Fighting Fire with Fire – The Impact of Obesity on Firefighter Health

A sure sign of the concern mounting over the rate of obesity in the U.S. is the number of studies that are coming out analyzing the issue from a myriad of different angles. One of the most recent, Adiposity Predicts Self-Reported Frequency of Poor Health Days Among Male Firefighters, looks at the issue of overweight or obese firefighters. Studies have shown that the prevalence of obesity among firefighters is greater than that of the general population (see our blog post). Obesity has been associated with cardiovascular problems and job disability; some posit that the physical demands of the job, combined with obesity, likely contribute to cardiovascular problems, identified by some as the leading cause of on-the-job firefighter fatality. Research undertaken by Austin L. Brown, MPH, et al. comes to the conclusion that firefighters who are overweight or obese are more likely to report feeling unwell. The importance of this cannot be understated. Studies of the general population have shown that self-reports of feeling below par are a “significant predictor” of an increased mortality risk. They are also associated with chronic health conditions, increased use of healthcare services and “risky health behaviors.” The question is whether these associations are equally applicable to the firefighter population.

There is no doubt that firefighting is a stressful occupation. It requires both physical fitness and mental acuity. Where this is lacking, where the firefighter feels in “poor health”, not only may the firefighter’s safety be compromised, but also the safety of those around him or her. Studies such as this one, which take a closer look at contributing factors, are therefore helpful.

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Risk Management Tip: According to Rebecca Shafer, JD, President of Amaxx Risk Solutions and author of Your Ultimate Guide to Mastering Workers’ Comp Costs, “The effects of obesity are well documented on total number, the length, and total cost of workers compensation claims. According to a Duke University study obese workers account for twice as many claims, 13 times more lost workdays, 7 times higher medical costs, and 11 times higher indemnity costs.  Given this known data, the industry specific information for firefighters is alarming as there is much more at stake for these workers on the job.  A recommended solution for this problem is the implementation of a wellness program, as well as, an active return to work program with transitional duty tasks while workers are recuperating. Making the wellness programs free of charge encourages participation.”

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The study analyzed data collected between 2010 and 2012 from 20 fire departments nationwide. Of these fire departments, 10 had implemented recommendations of the Fire Service Joint Labor Management Wellness-Fitness Initiative and 10 had not. All the participants were male firefighters, 66% were white, 67% of firefighter rank and 72% non-smokers. Firefighter measurements (BMI, waist circumference and percentage of body fat) were taken by trained personnel; physical health conditions were collected through a self-reported questionnaire. Firefighters were asked to respond to the question, “Now thinking about your health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?” The results showed that those with greater BMI, waist circumference and body fat reported feeling unwell approximately 1.57 days more in the previous 30 days than their leaner counterparts. That tallies up to nearly 19 more days annually. Furthermore, as the indicators of adiposity increased, so too did the frequency of self-reported days in which the subject felt unwell. According to the study, these findings are consistent with studies of the general population and therefore provide yet further evidence of the association between obesity and self-reported poor health.

The study acknowledges some limitations, including the fact that it relied on self-reporting, potentially subjecting the data to recall bias. Additionally, since this was a cross-sectional study, no conclusions can be drawn on causality, including why there is a prevalence of obesity amongst firefighters. In other words, the study did not look at which on-the-job stressors (such as long shifts, diet, frequent overtime, organizational pressures etc.) could potentially contribute to obesity levels. Nevertheless, the results are consistent with previous studies examining the deleterious effect of obesity on the health and job performance of firefighters. Given both the individual and public health and safety issues at play, the importance of a concerted effort to reduce obesity within this occupational subgroup seems clear.

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Occupational Medicine Perspective—The Most Important Exercise Is the Push-Away: Leslie J. Hutchinson, MD, MPH, FACOEM, of HLM Consultants points out: “Although the author correctly points out that a cross-sectional study cannot prove causality, the probability of a causal association is supported by abundant evidence already known. A search of the available medical literature on the internet for ‘obesity and feeling unwell’ yields many relevant pages. Obesity is causally associated with obstructive sleep apnea, which leads to daytime fatigue. Weight will contribute to shortness of breath with exertion. This article should encourage more departments to implement recommendations of the Fire Service Joint Labor Management Wellness-Fitness Initiative.”

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