Trends in overweight and obesity among 18-year-old applicants to the United States military, 1993-2006

Part II: Risk Factors for Stress Fractures in Female Military Recruits

INTRODUCTION

Stress fractures (SFx) represent a significant proportion of injuries in military recruits internationally. Stress fractures disproportionately affect female recruits, a disparity that has similarly been consistently demonstrated in female athletes. Stress fractures result in medical morbidity, financial burden, and medical discharge from military service. This review presents current literature regarding SFx risk factors to identify and/or mitigate in this high-risk population.

METHODS

A literature review was conducted using PubMed to find relevant articles. We utilized keywords stress fracture, military, recruits, female, risk factors, modifiable, non-modifiable, overuse, nutrition, and/or prevention. Articles older than 10 years (published before 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review.

RESULTS

Modifiable risk factors for SFx include nutritional deficiency, especially of iron, vitamin D, and possibly calcium, poor physical fitness, suboptimal training programming for injury development and recovery, load carriage, and military footwear. Non-modifiable risk factors include female sex, greater height, lower weight and body mass index in females but lower or higher weight and body mass index in males, lower body fat percentage, and lower bone mineral density. In addition, menstrual dysfunction, low energy availability, later age at menarche, and iron deficiency pose unique risks to female recruits. Preventive measures include leadership education, programs with recovery considerations, and risk factor screening.

CONCLUSION

This review, Part II of a two-part series, guides multidisciplinary management of military recruits, especially females, who are at risk for developing SFx. Unique nuances of the military recruit require specific knowledge to reduce high incidence rates of injury internationally.

New Training Program for the New Requirements of Combat of Tactical Athletes

Actual theaters of operations are complex contexts where soldiers must face different situations, such as symmetrical, asymmetrical, or close quarter combat. The requirements of the actual battlefield are different to the traditional conditioning military training. This new changing scenario produces an activation of the innate fight or flight defense mechanisms with large activations of the anaerobic metabolic pathways and the sympathetic autonomic nervous system. In these scenarios, the anaerobic, aerobic, and strength demands are so specific and the time to improve all training demands in the units is limited. We propose a new training periodization for the military population based on the latest research into the psychophysiological response of soldiers in actual theaters of operations (actual military missions) and actual civilian models of training and periodization to develop a specific, easy, and reliable periodization model for actual tactical athletes. This training intervention was developed in order to improve operational training according to the demands of actual theaters of operations, based on recent research in military and civilian populations. We tried to conduct a proposal that is easy to apply, with minimal use of material different to what could be found in a military base and that could be implemented in a short period of time.

A Cohort Study Comparing Pediatric Patients with Overweight and Obesity in the Military Health System

Background: National Health and Nutrition Examination Survey data from the 1960s to 2010s confirm that pediatric obesity rates are increasing. To assess obesity in the Military Health System (MHS), we evaluated a pediatric cohort's trends in BMI categorization from 2009 to 2016. Methods: We identified two age-based pediatric cohorts in the United States using the MHS Data Repository. We tracked them for BMI from 2009 to 2016. We calculated BMI percentiles and z-scores using validated growth charts, and biologically implausible BMI z-scores were removed from analyses. Using the Stuart-Maxwell test, we assessed the percent change in BMI categorization from 2009 to 2016 and stratified by age group. Results: Our cohort consisted of 130,675 pediatric patients (52.2% males and 47.8% females). The proportion in each BMI categorization changed significantly from 2009 to 2016 in all groups (p < 0.001). Increases in the Overweight and Moderate or Severe Obesity categories were observed in all age groups (2-5, 6-10, and 2-10), and increases in Obese were observed in 6-10-year olds. Most shifts occurred from healthy-weight individuals increasing in BMI category. Conclusions: We observed a significant increase in the proportion of children with overweight and obesity in a nationally representative MHS cohort from 2009 to 2016. The prevalence of obesity, but not overweight, in our cohort mirrored the civilian population. Increasingly heavier MHS and civilian children have implications for our future military force, as they are ineligible for military service if unable to meet weight standards.

Cognitive disinhibition and infrequent moderate-to-intense physical activity linked with obesity in U.S. soldiers

PURPOSE

To explore the relationship between body weight status and neurocognitive functioning in soldiers.

