By Steven Pitts, Chief, Reno, Nevada, Police Department; James Greenwald, MD, Specialty Health Clinic, Reno, Nevada; and Robb Wolf, Writer, The Performance Menu, and Editor The Journal of Nutrition and Metabolism, Reno, Nevada
he Reno, Nevada, Police Department (RPD) is developing a wellness initiative that applies a comprehensive systems approach to the prevention and the intervention of the many risk factors impacting its personnel. The RPD program is built around the concept of resiliency in the program and developing resilience within the impacted employees. This article will cover the history of the program, its effectiveness, and where the program is today.
Recent research and other evidence reveal the pressures facing law enforcement professionals. They are at high risk for cardiovascular disease, high blood pressure, diabetes, insomnia, increased levels of destructive stress hormones, posttraumatic stress disorder, certain cancers, and suicide. Also, according to a study completed in the year 2000 by the National Center for Health Statistics, the life expectancy is 76.5 years for men and 79.5 years for women. But, according to research conducted by John Violanti and his colleagues at the University of Buffalo in New York, the life expectancy of a police officer is estimated to be just 66 years.1
The RPD has partnered with SpecialtyHealth, a nationally recognized health and wellness company; Robb Wolf, a nutrition and Paleolithic–low carbohydrate diet expert; and several nationally recognized medical experts to develop a wellness initiative to address the many risk factors impacting police personnel. The initial results were alarming, to say the least.
The risk factors impacting law enforcement personnel are not only costly in terms of the quality of life for those serving and their families; the factors also are costly when measured in health-care and medical retirement costs. Interestingly, the program in Reno is developing solutions that could be applied to an epidemic impacting society as a whole. Consider that Medicare and Medicaid costs are projected to consume 300 percent of the U.S. gross domestic product by 2030. The cost increases are associated with obesity and obesity-related diseases such as insulin resistance, which is the nexus to other health risk factors previously mentioned.
This is not an academic analysis devoid of real-world meaning—municipalities, government agencies, and corporations are facing remarkably tough budgetary decisions with health-care costs as one of the fastest growing segments of budgets. The program in Reno proposes a solution that not only offers a remarkable return on investment (ROI) but also mitigates many of the intangible costs and health factors associated with an illness-prone law enforcement profession. This program is not based on the wellness concept popular in civilian medicine; rather, it focuses on resiliency as an approach to educate, perform medical interventions, and improve nutrition and exercise education at law enforcement agencies. The personnel in the RPD program are treated like athletes, not patients or casualties.
In the fall of 2008, James Greenwald, MD, met with the executive staff of the RPD and proposed an idea. Recent advanced lipid testing could change the way the medical profession addressed officers who are at risk for cholesterol-related heart attacks and strokes and identify those at greater risk earlier in their careers. The RPD worked closely with the labor organizations to get officers to volunteer to participate in the three- to four-month program of evaluation. The participating officers were selected after a review of the mandatory annual physical exams. Currently, 37 states require annual physicals for police and fire services. The costs of the program at the time were approximately $1,000 per officer. The RPD obtained funding to support the program from a grant and from the city council. The early program components included advanced lipid testing, nutrition, and exercise.
Fifteen police officers participated in the program. Nine of those officers were initially described as high risk. Following the three-month analysis, the fifteen officers were reevaluated, and we learned that the nine high-risk officers had reduced their risk factors significantly through exercise, nutrition, and pharmacology. Recent data cited by Thomas Dayspring, MD, a leading lipidologist, show that the single largest cause of myocardial infarction (MI)—or heart attacks—in the United States is insulin resistance. In young adults, preventing insulin resistance is predicted to prevent 42 percent of MIs. In Nevada, a workers’ compensation claim for heart illness or related illness costs approximately $1.2 million per impacted employee. The nine high-risk officers in the first program were headed in the direction of medical retirements related to heart, diabetes, and lung issues, with total costs at approximately $10.8 million. The ROI for the initial program was estimated to be 20 percent. This ROI was estimated using the following calculation:
- Police officer participants: 15
- Participants who were designated high risk with insulin resistance: 9
- Total costs associated with an MI for medical retirement benefits and medical care for these 9 officers: $10.8 million
- The total preventive costs for 15 officers during a 20-year period: $505,560
- The ROI applied to this initial RPD program: 20 percent
The Current Public Safety Program
The program in Reno has matured significantly since 2008 and now involves the Reno Fire Department and other local public safety employees. Approximately 80 City of Reno personnel have been impacted by the program to date. Further, several new components have been designed and implemented, including the following:
Advanced Lipid and Genetic Testing. Cholesterol is a lipid that is synthesized by the liver and absorbed from one’s diet. It is commonly used to assess risk of coronary artery disease. Standard blood fat or lipid tests reveal one’s total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglycerides. Unfortunately, routine testing does not provide full data needed and can be misleading.
