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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Multiple studies have demonstrated that significant levels of firefighters are either overweight or obese. Additionally several studies have demonstrated that the proportion of firefighters who are overweight or obese increases as they age. This has several implications; the first is that annual exams with BMI analysis would offer an opportunity to screen for this condition. The second is that healthy body weights could be maintained through preventative measures.

Losing weight and maintaining a healthy body weight is a function of two components: diet and exercise. Following a heart-healthy diet consists of a diet low in fat and sodium and rich in whole grains and fruits and vegetables. This diet typically contains fewer calories than a typical diet high in fat, simple carbohydrates and fried foods. Additionally, a heart-healthy diet contains more fiber than the typical American diet, resulting in feeling fuller earlier in meals and consuming fewer calories.

Exercise is the other component to losing weight. Current recommendations are 30 minutes of aerobic exercise a minimum of four times a week. Firefighters could be counseled during physical exams if they were found to be overweight or obese and could be given weight-loss strategies from qualified medical personnel. Additionally, firefighters could be referred to dietitians for further assistance in their weight-loss measures.

It is also recommended that extreme obesity be adopted by the NFPA as a Category A condition. Category A conditions are medical conditions that could severely impair a firefighter during firefighting operations and are exclusionary criteria for the position of firefighter. It is also recommended that all fire departments adopt extreme obesity as exclusionary criteria to firefighting. Extreme obesity has been shown to severely impair an individual's work capacity and aerobic functioning, which could place these individuals and other emergency responders at risk during an emergency. Career fire departments could make BMIs of less than 30 (all categories of obesity) criteria for employment to motivate their employees to keep their BMIs at acceptable levels. Volunteer fire departments could make a BMI of less than 30 criteria to perform interior structural firefighting, the most demanding task that occurs on the fireground.

Firefighting is a physically demanding activity that requires conditioning to perform optimally. Reducing the number of firefighters who are overweight or obese can improve the overall health of firefighters and reduce their risk of cardiac line-of-duty deaths. The first step includes annual physical exams with BMI monitoring and identifying firefighters who are overweight or obese. Offering guidance and weight-reduction strategies that can help firefighters can be implemented during these exams. These firefighters can then be monitored closely for other cardiac risk factors and their progress during their efforts. Above all, the goal of these recommendations is to give all of us the best chance to return home safely.

DR. RAYMOND BASRI, MD, FACP, is in the private practices of internal medicine and diagnostic cardiology in Middletown, NY. Dr. Basri is a Diplomate of the American Board of Internal Medicine and president of the Mid-Hudson Section. He received the 2008 Laureate Award of the American College of Physicians, of which he is a Fellow. Dr. Basri also is clinical assistant professor of medicine at New York Medical College, attending physician in the Department of Internal Medicine at Orange Regional Medical Center and on the consulting staff in cardiology at The Valley Hospital in Ridgewood, NJ. He is a member of the Excelsior Hook and Ladder Company in Middletown and a deputy fire coordinator for Orange County. Dr. Basri is the senior physician of the Disaster Medical Assistance Team (DMAT NY-4). He is a senior aviation medical examiner for the Federal Aviation Administration (FAA) and chief physician for Health & Safety Specialists in Medicine, which does onsite medical examinations for the fire service and consultant to FirePhysicals.com. ERIC BERGMAN, PA-C, is a physician assistant practicing internal medicine at Hartford Hospital in Hartford, CT. He earned a bachelor of science degree in allied health from the University of Connecticut and a master's degree from Albany Medical College. He is a member of the Killingworth, CT, Volunteer Fire Company; a past company officer and life member of the Avon, CT, Volunteer Fire Department; and a past member of the Shaker Road-Loudonville Fire Department in Colonie, NY.

BODY MASS INDEX
BMI CLASSIFICATION DISEASE RISK
&llt; 18.5 Underweight Low
18.5 – 24.9 Normal Low
25.0 – 29.9 Overweight Increased
30.0 – 34.9 Obesity I High
35.0 – 39.9 Obesity II Very High
> 40 Extreme Obesity III Extremely High