On average, space missions are associated with cumulative loss of bodyweight over time. Unless effective countermeasures are implemented, significant weight loss will be a likely outcome in a subset of astronauts as mission durations increase. New predictors of intra-mission bodyweight changes and other associated factors are identified.

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Almost nothing was known about the effects of spaceflight on human physiology when, in May of 1961, President John F. Kennedy committed the United States to land a man on the Moon and return him safely to Earth within the decade. There were more questions than answers regarding the effects of acceleration, vibration, cabin pressure, CO2 concentration, and microgravity. There were known external threats to life, such as solar and ultraviolet radiation, meteorites, and extreme temperatures as well as issues for which the physicians and scientists could not even formulate the questions. And there was no time for controlled experiments with the required numbers of animal or human subjects. Of necessity, risks were evaluated and mitigated or accepted based on minimal data. This article summarizes presentations originally given as a panel at the 79th Annual Scientific Meeting of the Aerospace Medical Association in Boston in 2008. In it, five pioneers in space medicine at NASA looked back on the development of their field. The authors related personal anecdotes, discussed the roles of various people and presented examples of contributions to emerging U.S. initiatives for human spaceflight. Topics included the development of quarantine facilities for returning Apollo astronauts, the struggles between operational medicine and research personnel, and observations from the first U.S. medical officer to experience weightlessness on orbit. Brief biographies of the authors are appended to document their participation in these historic events.