Exploring Occupational and Behavioral Risk Factors for Obesity in Firefighters: A Theoretical Framework and Study Design

Abstract

Firefighters and police officers have the third highest prevalence of obesity among 41 male occupational groups in the United States (US). However, few studies have examined the relationship of firefighter working conditions and health behaviors with obesity. This paper presents a theoretical framework describing the relationship between working conditions, health behaviors, and obesity in firefighters. In addition, the paper describes a detailed study plan for exploring the role of occupational and behavioral risk factors in the development of obesity in firefighters enrolled in the Orange County Fire Authority Wellness Fitness Program. The study plan will be described with emphasis on its methodological merits: adopting a participatory action research approach, developing a firefighter-specific work and health questionnaire, conducting both a cross-sectional epidemiological study using the questionnaire and a sub-study to assess the validity of the questionnaire with dietary intake and physical activity measures, and evaluating the strengths and weaknesses of the body mass index as an obesity measure in comparison to skinfold-based percent body fat. The study plan based on a theoretical framework can be an essential first step for establishing effective intervention programs for obesity among professional and voluntary firefighters.

Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors

“…The main purpose of the FORWARD study (2010)(2011)(2012)(2013) was to identify occupational and behavioral risk factors for obesity in firefighters who work for a fire department in Sothern California, USA (Choi et al 2011Dobson et al 2013). The FORWARD study had strong support from both the fire department and a local union of the International Association of Fire Fighters (IAFF).…”

“…The prevalence of obesity in the working population of the USA as in the general population has increased, particularly over the last three decades (Caban et al 2005). Male firefighters are among the top three occupational groups with the highest obesity prevalence in the USA (Caban et al 2005;Choi et al 2011;Haddock et al 2011). As a result, overweight and obesity is an important occupational health issue to be urgently addressed for the 1.1 million US firefighters ) who are at high risk of on-duty cardiovascular disease (CVD) mortality (Geibe et al 2008;Kales et al 2007) and musculoskeletal injuries Poplin et al 2012).…”

“…Two assumptions underlying firefighter skepticism are: (1) BMI may overestimate the prevalence of overweight and obesity among firefighters because of its intrinsic inability to differentiate fat body mass and lean body mass and (2) other anthropometric adiposity measures such as waist circumference and skinfold-based percent body fat may be more strongly associated with biological CVD risk factors among firefighters than BMI (Choi et al 2011).…”

“…Although body mass index (BMI) has been the most widely used adiposity measure at wellness and fitness (WEFIT) programs for firefighters across the nation (Clark et al 2002;Donovan et al 2009;Soteriades et al 2005;Tsismenakis et al 2009) as for other occupational groups (Alasagheirin et al 2011;Caban et al 2005;Escoto et al 2010;Sieber et al 2014), there has been a strong skepticism as to whether BMI is a valid measure for adiposity among firefighters (Choi et al 2011;Haddock et al 2011;Jitnarin et al 2013;Poston et al 2011) because of selfselection into the occupation and the possibility of building musculature through on-the-job physical training. Two assumptions underlying firefighter skepticism are: (1) BMI may overestimate the prevalence of overweight and obesity among firefighters because of its intrinsic inability to differentiate fat body mass and lean body mass and (2) other anthropometric adiposity measures such as waist circumference and skinfold-based percent body fat may be more strongly associated with biological CVD risk factors among firefighters than BMI (Choi et al 2011).…”

“…The objectives of this study are (1) to examine whether BMI overestimates the prevalence of overweight or obesity among firefighters when compared to WC and skinfold PBF and (2) to compare the relationships of the three adiposity measures with several biological CVD risk factors in firefighters from Southern California who participated in the Firefighter Obesity Research: Workplace Assessment to Reduce Disease (FORWARD) study (Choi et al 2011). …”