"F!reF!ghterF!t": Lifestyle Coaching Interventions for Obese Firefighters (FireFit)

RATIONALE/GOALS: Obesity is a major health hazard in the US fire service. It contributes to excess cancer, cardiovascular disease and behavioral health issues. Obesity is negatively associated with 12/13 health priorities identified by the National Fallen Firefighter Foundation. Mitigating obesity is crucial to the fire service's goals of reducing chronic diseases and their adverse economic/operational impacts.

METHODS: At least 75 male firefighters self-reporting a body mass index (BMI) of >/= 30 kg/m2 AND interest in weight loss will complete a baseline health assessment including: lifestyle scores, body composition, metabolic/hormonal indices, physical fitness, and behavioral health screens, until 50 eligible firefighters have been consented and enrolled. After the initial clinical evaluation, 50 eligible firefighters will be randomized into the two study groups (about 25 firefighters to each arm): 1. General Health Instructions (CONTROL) and 2. Individual & Group Lifestyle Coaching based on the six pillars of Lifestyle Medicine & Full Plate Living. Participants will repeat the all health/fitness measures at 3-, 6- and 9-months post study entry. The two treatment groups will be compared on an intention to treat basis.

ANTICIPATED OUTCOMES: Compared to CONTROL, firefighters receiving the Lifestyle Coaching Intervention should achieve significantly greater improvements in body composition, metabolic & other health measures, as well as adopt healthy lifestyle behaviors.

Inclusion criteria

• Male firefighters aged 18-60 years
• Currently active as volunteer or career firefighters
• Body mass index (BMI) ≥30 kg/m² based on self-reported height and weight
• Express interest in participating in a clinical study aimed at improving body composition (weight loss), metabolic status, and quality of life
• Residing and/or working in Massachusetts, Rhode Island, or Southern New Hampshire (Boston metro area)

Exclusion criteria

• Female sex*
• BMI <30 kg/m² based on self-reported height and weight
• Active psychosis
• History or diagnosis (during the RCT) of any of the following:

Major cardiovascular disease event (e.g., myocardial infarction, cardiac arrest, cerebrovascular accident) Cancer (excluding non-melanoma skin cancer) Abnormal liver function (aminotransferase, bilirubin, or alkaline phosphatase ≥3× the upper limit of normal) Renal dysfunction (estimated glomerular filtration rate ≤30 mL/min/1.73 m²)

• Current or recent (within 6 months) use of testosterone treatment or anti-obesity/obesogenic medications
• Unwillingness to adhere to potential intervention assignments

• Because this is an exploratory study, the number of subjects is limited, and men make up roughly 85% of the US fire service, the current proposal is limited to men. In future studies, we will include women firefighters.