We live increasingly, it seems, in a world of too much heat, and too little light. Our failure to get the memo about climate change even as our goose is cooking is certainly an example. But in general, life seems inclined to imitate our fractious system of dysfunctional politics -- where no on can agree with anyone about anything. Opinions are overcooked, rhetoric is overheated, and an illuminated understanding of one another and the common bonds of humanity we all share is very elusive indeed.
But I believe, and hope, that in spite of it all -- we can agree on fire fighters. There must surely be a short list of things on which we can still agree despite the modern castigate-first-and-consider-after (if ever) reflex. If so, an appreciation for fire fighters must be near the top of the list. I mean really: who doesn't?
These guys are the real deal: dyed in the wool heroes. Often, heroism is accidental -- someone just happens to be in a given place at a given moment where doing the reasonable thing is redolent with drama. But in fire fighting, heroism is built in and predictable; it's part of the job. These guys know in advance they will putting their lives on the line to save the lives of others. They sign up knowing they will need to rush in to the very infernos out of which most of us would run, screaming.
And, of course, along with the gig comes a certain reputation. There are now some women in the ranks, but that's a rarity, and likely to remain so. Few enough men, let alone women, have the strength to carry a potentially heavy, unconscious adult over an obstacle course and out of a burning building. Fire Fighter tends to conjure the image of a big, burly guy -- or perhaps one of their chiseled members who grace the pages of those notorious and slightly scandalous calendars. Either way, we tend to think big and strong, tough and brave -- and rightly so.
Fire fighters are generally well put together to face the obvious perils of their vocation: smoke and flame, intense physical challenges and intense heat. But that's only on the outside. On the inside, they are put together just like all the rest of us -- and that creates a special problem. Because the tougher the veneer, the harder it is to see the underlying vulnerabilities -- until it is too late.
We just got a bracing dose of this very reality in a report issued by the CDC. While we tend to think big and burly, it turns out that -- much like the rest of us -- many fire fighters are just plain fat. In fact, the rate of overweight and obesity is higher among fire fighters -- at 70 percent -- than the general population.
We might shrug this off if our heroes weren't paying for it with their lives -- but far too many of them are. Heart attack, often related to obesity and its metabolic complications, kills nearly twice as many fire fighters as trauma and all the direct hazards of fire exposure combined. It is by far the number one cause of death among fire fighters still on the job -- let alone those in retirement.
Compounding the problem, doctors tend to ignore weight and its implications when they see fire fighters as patients. Doctors, too, are affected by prevailing cultural norms -- and fussing about big, burly fire fighters' weight just isn't one of them.
In general, women are far more health conscious than men, because our culture insinuates that for guys at least, attention to one's health is a kind of weakness. Real men don't eat quiche, after all -- or salad. Real men don't worry about their 'diets' at all -- they are too tough for that nonsense. And if real men in general don't fret about their health, how much less so our tough-as-nails, braver than brave fire fighters.
The result, though, is that far too many of these guys die young, not of too much heat, but of too little light on the issue of their inner vulnerability. They leave behind wives and children, and brothers in arms, in mourning, wondering how such a tough guy could have fallen.
As is true of heart disease in the rest of us, the heart disease plaguing our heroes is overwhelmingly, almost entirely preventable. But that requires awareness of, and attention to, the problem. And our culture tends to fall down when it comes to our own preventive maintenance -- particularly that of men.
Doctors need to address weight, and metabolic health, even in big, tough guys; lifestyle is good medicine for everyone. Big, tough guys need to know that preventive maintenance is part of the gig -- because you aren't around to protect anyone when a heart attack takes you away at 45.
There is plenty of attention to what we think is the principal danger our fire fighters face: too much heat. It turns out that too little light is an even greater peril. We all share the same inner vulnerabilities, and the right response to them is awareness, and preventive maintenance.
Preventive maintenance is routine for fire trucks. It would be sense, not weakness, to extend the same standard of care to the big, burly, brave, yet vulnerable guys who drive them.
-fin
David L. Katz, MD, MPH, FACPM, FACP is an Internist and Preventive Medicine specialist. He is President of the American College of Lifestyle Medicine and author of Disease Proof.