian C. Lein, the U.S. Army Medical Command Deputy Commanding General for Operations, the Army's System for Health initiative is a partnership among Soldiers, Families, leaders, health teams and communities to promote Readiness, Resilience, and Responsibility.The System for Health intends to maintain the Army Family's health through fitness and illness and injury prevention; restore health through patient centered care; and improve health through informed choices in what the Army Surgeon General Lt. Gen. Patricia D. Horoho refers to as the Lifespace-- those more than half a million minutes a year that people spend outside of a doctor's office; i.e. the time they spend living their lives.Horoho's main strategy for helping Soldiers and the Total Army Family be healthier is through her "Performance Triad" of Activity, Nutrition and Sleep."It is in these areas that I think we can have the biggest impact to really make sure that we are ready and resilient and able to respond to whatever the future challenges are for our Army," said Horoho.Lein further explained, "The goal of the Performance Triad is to improve individual performance and resilience through improved sleep, activity, and nutrition discipline. Improvements in individual readiness equals improvements for the entire unit," he said. "The reality is that --with sleep for example-you are as dysfunctional if you haven't slept for 24 hours as you are if you were legally drunk. Proper sleep discipline is critical for a fighting force. We really have to face our challenges regarding poor sleep, nutrition, and activity discipline head on," Lein said.At a recent symposium at Washington, D.C.'s Newseum called Inactivity in America: A Looming Public Health Crisis, Army Medicine's Col. Theresa Gonzales said, "A growing number of [possible] recruits are quite frankly and regrettably too fat to fight. More than 9 million Americans of prime recruiting age are too heavy to join. One in four between the ages of 17-24 are simply ineligible to serve," she said.The health of the military and the health of the nation are not separate discussions, Gonzales explained."Our nation's Warriors come from our nation's citizens. Therefore, Army Medicine cannot overlook the issues that affect the health of our national population," Gonzales said.If large numbers of possible recruits are ineligible to serve because they are overweight, then poor activity and nutrition discipline is not just a matter of national health. It is, in fact, a matter of national security. So far in 2012, the Army has discharged more than 1600 Soldiers for not meeting its height and weight standards.The Surgeon General's/Army Medicine's Performance Triad is designed so that Soldiers, leaders and all members of the Army Family are practicing proper sleep, activity, and nutrition discipline because they believe it is the best for them--not just because they are being told to do so. The hope is that with the nation's Warriors leading the way, the rest of the nation will jump on board."The [healthier] behaviors must be adopted as a nation," said Gonzales. "It cannot just be a condition of employment."While the Army may have significant influence in the Lifespace of its full time serving population, the challenges become greater with regard to the Army Reserve and National Guard-the reserve component (RC). They constitute more than a half of the Army's force, but serve part-time unless called to full-time service. In fact, 80 percent of the transportation capability is in the RC, 75 percent of the engineers, and 70 percent of the medical are also in the RC. About two-thirds of the Army's enabling capability is in the RC and the Army has activated more than half a million RC Warriors since 911. Army Medicine leaders did not seem clear yet on how they will implement the Performance Triad within the reserve component."This challenge is high on my priority list," said Horoho. "The reserve component provides strategic depth to our force and they have a valuable connection to the broader U.S. population. And quite frankly, 70 percent of my medical capabilities are within the reserve component. Therefore, in terms of readiness of the force the Performance Triad is just as important for the part-time Warriors as it is for those who serve on active-duty full-time," said Horoho.Army Medicine intends to implement a Performance Triad pilot program at three installations: Joint Base Lewis McChord, Wash., Fort Hood, Texas, and Fort Campbell, Ky. They will test the program with one battalion sized element at each location for a total of about 2200 Soldiers for 180 days.The key indicators for activity will include: Army Physical Fitness Test score, metabolic rate, and abdominal circumference. For nutrition the indicators will include quantity and quality of caloric intake and number and time of day of meals. For sleep the indicators will be duration, quality and psychomotor vigilance test.In order for the program to be successful, full support is needed at the highest levels."It's going to be important for Army leaders to not only be on board with this intellectually, but in practice," said Lein. "We in Army Medicine specifically will have to lead by personal example. I am asking you as Army Medical Department Leaders to adopt this program," Lein appealed to Army Medicine leaders--so that when you are talking to your Soldiers about their sleep, activity, and nutrition behaviors, you can honestly say--"and oh by the way, I'm doing this too," said Lein.Army Medicine expects to roll out the Performance Triad pilot program between March and April of 2013.