METHODS

U.S. soldiers (N = 109) answered survey questions and completed neurocognitive tests including simple reaction time, code substitution, procedural reaction time, go-no-go, matching to sample, code substitution recall, and four versions of the Stroop test including congruent (color and meaning of word agreed); incongruent (color and meaning of word differed); neutral (nonsense words appeared), and emotional (combat-related words such as "I.E.D" and "convoy" appeared). Self-reported heights and weights were used to calculate BMI. A BMI ≥ 30.00 kg/m² was categorized as obese. Multivariate analysis of variance was used to analyze weight status differences (p ≤ 0.05) across neurocognitive variables. Binomial logistic regression analysis with obesity as the dependent variable was used to ascertain the contributions (p ≤ 0.05) of exercise and the neurocognitive measures that differed based on weight status.

RESULTS

Twenty-nine participants (26.6%) were obese. The obese group had significantly lower scores on code substitution, and both neutral and emotional Stroop tasks. Only Stroop emotional scores, p = 0.022, OR = 0.97, and frequency of moderate/intense physical activity, p = 0.009, OR = 0.10, were significant predictors of weight status.

CONCLUSIONS

Obesity was associated with less frequent moderate/intense physical activity and compromised executive functioning, namely decrements in response inhibition. Given the design and sample size, additional research is needed to better understand the direction of the relationship between these variables and to inform research related to the treatment and prevention of obesity within military populations.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

The relationship between weight stigma, weight bias internalization, and physical health in military personnel with or at high-risk of overweight/obesity

Perceived weight stigma is associated with adverse health indices, such as elevated cortisol, lipid/glucose dysregulation, and poorer self-rated health. This relationship may be particularly relevant for military personnel, given the cultural emphasis on fitness and weight/shape. Therefore, we investigated the relationship between weight stigma and physical health in 117 active duty personnel (66.7% male; 56.4% non-Hispanic White; age: 30.8 ± 7.4 years; BMI: 29.5 ± 2.5 kg/m²). Participants reported weight stigma (general and military-specific), weight bias internalization, and the presence (≥1; n = 55) or absence (n = 62) of medical conditions. Logistic regressions were conducted examining the ability of weight stigma (general or military-specific) and weight bias internalization to predict the presence or absence of medical conditions. General weight stigma was not significantly associated with the presence of a medical condition (p > .05). However, individuals with military-specific weight stigma scores twice that of their peers were over three times more likely (p =  .04) to report a medical condition. Weight bias internalization was not significant in any model (ps > .20). Longitudinal studies should prospectively examine the relationship between weight stigma in the military setting and health among service members.

The prevalence of overweight and obesity among Iranian military personnel: a systematic review and meta-analysis

Background

The overweight and obesity among military personnel, as an occupational group, beside the health issues, might affect their military performance. A systematic review and meta-analysis were conducted to estimate the pool prevalence of overweight and obesity among Iranian military personnel.

Methods

The national databases including Science Information Database, MagIran, and the following international databases; Web of Science, Medline via PubMed, and Scopus were searched, up to December 2017, for relevant published studies without time limitation.

Results

Totally,1431 studies were reterived and 10 studies included in meta-analysis. The pooled prevalence of overweight and obesity were 41% (95%CI:26, 57%) and 13% (95%CI:10, 17%), respectively. In the subgroup analyses, a lower and higher prevalence of overweight was reported in the ground (12%) and Navy (69%) forces military, recpectively. For the obesity, the air forces had the lowest prevalence (11%) and the ground and Navy forces military had highest prevalence (15%). The prevalence of overweight and obesity were slightly higher in studies conducted after 2014.

Conclusion

Our findings suggest a high prevalence of overweight and obesity in the military personnel as a high-risk occupational group. Owing to the high observed heterogeneity among the included studies, large representative studies are needed to estimate the prevalence of overweight and obesity in the military personnel.

Selected weight management interventions for military populations in the United States: a narrative report

Overweight and obesity continues to be a significant public health burden in the US and particularly among military personnel. Although the US Department of Defense mandates standardized physical activity requirements for military members, incidence and prevalence of overweight and obesity among military personnel continue to increase. Each military department controls their own interventional strategies for physical fitness and weight control. However, unique challenges such as geographic transients, lack of central standardization and empirical efficacy data across military departments, and chronic stress associated with military service adversely affect program outcomes. This brief narrative report explores overweight and obesity interventions among military populations from 2006 to 2016 and includes programmatic reviews of eight overweight and obesity interventions: The Prevention of Obesity in Military Community; Health Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H); ArmyMOVE!; L.I.F.E.; Look AHEAD; Nutrition-focused Wellness Coaching; Go for Green; and LE3AN. A majority of these interventions did not report significant weight loss 6 months post intervention, and did not mention a theoretical foundation within the interventions. Further research to examine the importance of theory-based programming is warranted to improve process and outcome objectives.

