More than 70% of U.S. firefighters are overweight or obese, exceeding the national average for adults and presenting a major threat to firefighter health and safety, statistics show.
Obesity is associated with an increased risk of high blood pressure, cardiovascular disease, job-related disability and line-of-duty death.
However, a study of 1,002 male firefighters (http://www.cdc.gov/pcd/issues/2014/14_0091.htm) recently published in the CDC’s electronic journal, Preventing Chronic Disease (PCD), found that most firefighters (69.2%) reported receiving no weight advice in the past year, and fewer than half of the obese firefighters reported being advised to lose weight.
This marks a missed opportunity to prevent further weight gain and reduce obesity-related health outcomes, the study concludes.
About the study
“The objective of this study was to describe the prevalence of health care professionals (HCPs) weight advice among male career firefighters and assess the association of age and BMI with receiving advice,” the study states.
Researchers utilized firefighters’ self-reported data on the weight recommendations they received, and measured the body mass index (BMI) of participants from a 2011–2012 national sample of male firefighters.
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The weight recommendations were recorded as no advice, maintain, gain, or lose weight, and BMI was categorized as normal (<25.0 kg/m2), overweight (25.0–29.9 kg/m2), class I obese (30.0–34.9 kg/m2), and class II or III obese (≥35.0 kg/m2). The study estimated the odds of receiving weight advice by age and BMI category. Results
Overall, 82.5% of firefighters were overweight (BMI of 25.0–29.9 kg/m2) or obese (BMI of ≥30.0 kg/m2).
The study found that most (69%) firefighters and 48% of class I to III obese firefighters reported receiving no weight advice. Among overweight firefighters, only 12% received advice to lose weight.
Higher BMI predicted HCP advice to lose weight.
Younger firefighters were less likely to receive weight loss advice than older firefighters, except those who were class II or III obese.
The finding that receipt of advice to lose weight depends on the joint effects of age and BMI indicates that many health care providers may reserve weight loss counseling for individuals with established obesity-related complications, the study suggests.
However, this lack of weight counseling for young overweight or class I obese firefighters marks a missed opportunity to prevent further weight gain, and potentially delay or prevent the onset of obesity-related morbidities.
Also notable, the study concludes that firefighters from departments reporting implementation of Wellness-Fitness Initiative recommendations had higher odds of receiving weight loss advice from an HCP than firefighters in standard departments.
The Wellness-Fitness Initiative is a voluntary program that recommends annual medical evaluations. As a result, participating firefighters are encouraged to be more aware of their health risks and may be more likely to see HCPs specializing in occupational medicine, who may be more aware of the health risks associated with obesity in the fire service than primary care physicians.
The study concedes that although it primarily used BMI to define obesity, BMI may not be the most appropriate metric for defining overweight and obesity in populations with high levels of muscle mass.
It notes, “The proportion of overweight firefighters receiving weight loss advice increased slightly from the proportion of BMI-only defined overweight (12.75% and 12%, respectively).” It defends the use of BMI, stating this study and previous studies of firefighters demonstrate high agreement between BMI, body fat percentage and waist circumference for defining obesity.
“Because BF% and WC assessments are not part of routine physical assessments for many HCPs and national recommendations for the diagnosis and treatment of obesity are based on BMI, BMI was used as the main measure of adiposity in this study.”
Reducing overweight and obesity in the fire service could correspond to an improvement in overall firefighter health and public safety, the study states.
“HCPs should appropriately advise firefighters on weight loss and maintenance according to national guidelines; however, this study identified inconsistent weight loss advice for overweight and obese firefighters. In particular, young overweight and obese firefighters are not receiving adequate weight counseling.”
Previous studies of HCP advice in the general population have found a significant positive association with advice and successful attempts to lose weight, the study says.
Recently, the American Heart Association, American College of Cardiology, and The Obesity Society released the “2013 Guidelines for the Management of Overweight and Obesity in Adults.”
“This report provides evidence-based guidelines for HCPs and recommends that every adult patient be screened annually for overweight and obesity using BMI and WC standard cutpoints,” the study notes.
“Patients identified as overweight or obese should receive counseling on the risks for cardiovascular disease (CVD), type 2 diabetes, and all-cause mortality associated with increased adiposity and prescribed dietary strategies for weight loss and lifestyle interventions, as necessary.”
The study notes that additional research is necessary to evaluate the effect of the updated guidelines on HCP weight counseling practices. In addition, “Future research should investigate barriers to receiving weight loss advice and health benefits of HCP weight loss counseling in the fire service.”