New Emergency Workers in Poor Shape

Firefighting has always attracted big, burly guys, but is it muscle — or is it fat? A new study says tryouts for emergency responder jobs in the Boston area are getting heavier, and it may undermine their ability to do the job, as well as their health.

The study looked at 370 new recruits for firefighting and emergency medic jobs examined in two Boston-area clinics. Almost all were either overweight or obese. And while the vast majority of those who were merely overweight were able to pass an exercise treadmill stress test now recommended by a national firefighters association, almost half of the obese recruits — 42 percent — failed it, the study reported.

The study was published online on Thursday in the journal Obesity.

As levels of overweight increased, "the risk of failing the standard increased dramatically, and this is when they’re at the beginning of their career, when they are probably at or near peak fitness,” said Dr. Stefanos N. Kales, senior author and assistant professor at Harvard School of Public Health. “As you would expect with age, unless the individual is on a very vigorous training program, their exercise capacity will gradually decrease over time, and they will gradually gain weight"

By the time they are 45, Dr. Kales added, "the cardiovascular profiles of these individuals are really not going to be very favorable unless something is done.”

The firefighter, emergency medical technician and paramedic candidates in the study were recruited between October 2004 and June 2007, with an average age of 26. Candidates who failed to meet minimal criteria for the services were excluded, as were those who were 35 or older or extremely underweight.

Just over 22 percent of the recruits were of normal weight, defined as a body mass index, or B.M.I., of 18.5 to 24.9. Almost 44 percent were considered overweight, with B.M.I.’s of 25 to 29.9, and about a third were obese, with B.M.I.’s of 30 or more. B.M.I. is a measure of body fat based on height and weight.

The heavier the recruits were, the more likely they were to have higher blood pressure and a lower tolerance for exercise. All of the normal weight recruits achieved the minimum exercise threshold based on a stress test that is now recommended by the National Fire Protection Association for safe firefighting, and 93 percent of overweight recruits achieved it. But 42 percent of obese recruits failed the exercise standard, which measures aerobic capacity and endurance.

Dr. David Williamson, a visiting professor at the Rollins School of Public Health at Emory University who has studied the effects of obesity on health, said the risk of failing the treadmill test did not appear to increase in a linear fashion, however, suggesting the study “obscures the very dramatic difference between obesity and overweight.”

But the study’s authors said the physical condition of emergency responders can affect public health and safety. They noted that firefighters and medics depend on one another during emergencies, and a health condition that incapacitates one worker can jeopardize the lives of others and the community at large.

Excess weight also contributes to heart disease and back and neck injuries, which are already major causes of death and disability among emergency responders. These conditions also carry a steep price tag for government health, disability and pension plans, the authors said. In addition, being overweight increases the risk of obstructive sleep apnea, raising the risk for driving accidents.