Improving Diagnostic Accuracy and Efficiency of Suspected Bone Stress Injuries

CONTEXT

Lower extremity stress fractures among athletes and military recruits cause significant morbidity, fiscal costs, and time lost from sport or training. During fiscal years (FY) 2012 to 2014, 1218 US Air Force trainees at Joint Base San Antonio-Lackland, Texas, were diagnosed with stress fracture(s). Diagnosis relied heavily on bone scans, often very early in clinical course and often in preference to magnetic resonance imaging (MRI), highlighting the need for an evidence-based algorithm for stress injury diagnosis and initial management.

EVIDENCE ACQUISITION

To guide creation of an evidence-based algorithm, a literature review was conducted followed by analysis of local data. Relevant articles published between 1995 and 2015 were identified and reviewed on PubMed using search terms stress fracture, stress injury, stress fracture imaging, and stress fracture treatment. Subsequently, charts were reviewed for all Air Force trainees diagnosed with 1 or more stress injury in their outpatient medical record in FY 2014.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

In FY 2014, 414 trainees received a bone scan and an eventual diagnosis of stress fracture. Of these scans, 66.4% demonstrated a stress fracture in the symptomatic location only, 21.0% revealed stress fractures in both symptomatic and asymptomatic locations, and 5.8% were negative in the symptomatic location but did reveal stress fracture(s) in asymptomatic locations. Twenty-one percent (18/85) of MRIs performed a mean 6 days (range, 0- 21 days) after a positive bone scan did not demonstrate any stress fracture.

CONCLUSION

Bone stress injuries in military training environments are common, costly, and challenging to diagnose. MRI should be the imaging study of choice, after plain radiography, in those individuals meeting criteria for further workup.

A review of the physiological and psychological health and wellbeing of naval service personnel and the modalities used for monitoring

Naval cohorts rely heavily on personnel to ensure the efficient running of naval organisations. As such, the wellbeing of personnel is essential. In an occupational setting, naval service personnel experience a variety of physiological and psychological stressors. Most naval services arrange annual physical fitness and body composition tests to ensure the physical readiness of personnel. However, these tests only evaluate a small amount of physiological capabilities. Components such as aerobic and strength capabilities are assessed, however, other components of physical fitness such as speed, agility, anaerobic capacity and flexibility are not. In addition to the physical capabilities, personnel are impacted by fatigue, nutrition and psychological stressors such as copping in stressful situations or dealing with time away from family and friends. This review will discuss the physiological and psychological factors that affect personnel's wellbeing. In addition to this, it will also evaluate the methods that are used to assess both physiological and psychological wellbeing.

Risk factors for lower leg, ankle and foot injuries during basic military training in the Maltese Armed Forces

OBJECTIVES

Basic military training is physically and psychologically demanding placing recruits at high risk of injury and premature discharge. This study aimed to identify risk factors for lower leg, ankle and foot injury in Maltese military recruits during basic training.

DESIGN

This was a prospective cohort study.

SETTING

An armed forces barracks.

PARTICIPANTS

127 recruits commencing one basic military training course agreed to participate in the study. The cohort comprised 114 males and 13 females with a mean age of 21.7 ± 2.4 years.

MAIN OUTCOME MEASURES

All injuries to the lower leg, ankle and foot were recorded using the Orchard Sports Injury Classification System. Injuries were analysed for associations with fitness scores, smoking status, body mass index and foot type.

RESULTS

A total of 34 (26.2%) recruits sustained at least one injury, with 10 recruits (7.9%) terminating their training prematurely (three due to musculoskeletal injury). Smoking history, body mass index and foot type were not associated with injury risk. Lower fitness levels at the commencement of basic military training compared with fitness levels measured six months prior, were associated with higher injury risk.

CONCLUSIONS

Lower fitness at the commencement of basic training was associated with higher injury risk in army recruits. Thus, conditioning programmes aimed at improving recruit fitness should be considered within an injury prevention strategy.

