Fighting Fires and Fat: An Educational and Environmental Nutrition Intervention to Address Obesity and Cardiovascular Risk Factors in the Fire Service
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An estimated 80% of paid and volunteer firefighters are overweight or obese, compromising firefighting performance and increasing risk of injury. Over 77% of firefighters have elevated blood pressure, and between one-quarter and one-half meet criteria for Metabolic Syndrome. These risk factors combined with the cardiovascular stress that is intrinsic in fire extinguishing activities have resulted in heart attacks being the leading cause of on-duty death among both paid and volunteer firefighters, contributing to over 40% of fatalities. While data on dietary intake in firefighters is scarce, meals that are traditionally served at stations are typically high in saturated fat and refined carbohydrates. Furthermore, firefighters face unique challenges to eating healthfully due to their shift work schedules, the uncertainty of call times and duration, and time spent away from home. Firefighters have expressed interest in nutrition education and guidance; however, existing firefighter wellness programs focus primarily on physical activity and fitness. The Firefighter Food Intervention, Research, and Evaluation (FFIRE) study aimed to address these concerns through the development of a quasi-experimental pilot nutrition intervention to reduce obesity and risk of heart attack. Since volunteers account for nearly 70% of firefighters in the U.S., participants were recruited from eight volunteer and combination volunteer/paid fire stations from across Maryland. The 112 study participants had a median age of 41 years and 85% were male. Over 90% had a BMI in the overweight or obese range at baseline, with 62.5% obese. Participation at each station ranged from eight to twenty individuals, representing 16% to 30% of all station personnel. The six-month intervention included environmental, behavioral, and educational components, e.g., monthly sessions with cooking demonstrations, provision of kitchen equipment, interdepartmental competitions, and tailored medical feedback, incorporating suggestions from area firefighters. Feasibility and process data were collected through attendance, interventionist logs, participant session evaluations, and a post-intervention evaluation and exposure survey. Study impact was assessed using the web-based Diet History Questionnaire II at baseline, six months (post-intervention), and twelve months (six months post-intervention). Additional eating habits, stages of change, and nutrition knowledge questions were administered through a written survey. Baseline results suggest macronutrient composition followed dietary recommendations; however, diet quality was poor. Fruit (1.2 cups), vegetable (1.8 cups), and whole grain (0.7 ounces) intake fell far below recommended amounts, while added sugars (20 teaspoons), saturated fats (28 g), and sodium (3501 mg) far exceeded recommendations. Nearly 60% of participants reported currently trying to lose weight and consumed on average 300 fewer calories (p=0.11), with lower intake of added sugars (p<0.05) and a higher percent of calories from protein (p<0.001). Nutrition facts label literacy was higher than knowledge of other nutrition topics. Responses to stages of change questions indicated a disconnect between perceived and actual intake. The intervention was implemented at all stations with high fidelity. Participants rated the intervention favorably, reported trying new foods and cooking methods, and indicated changes to food environments at their stations and homes. On average, participants attended 70% of the education sessions and read 79% of handouts. Total caloric, saturated and trans fat, refined grain, added sugar, and sodium intakes decreased significantly in both the intervention and control groups, while Healthy Eating Index 2010 total scores increased in both groups (p<0.05). The intervention group additionally reported significant improvement in eating habits, e.g., proportion of plate containing vegetables or grains, and progression through the stages of change for fruit and vegetable, fiber, sugar-sweetened beverage, solid fat, and sodium intake (p<0.05). The FFIRE study pilot nutrition intervention successfully improved diet and promoted progression through dietary stages of change. Further exploration is needed to assess the impact of biannual medical evaluations on motivating dietary change. Results show promise for use in larger firefighter populations to improve cardiovascular risk factors and reduce fatalities.