Weight loss advice, diet, physical activity and obesity among firefighters
Introduction: Overweight and obesity compromise firefighter health and safety. Still, the majority of career firefighters are overweight or obese. This study evaluated (1) the association between healthcare professional weight loss advice and firefighter weight perceptions, weight loss behavior, and six month weight change, and (2) the impact of dietary patterns on six month weight change. Methods: Fuel 2 Fight was a nationally representative prospective cohort study of career firefighters. Firefighters self-reported healthcare provider weight advice, current perceptions of weight status, and weight loss behavior. Body mass index, weight, waist circumference, and percent body fat were measured by trained study staff. Twenty-four hour dietary recalls were collected by trained interviewers. Dietary patterns were derived using principal components analysis (PCA) and outcomes were modeled with multilevel logistic and linear regression models. Results: Firefighters who reported receiving healthcare professional advice to lose weight were more likely to perceive themselves as overweight (OR: 4.78; 95% CI: 2.16-10.57), report attempts to lose weight (OR: 2.06; 95% CI: 1.25-3.38), changes in diet to lose or maintain weight (OR: 1.26; 95% CI: 0.82-1.95), and increases in physical activity to lose or maintain weight (OR: 1.51; 95% CI: 0.89-2.61). Healthcare professional weight loss advice, however, was not significantly associated with six month weight change (mean weight change advice to lose weight: -0.35 kg; other weight advice: -0.6kg). PCA identified two dietary patterns consistent with healthy eating habits. Baseline scores indicating firefighters' diet representativeness on both diet patterns were not significantly associated with weight change. Compared to individuals with low scores at both baseline and six months (mean weight change pattern 1: -0.1 kg; pattern 2: 0.2 kg), more favorable weight loss was observed for individuals with highly representative scores at baseline and follow-up (mean weight change pattern 1: -0.7 kg; pattern 2: -1.0 kg) or increasingly representative scores (mean weight change pattern 1: -1.8 kg; pattern 2: -1.1 kg). Conclusions: Healthcare professional weight loss advice appears to promote healthy behaviors in firefighters, but was not associated with significantly more weight loss at six months. High-intensity weight loss interventions may be necessary to promote successful weight loss. These results suggest many firefighters realize the need to lose weight and are actively participating in weight loss activities, but few are able to achieve clinically meaningful weight loss. Even among firefighters with healthier diet scores, many firefighters consume too many calories and do not meet recommended intakes of key nutrients. Thus, firefighters would likely benefit from nutritional education and dietary weight loss programs.
Brown, Austin, "Weight loss advice, diet, physical activity and obesity among firefighters" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3641713.