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Letters to the Editor  |   March 2009
Response
Author Affiliations
  • Elizabeth Ablah, PhD, MPH
    Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, Mass
    Department of Preventive Medicine and Public Health University of Kansas School of Medicine-Wichita
    Assistant Professor
Article Information
Cardiovascular Disorders / Disaster Medicine / Preventive Medicine
Letters to the Editor   |   March 2009
Response
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 123-191. doi:
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 123-191. doi:
Dr Fleming is absolutely correct to note that the National Fire Protection Association standard on comprehensive occupational medical programs has been updated.1,2 We express our apologies for citing an outdated standard in our December 2008 article.3 
Regarding our use of body mass index (BMI), we agree about the limitations of this measurement, especially among firefighters. Although the World Health Organization4 allows for BMI (≥30 kg/m2), waist-hip ratio (>0.90 in men, >0.85 in women), or both to be used in obesity assessments, the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults5 and the International Diabetes Federation Epidemiology Task Force Consensus Group6 suggest the use of waist circumference to measure obesity—as one component of metabolic syndrome. 
Our use of BMI arose from inherent limitations of the self-report instrument used in our survey-based study.3 With a larger, funded study, waist circumference would likely be used in lieu of BMI, resulting in improved evaluation of health behaviors that modify cardiac risk factors (eg, physical activity, healthful diet). 
We agree with Dr Fleming that wonderful mechanisms have been developed to support firefighters' health. Regardless of the support mechanisms in place, however, volunteer firefighters may not have the time or inclination to be involved in these initiatives because they are not paid fire-department employees and most often have other jobs. 
In addition, many volunteer fire departments may not have the funding necessary to support such health-related amenities as weight-loss programs, gym memberships, or gyms in the firehouse. 
Of course, these assumptions are based on anecdotal experiences, and this topic certainly deserves more serious attention in the medical literature. 
Because respondents to our survey3 reported that they wanted to know more about cardiac risk factors—and they wanted their fire departments to play a more active role in providing members with opportunities to improve their health—perhaps needs assessments and evaluations of current health and wellness initiatives could also be conducted among the volunteer fire-fighting community. 
Section 1582: Standard on comprehensive occupational medical program for fire departments. In: National Fire Protection Association. Fire Department Occupational and Health Safety Standards Handbook. Quincy, Mass: National Fire Protection Association;1998 .
National Fire Protection Association. NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments, 2007 Edition. Quincy, Mass: National Fire Protection Association;2006 .
Scanlon P, Ablah E. Self-reported cardiac risks and interest in risk modification among volunteer firefighters: a survey-based study. J Am Osteopath Assoc. 2008;108:694-698. Available at: http://www.jaoa.org/cgi/content/full/108/12/694. Accessed March 3, 2009.
World Health Organization. Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation. WHO Technical Report Series 894. Geneva, Switzerland: World Health Organization; 2000.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.
Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366:1059-1062.