firefighters had substantially higher CVD risk profiles. Obesity and overweight were less prevalent in female and Asian male firefighters. Conclusions BMI overestimated the prevalence of total overweight and obesity among male firefighters, compared to WC and skinfold-based PBF. Overweight by BMI needs to be more narrowly defined, or the prevalence of BMI-based overweight (27.5-29.9 kg/m 2 ) should be reported additionally for prevention of CVD among male firefighters.Keywords California · Professional firefighters · Obesity · Overweight · Ethnicity · Gender IntroductionObesity is a well-documented risk factor for chronic diseases such as hypertension, coronary heart disease, osteoarthritis, dyslipidemia, type II diabetes, some cancers as well as increased mortality (Flegal et al. 2013 . The prevalence of obesity in the working population of the USA as in the general population has increased, particularly over the last three decades (Caban et al. 2005). Male firefighters are among the top three occupational groups with the highest obesity prevalence in the USA (Caban et al. 2005;Choi et al. 2011;Haddock et al. 2011). As a result, overweight and obesity is an important occupational health issue to be urgently addressed for the 1.1 million US firefighters ) who are at high risk of on-duty cardiovascular disease (CVD) mortality (Geibe et al. 2008;Kales et al. 2007) and musculoskeletal injuries Poplin et al. 2012). AbstractPurpose This study aims to examine whether body mass index (BMI) overestimates the prevalence of overweight or obese firefighters when compared to waist circumference (WC) and skinfold-based percent body fat (PBF) and to investigate differential relationships of the three adiposity measures with other biological cardiovascular disease (CVD) risk factors. Methods The adiposity of 355 (347 males and eight females) California firefighters was assessed using three different measures. Other CVD risk factors (high blood pressure, high lipid profiles, high glucose, and low VO 2 max) of the firefighters were also clinically assessed. Results The prevalence of total overweight and obesity was significantly (p < 0.01) higher by BMI (80.4 %) than by WC (48.7 %) and by PBF (55.6 %) in male firefighters. In particular, the prevalence of overweight firefighters was much higher (p < 0.01) by BMI (57.3 %) than by WC (24.5 %) and PBF (38.3 %). 60-64 % of male firefighters who were assessed as normal weight by WC and PBF were misclassified as overweight by BMI. When overweight by BMI was defined as 27.5-29.9 kg/m 2 (vs. the standard definition of 25.0-29.9 kg/m 2 ), the agreement of the adiposity classification increased between BMI and other two adiposity measures. Obese firefighters had the highest CVD risk profiles across all three adiposity measures. Only when overweight by BMI was defined narrowly, overweight

Firefighters and police officers have the third highest prevalence of obesity among 41 male occupational groups in the United States (US). However, few studies have examined the relationship of firefighter working conditions and health behaviors with obesity. This paper presents a theoretical framework describing the relationship between working conditions, health behaviors, and obesity in firefighters. In addition, the paper describes a detailed study plan for exploring the role of occupational and behavioral risk factors in the development of obesity in firefighters enrolled in the Orange County Fire Authority Wellness Fitness Program. The study plan will be described with emphasis on its methodological merits: adopting a participatory action research approach, developing a firefighter-specific work and health questionnaire, conducting both a cross-sectional epidemiological study using the questionnaire and a sub-study to assess the validity of the questionnaire with dietary intake and physical activity measures, and evaluating the strengths and weaknesses of the body mass index as an obesity measure in comparison to skinfold-based percent body fat. The study plan based on a theoretical framework can be an essential first step for establishing effective intervention programs for obesity among professional and voluntary firefighters.

HRR, a simple cardiovascular fitness measure, was inversely associated with MetS among middle-aged professional firefighters.

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