Obesity and associated adverse health outcomes among US military members and veterans: Findings from the millennium cohort study

OBJECTIVE

To assess the prevalence of obesity and associated health outcomes among US service members and veterans.

METHODS

Data from three survey cycles (2001-2008) of the Millennium Cohort Study were used to examine the prevalence of obesity and associated health outcomes.

RESULTS

Of the 42,200 individuals, 25% were of normal weight in 2007/2008. Rates of obesity were significantly higher among veterans (32%) compared with service members (20%). Over a 7-year period, obesity rates doubled among both service members (10%-20%) and veterans (14%-32%). Participants with obesity were significantly more likely to be male, older, less educated, in the Army or Navy, and separated/retired from the military. Hypertension, diabetes, and sleep apnea were significantly more common among individuals with obesity compared with participants with normal weight (all P < 0.05). Individuals with obesity also had significantly higher rates of depression and post-traumatic stress disorder than individuals with normal weight and had lower mental and physical functional scores (all P < 0.05).

CONCLUSIONS

These findings indicate an urgent need to enhance strategies for preventing and reducing excess weight gain within the military and veteran populations. Such strategies should aim to ensure a fit military force and promote health after military service.

Lower extremity stress fractures in the military

Stress fractures of the lower extremities are common among the military population and, more specifically, military recruits who partake in basic training. Both intrinsic and extrinsic factors play a role in the development of these injuries, and it is important to identify those individuals at risk early in their military careers. Some of these factors are modifiable, so they may become preventable injuries. It is important to reiterate that one stress fracture places the soldier at risk for future stress fractures; but the first injury should not be reason enough for separation from the military, as literature would support no long-term deficits from properly treated stress fractures. Early in the process, radiographic analysis is typically normal; continued pain may warrant advanced imaging, such as scintigraphy or MRI. Most stress fractures that are caught early are amendable to nonoperative management consisting of a period of immobilization and NWB followed by progressive rehabilitation to preinjury levels. Complete or displaced fractures may require operative intervention as do tension-sided FNSF. Improving dietary and preaccession physical fitness levels may play a role in reducing the incidence of stress fractures in the active-duty military population. It is important to keep in mind when evaluating soldiers and athletes who present with activity-related pain that stress fractures are not uncommon and should be given significant consideration.

Trends in overweight and obesity in soldiers entering the US Army, 1989-2012

OBJECTIVE

The US Army recruits new soldiers from an increasingly obese civilian population. The change in weight status at entry into the Army between 1989 and 2012 and the demographic characteristics associated with overweight/obesity at entry were examined.

METHODS

1,741,070 unique individuals with complete sex, age, and anthropometric information contributed data to linear and logistic regressions examining time trends and associations between demographic characteristics and overweight/obesity.

RESULTS

The prevalence of overweight (body mass index 25-<30 kg/m(2)) generally increased, from 25.8% (1989) to 37.2% (2012), peaking at 37.9% (2011). The prevalence of obesity (body mass index ≥30 kg/m(2)) also increased from 5.6% (1989) to 8.0% (2012), peaking at 12.3% (2009); 2005-2009 annual prevalence exceeded 10%. The most consistent demographic characteristics predicting overweight/obesity were male sex, older age, Hispanic or Asian/Pacific Island race/ethnicity, and being married. There were no distinct geographic trends.

CONCLUSIONS

The US Army is not immune to the US obesity epidemic. Demographic characteristics associated with being overweight or obese should be considered when developing military-sponsored weight management programs for new soldiers.

Analysis of the change of health status among the republic of Korea air force soldiers during military service

Objectives:

The aim of this study was to investigate whether the health status of Republic of Korea Air Force (ROKAF) soldiers changed after one year of military service.

Methods:

We selected 483 ROKAF soldiers from the 11 749 recruits who participated in the 2011 physical examination. The selected soldiers underwent another physical examination in 2012 for advancement to senior airman. Data from 2011 and 2012 were merged. To collect data on lifestyle, a questionnaire was sent to all included subjects via the military intranet e-mail service.

