The Prevalence of Overweight, Obesity, and Substandard Fitness in a Population-Based Firefighter Cohort

Abstract

Objective To examine the prevalence of overweight and obesity in firefighters. Methods Body mass index (BMI), waist circumference, and body fat percentage (BF%) were assessed in 478 career and 199 volunteer male firefighters from randomly selected departments. Results High prevalence rates of overweight + obesity (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were found in career (79.5%; 33.5%) and volunteer firefighters (78.4%; 43.2%). False-positive obesity misclassification based on BMI, compared to waist circumference and BF%, was low (9.8% and 2.9%, respectively). False negatives were much higher: 32.9% and 13.0%. Obese firefighters demonstrated unfavorable cardiovascular disease (CVD) profiles. Conclusions The prevalence of overweight and obesity exceeded that of the US general population. Contrary to common wisdom, obesity was even more prevalent when assessed by BF% than by BMI, and misclassifying muscular firefighters as obese by using BMI occurred infrequently.

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

“…However, the findings of the aforementioned studies (Jitnarin et al , 2014Poston et al 2011) cannot be generalized until it is evaluated in more samples of US firefighters who have different backgrounds based on age, region, race/ethnicity, overweight and obesity prevalence, and WEFIT program. Also due attention should be paid to the possible overestimation of body fat by the PBF-F method that was used in the previous studies (Jitnarin et al , 2014Poston et al 2011), compared to the hydrodensitometry (hydrostatic weighing) or dual-energy X-ray absorptiometry (DXA) method in healthy non-obese and obese adults (Pateyjohns et al 2006;Rutherford et al 2011;Swartz et al 2002).…”

“…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).…”

“…To the best of our knowledge, only one research group compared three anthropometric adiposity measures [BMI, waist circumference (WC), and foot-to-foot bioimpedancebased percent body fat (PBF-BIA-F)] among 478 male professional firefighters from the Missouri Valley region Poston et al 2011) and recently among 994 male professional firefighters from 20 fire departments (Jitnarin et al 2014;Poston et al 2013) in the USA. They reported that the prevalence of obesity by BMI was lower (about 14-18 %) than by PBF-F, while it was similar to WC-based obesity prevalence (Jitnarin et al 2014;Poston et al 2011). However, they reported in another study with the Missouri Valley firefighters that BMI substantially overestimated the prevalence of "overweight" (defined as BMIs of 25.0-29.9 kg/m 2 ), compared to WC (a significant portion of firefighters were misclassified as overweight by BMI), while the prevalence of overweight by BMI was still lower than by PBF-F-based one .…”

A dietary and lifestyle worksite intervention to reduce high prevalence of overweight and obesity for London firefighters

“…This compromises physical fitness (2) and concomitant firefighter and public safety (3) . Research has identified specific exposures related to firefighting (4)(5) , which may also contribute to uniquely high rates of coronary heart disease (CHD) and acute myocardial infarctions (MI) seen in this occupational group (6) .…”

Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

“…Second, it is possible that obese firefighters are also at increased risk of traumatic fatalities because their body size makes them more susceptible to becoming physically trapped or because they cannot egress a building as quickly during rapidly changing fire conditions. Importantly, there was a high prevalence of obesity among both the cardiac cases and trauma controls compared with population studies in the US fire service 42, 43, 44, 45. In fact, in the multivariate analysis, obesity was associated with an increased risk of death in the trauma controls.…”