Army Overweight Counseling Statement Example in MS Word and Pure-edge

Soldiers fail to meet Army Height and Weight standards for various reasons which range from poor eating habits and training to
just plain lack of discipline. When a Soldier fails the "Tape Test" he or she must be counseled on a DA Form 4856, FLAGGED,
referred to a health care professional screening and diet planning, Also given extra PT but be sure to check your Unit SOP and
Command Policy Letters. Here is an Example Counseling Statement for you to use as a guide while writing your DA 4856.
Download this Counseling Statement in MS Word or Pure-edge  See Also: AR 600-9 and FM 7-22
Army Overweight Counseling Statement
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PART II - BACKGROUND INFORMATION
Purpose of Counseling

To Discuss:

PFC Obama’s noncompliance with the Army Overweight and Body Fat Standards IAW AR 600-9
Possible courses of action and corresponding solutions
Inform PFC Obama of possible actions that could adversely affect his career
PART III - SUMMARY OF COUNSELING
Complete this section during or immediately subsequent to counseling.
Key Points of Discussion:
On 16 July 2013 you were weighed IAW AR 600-9.
1.        Your authorized screening weight IAW AR 600-9 is:            _____ lbs.   
Your current weight is:                                                           _____ lbs.
You are over your screening weight by:                                 _____ lbs.

2.        Your authorized body fat % IAW AR 600-9 is:                               _____ %
Your current body fat % as determined using the tape method is:     _____ %
You are over your allowable body fat % by:                                    _____ %
Actions:
As a result of this weigh in I am recommending to the Commander that you be placed in the Army Overweight Program.  Should the
Commander place you in the overweight program the following actions may be taken:

1.  You will be flagged IAW AR 600-8-2.  This flag will suspend all favorable actions to include enrollment in any military school and
tuition assistance.
2.  You will be evaluated by a health care professional to determine if there are any medical conditions causing this condition.  Your
appointment for the medical screening has been scheduled for: 27 July 2013, at Warner TMC.
3.  You will be required to attend nutrition counseling.  Your nutrition counseling appointment has been scheduled for 28 July 2013, at
Warner TMC.
4.  You will be enrolled in Special Population physical training.
5.  You will be required to maintain satisfactory progress.  Satisfactory progress is defined as a weigh loss of 3-8 pounds per month.
6.  You may not be removed from the program until you achieve your body fat percentage.  The screening table weight will not be
used to remove you from the program.
7.  You will be required to attend a monthly weigh-in as directed.  Monthly weigh-ins will be conducted on the first Tuesday of every
month.  

In addition, if you fail to achieve satisfactory progress for any two consecutive months you may be processed for separation from the
military.  If after a period of 6 months, you have not made satisfactory progress you may be separated from the military.  If you meet
the body fat percentage and are dis-enrolled from the program the following statements will apply:

•  If you are enrolled in the program within 12 months from the date of your removal, you will be separated from the military.      
•  If you are enrolled in the program after 12 months but within 36 months from the date of your removal, you will be given 90 days to
meet the standard.  If you fail to meet the standard in the allotted 90 days, you will be separated from the military.  _____(SM initials)
Soldier understands they will be removed from the program once the meet the required body fat standard. Soldier received Standard
Derogatory Counseling concerning separation. Soldier received a counseling statement containing the specifics of the flag action.
OTHER INSTRUCTIONS
APFT Failure