Results:

The percentage of recruits with an abnormal alanine transaminase level (normal range <40 IU/L) decreased from recruitment (13.7%) to the following year (2.7%). Moreover, the percentage of obese soldiers (body mass index ≥25 kg/m²) decreased from recruitment (20.5%) to the following year (10.4%). There was a significant change in mean duration of exercise carried out each day before (0.8±1.3 hours) and after (1.0±0.7 hours) joining the ROKAF service.

Conclusions:

These ROKAF soldiers were generally in good health before and after joining the armed service. After one year of military service, the health status of most soldiers improved, especially with respect to body mass index and alanine transaminase level.

Obesity trends by ethnicity in Hawai'i: The last ten years (1999-2008)

SUMMARY

Obesity levels are rising rapidly in United States of America however, less is known about the obesity trends regarding the specific ethnicities prevalent in Hawai'i, which may inform efforts to eliminate disparities.:

OBJECTIVE

The purpose of this report is to analyze the body mass index (BMI) trends of the four major ethnicities in Hawai'i (White, Japanese, Hawaiian, and Filipino) over the last ten years.

METHOD

The BMI data overall and by ethnicity from 1999 to 2008 were utilized from the Behavioral Risk Factor Surveillance System (BRFSS).

RESULTS

We found that all ethnicities experienced a 47% increase in mean percent of obese persons. The Hawaiian ethnic group had the largest number of obese individuals, but they experienced the smallest increase. The Filipino ethnic group had less obese individuals, but they experienced the largest percentage increase.

CONCLUSION

Based on these findings, obesity prevention efforts aimed at Hawai'i's multicultural population need to be improved and increased.

Cardiovascular reactivity, stress, and physical activity

Psychological stress has been proposed as a major contributor to the progression of cardiovascular disease (CVD). Acute mental stress can activate the sympathetic-adrenal-medullary (SAM) axis, eliciting the release of catecholamines (NE and EPI) resulting in the elevation of heart rate (HR) and blood pressure (BP). Combined stress (psychological and physical) can exacerbate these cardiovascular responses, which may partially contribute to the elevated risk of CVD and increased proportionate mortality risks experienced by some occupations (e.g., firefighting and law enforcement). Studies have supported the benefits of physical activity on physiological and psychological health, including the cardiovascular response to acute stress. Aerobically trained individuals exhibit lower sympathetic nervous system (e.g., HR) reactivity and enhanced cardiovascular efficiency (e.g., lower vascular reactivity and decreased recovery time) in response to physical and/or psychological stress. In addition, resistance training has been demonstrated to attenuate cardiovascular responses and improve mental health. This review will examine stress-induced cardiovascular reactivity and plausible explanations for how exercise training and physical fitness (aerobic and resistance exercise) can attenuate cardiovascular responses to stress. This enhanced functionality may facilitate a reduction in the incidence of stroke and myocardial infarction. Finally, this review will also address the interaction of obesity and physical activity on cardiovascular reactivity and CVD.

Is the obesity epidemic a national security issue around the globe?

PURPOSE OF REVIEW

To understand how obesity affects national security by focusing on three case study countries - the USA, China, and Mexico.

RECENT FINDINGS

Whereas in the USA and Mexico, over two-thirds of adults are overweight and obese compared to about 29% of Chinese, large increases in the prevalence of overweight and obesity have occurred in all three countries in the past two decades. National security affected in the USA ranges both from an economic perspective - increasing healthcare problems and costs to the point where our labor costs have reached uncompetitive cost levels, and from a military preparedness perspective, namely our overweight soldiers are unable to perform normal activities and functions required of soldiers. In both Mexico and China, it is the economic and health system costs that are dominant concerns, both the costs of obesity-related medical care and the productivity of the work force are creating potential long-term effects on economic competitiveness.

SUMMARY

Obesity is adversely affecting the welfare, economic, and in some cases military security of these three countries.

Occupational Stress

Occupational stress can affect physiological and psychological homeostasis. In addition, the occupational challenges associated with firefighting and law enforcement have been linked to increased mortality ratios for ischemic heart disease when compared with other population cohorts. Laboratory studies have shown that the exacerbation of stress hormones (eg, catecholamines) following dual challenge (physical and psychological stress) may affect immune system responses, which may partially explain the link between cardiovascular disease and inflammation. Physical fitness has been shown to attenuate both cardiovascular and inflammatory cytokine responses following physical and/or psychological stress; however, criteria for safe and effective occupation-specific fitness levels have not been established. In addition, firefighters and police officers have high overweight and obesity rates, which also contribute significantly to the development of cardiovascular disease. Future investigation on the possible interaction (additive or synergistic) of obesity and psychological stress on the development of cardiovascular diseases in these professions is warranted, and a criterion for fitness level should be established for safe and effective participation in occupation-related activities.

