Obesity and Emergency Responders
Friday, September 25, 2009
This post is not about the problems facing emergency responders because of the increase in severely obese clients. Nor is this post about the increasing need for “supersized” ambulances and rescue equipment. It is also not about teaching emergency responders sensitivity skills in their dealings with people with excess weight.
No, this post is about obesity in emergency responders themselves.
In a paper published in last month’s issue of OBESITY, Antonios Tsismenakis and colleagues from the Harvard School of Public Health, Boston, MA, USA, studied the prevalence and health associations of excess weight among 370 consecutive emergency responder candidates for fire and ambulance services in Massachusetts.
The average BMI of the young candidates (mean age 26.3 yrs) was 28.5, i.e. just below the BMI cutoff for obesity. In fact, 77% were in the overweight category and 33% had obesity (i.e. not very different from the US general population).
Not surprisingly higher BMI was associated with higher blood pressures, worse metabolic profiles, and lower exercise tolerance.
These findings are of particular concern as emergency responders are routinely required to perform demanding duties that require optimal cardiovascular fitness. A similar problem is faced by other services like the police, armed forces and other professions that have to rely on a constant supply of healthy and fit young adults.
Of course, as readers of these pages know, there is a wide range of weights across which people can be quite fit and healthy. Nevertheless, excess weight in prospective emergency responders is certainly not something to be taken lightly and how to deal with this issue without overtly discriminating against recruits simply based on BMI (just a number on your scale) may prove challenging.
AMS
Edmonton, Alberta
Friday, September 25, 2009
Who is to say that the extra weight these folks carry is because of extra fat and not extra muscle? 240 lbs on a well muscled man is quite a lot different than 240 lbs on a flabby person. Think of the difference between Arnold Schwartzenegger and John Canday. The first is associated with health and fitness most likely, the latter, probably not so much. Weight is only one of many numbers that we conveniently use as a proxy for health but it in itself does not define health. It is probably time that we start talking about health and not the surrogate measures of it like weight or cholesterol levels. Just like food, health is a package and the sum is greater than the parts. Just like a single nutrient like fat or salt doesn’t define the healthiness of food, weight is a single parameter and doesn’t define health. I believe, that because many of us are so weight prejudiced, it is hard for us to see that body weight is not what we are against, but it is health that we are for. Remembering this would help us to point our patients in the right direction and when they are attempting to address weight issues that impair health ( like fasting or fad diets), we can send them in the right direction to improve health. For example, many of your posts, Dr. Sharma, point out that exercise doesn’t often result in significant weight loss. Exercise, does, however, improve health on many levels, irrespective of weight and so should not be discouraged.
Having said all that, emergency workers can also sit for extended period of times and have a significant amount of job stress, all of which could be related to gaining additional body fat. (please note the wording is quite specific here) I think therefore, it is important to measure many other aspects of health when reporting such a study, not just the one number shorthand we have grown so accustomed to using.
Saturday, September 26, 2009
Great post Arya. Very topical. Currently, our clinic has the contract to medically assess an entire emergency response service division, these people are currently working, some for 20 years on the job, and some new recruits. The range of BMI is similar to the study you quoted. As you the group got older the BMI increased. The biggest concern and observation, is that these big guys (with muscle), when they are young, turn into big guys with fat as they get older and move into desk jobs. This is a major concern, and we see it in many large athletes, football players, wresters etc. This is a great area to study and the data is not hard to obtain. I have also found that the metabolic syndrome’s parallel the increased weight, which parallels the age, but i feel that the weight trumps the age for most of the cases.
cheers
Sean