Cardiovascular Disease in Firefighters: The Impact of Obesity on Fitness for Duty

Obesity is becoming an American epidemic. An estimated 97 million Americans are overweight or obese. That equals roughly half of the American adult population.


Obesity is becoming an American epidemic. An estimated 97 million Americans are overweight or obese. That equals roughly half of the American adult population. Obese individuals are at a higher risk of many medical conditions, including Type 2 diabetes, stroke, gallbladder disease, arthritis...


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Obesity is becoming an American epidemic. An estimated 97 million Americans are overweight or obese. That equals roughly half of the American adult population.

Obese individuals are at a higher risk of many medical conditions, including Type 2 diabetes, stroke, gallbladder disease, arthritis, respiratory problems and some cancers. Obesity is also associated with increased rates of high blood pressure, high cholesterol and cardiovascular disease. In fact, obesity is now regarded as an independent risk factor for cardiovascular disease. Obesity also can impact overall fitness and the ability to perform work. When obesity affects firefighters, it can compromise the safety of fellow firefighters and the public.

Cardiovascular disease continues to be the number-one cause of firefighter line-of-duty deaths (LODD) each year. In addition to being associated with high blood pressure and high cholesterol, obesity significantly impairs respiratory and cardiovascular fitness, increasing the workload on these systems during stress. For firefighters, this increased stress occurs during fire suppression operations where high levels of exertion are required. Obese firefighters are also more likely to have a decreased tolerance to heat exposure and may be at a higher risk of the detrimental effects of heat exposure. Simply put, obese firefighters are at a higher risk of cardiac LODD than non-obese firefighters.

Obese individuals have been shown to have significant impairments on physical activity. The extra body mass stresses the cardiovascular system and impairs an individual's ability to perform physical activity. As the body mass increases, the heart enlarges to supply the extra body mass with blood. The heart also has to pump harder to overcome the resistance in the vascular beds of the fat tissue. These factors increase the workload of the heart even during rest, and physical exertion further increases the demand on the already taxed cardiovascular system.

Obesity is defined as a body mass index (BMI) greater than 30. The BMI is calculated by using a ratio of an individual's height versus weight. It must be noted that a BMI is not a perfect measure and that muscular individuals may have a falsely high BMI due to the extra muscle mass. Therefore, BMI measurements must take into consideration a firefighter's body type. Overweight is defined as BMI 25 to 29.9 and a normal BMI is considered 18.5 to 24.9. Current recommendations outlined in National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, is to measure and record firefighter BMIs during physical exams. However, the NFPA standards make no further recommendations on what to do with this information.

Firefighting is a physically demanding activity that requires high levels of cardiovascular functioning to typically perform tasks at structure fires. Studies have documented that ladder work, carrying tools and equipment, and other physical support tasks as well as interior firefighting requires high levels of cardiovascular functioning. Extreme obesity (BMI greater than 40) has been documented to severely impair an individual's cardiovascular capacity and lower exercise tolerance. These factors place obese firefighters at risk due to the high stress on the cardiovascular system. This also places other firefighters and the public at risk, since obese firefighters may not be able to perform required tasks or may become incapacitated requiring a firefighter-rescue situation. Additionally, it is hard enough to try to extricate an average-sized firefighter from a firefighter-rescue situation. Rescuing an obese firefighter with the extra weight of self-contained breathing apparatus (SCBA) and personal protective equipment (PPE) would be technically difficult and extremely labor intensive.

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