Efficacy of a pilot Internet-based weight management program (H.E.A.L.T.H.) and longitudinal physical fitness data in Army Reserve soldiers

BACKGROUND

The primary aims of this article are to describe the utilization of an Internet-based weight management Web site [Healthy Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H.)] over a 12-27 month period and to describe concurrent weight and fitness changes in Army Reserve soldiers.

METHODS

The H.E.A.L.T.H. Web site was marketed to Army Reserve soldiers via a Web site promotion program for 27 months (phase I) and its continued usage was observed over a subsequent 12-month period (phase II). Web site usage was obtained from the H.E.A.L.T.H. Web site. Weight and fitness data were extracted from the Regional Level Application Software (RLAS).

RESULTS

A total of 1499 Army Reserve soldiers registered on the H.E.A.L.T.H. Web site. There were 118 soldiers who returned to the H.E.A.L.T.H. Web site more than once. Registration rate reduced significantly following the removal of the Web site promotion program. During phase I, 778 Army Reserve soldiers had longitudinal weight and fitness data in RLAS. Men exceeding the screening table weight gained less weight compared with men below it (p < .007). Percentage change in body weight was inversely associated with change in fitness scores.

CONCLUSIONS

The Web site promotion program resulted in 52% of available Army Reserve soldiers registering onto the H.E.A.L.T.H. Web site, and 7.9% used the Web site more than once. The H.E.A.L.T.H. Web site may be a viable population-based weight and fitness management tool for soldier use.

Body mass index, medical qualification status, and discharge during the first year of US Army service

BACKGROUND

The high prevalence of overweight and obesity in military recruits and in the US population as a whole necessitates understanding the health effects of body composition and associated morbidity.

OBJECTIVE

In this study, we examined the effect of body mass index (BMI; in kg/m(2)) and medical status on premature discharge from the US Army in a large cohort of first-time-enlisted, active-duty soldiers.

DESIGN

We determined the odds ratios (ORs) associated with BMI and medical status at enlistment by using a retrospective cohort of first-time, active-duty army recruits.

RESULTS

ORs for BMI, calculated by using 24-24.9 as a reference, exhibited a U-shaped pattern. Soldiers with a BMI >34 had the highest ORs for all-cause (OR: 1.47; 95% CI: 1.32, 1.64) and medical (OR: 1.68; 95% CI: 1.46, 1.93) discharges. A BMI <17 was 1.35 times as likely (95% CI: 1.02, 1.80) to result in an all-cause discharge and 1.45 times as likely (95% CI: 1.01, 2.08) to result in a medical discharge. ORs for soldiers who required a medical reexamination did not vary when all-cause discharge (OR: 1.10; 95% CI: 1.06, 1.14) and medical discharge (OR: 1.10; 95% CI: 1.05, 1.15) were compared. The medical discharge OR for soldiers who required a medical waiver to enter the army (OR: 1.56; 95% CI: 1.48, 1.64) was higher than the OR for all-cause discharge (OR: 1.27; 95% CI: 1.22, 1.32).

CONCLUSION

Enlistment BMI and medical qualification status play an important role in early discharge and may provide a valuable tool in the development of fitness, nutrition, and injury-prevention interventions in higher-risk groups.

The obesity epidemic and future emergency responders

Emergency responders should be fit to safely perform strenuous duties. In particular, young recruits are expected to be at or near peak career fitness. We studied the prevalence and health associations of excess weight among 370 consecutive emergency responder candidates for fire and ambulance services in Massachusetts. The mean age and BMI of the recruits were 26.3 (3.8) years and 28.5 (4.9) kg/m(2), respectively. Seventy-seven percent had BMI >or=25 kg/m(2), and 33% were obese (BMI >or=30 kg/m(2)). After multivariate adjustment, both higher BMI categories and unit increases in BMI were significantly associated with higher blood pressures, worse metabolic profiles, and lower exercise tolerance. Excess weight is highly prevalent and associated with elevated cardiovascular risk among future emergency responders. These findings in a population expected to perform demanding duties supporting public safety merit prompt public health intervention.