The advanced lipid test requested most often is the nuclear magnetic resonance (NMR), by LipoScience Incorporated. The NMR uses magnetic resonance technology to measure the number of lipoproteins, which are the transporters of cholesterol and triglycerides throughout the body. Doctors now know that the total number of lipoproteins correlates best with the true risk of having a heart attack. Officers also receive an insulin resistance score from this test that doctors relate to downstream risk of diabetes. Combining all of this additional information markedly improves the medical community’s ability to predict cardiovascular disease, diabetes, and even stroke. In the highest risk cases, doctors order testing from Health Diagnostic Laboratory Incorporated (HDL Inc.) in Richmond, Virginia. HDL Inc. testing includes advanced genetic testing that provides tools for physicians to personalize treatment options.
Nutrition. Early iterations of the program followed standard American Dietetics Association guidelines that endorse a highcarbohydrate, low-fat, grain-based diet. Advanced testing exposed the weakness of this dietary approach as it failed to improve blood lipid parameters and frequently worsened insulin resistance scores while elevating triglycerides and decreasing HDL cholesterol. For the past several years, the RPD program has followed a Paleolithic/low-carbohydrate dietary plan that has consistently improved markers of systemic inflammation, insulin resistance, and body composition. The gold standard of medical science called the randomized controlled trial has shown a Paleolithic/low-carbohydrate approach to be superior in improving the health characteristics the program finds most important in preventing morbidity and mortality.
Exercise. The physical demands of the public safety athlete can be quite variable. Exercise physiology analysis clearly illustrates police work as anaerobic (power output in excess of peak oxygen update) and more akin to the needs of a wrestler or a football player than a marathon runner. As such, the medical community has found significant benefit in a strength and conditioning approach that develops the attributes of strength and power via the conjugate periodization method. The conjugate method allows for the development of several attributes over the course of a few weeks, allowing for customization based on recovery, orthopedic issues, arrest and control training, and so forth. The main training attributes follow:
Functional mobility. Police work is highly repetitious, and addressing imbalances is critical in preventing common orthopedic issues such as lower back injuries.
Maximum strength. Compound barbell movements are used to improve neuromuscular efficiency and full body strength.
Rate of force production. The warrior athlete must not only be strong but also proficient in executing movements with significant speed and power. Barbell and dumbbell variants of the Olympic lifts are generally the first choice for this work.
Metabolic conditioning. Short circuits involving sprints, obstacle course work, and high repetition bodyweight movements are used to improve local muscular endurance and cardiovascular efficiency via peripheral heart action. These circuits provide a stimulus more akin to an arrest and control scenario than traditional low-powered cardiovascular training.
The Cooper Institute, which coined the term aerobics, has largely abandoned the singular approach of long, low-powered endurance work in favor of weight lifting and interval training similar to the program described above. This approach has shown not only superior results with regard to athletic development but also superior improvement in body composition, insulin sensitivity, and injury prevention.
Lifestyle Management and Emotional Survival
The term emotional survival was coined by Kevin Gilmartin, PhD. Gilmartin pointed out the job for a police officer requires a significant portion of officers’ time and energies and becomes not a job but the central theme and defining role in their lives. Anyone who has had a family member, a friend, or a colleague in policing has observed and probably commented on how the job has changed that person’s life and perspective. Further research by John Violanti and his colleagues’ reports reveals that the national annual average of suicide in the police profession is now 17 for every 100,000. This falls right behind the highest, which is U.S. military personnel at 20 for every 100,000.
The changes and risks observed in officers’ lives are all too often associated with the inherent officer safety risks of the job. However, the longer term impacts to their emotional and physical well being are not mitigated. The costs associated with this journey manifest in many ways. These include but are not limited to substance abuse, dissatisfaction with the organization and life in general, deterioration of physical fitness and overall wellness, and the destruction of marriages and families.
The RPD program includes an emotional wellness section that is supported by the following components:
Annual Wellness Clinics. Annual Wellness Clinics focus on emotional survival and overall physical wellness programs. In 2012, the RPD has hosted two wellness clinics with a program from Gilmartin on emotional survival and a program from Wolf on nutrition. RPD employees and their families are invited and encouraged to attend.
Immediate Interventions for Traumatic Events. The RPD has contracted with local psychological services to provide immediate interventions following traumatic events in the field. Examples in 2011 include the National Air Race tragedy and a family homicide-suicide event that involved the attempted homicide of several children. These events required RPD personnel to begin lifesaving efforts and manage a quickly evolving tactical incident.
Wellness Policy. In 2011, the RPD implemented a policy that provided for various wellness initiatives and solutions. The focus of this policy is to create an early warning system that provides solutions and resources for various wellness issues and problems.
RPD Case Studies
As mentioned earlier, the program in Reno impacted approximately 80 personnel in both the police and fire departments. To date, the program has involved approximately 60 police officers, and the number of participants is increasing. Chief of Police Steven Pitts works closely with officers following annual physicals to identify those who are at risk in a variety of areas and then introduces the officers to the RPD Program. Voluntary participation is at approximately 90 percent. Following are two case studies that demonstrate the effectiveness of the program and its sustainability. Case studies and graphs are the property of SpecialtyHealth’s Wellness and Prevention Program (all rights reserved, June 2012).
Case one. This case involves a highly motivated 33-year-old police officer who, over a four-month period, has had a spectacular reversal of insulin resistance. This was accomplished with a low-carbohydrate diet, exercise, a weight loss of 12 pounds, and medication—in this case, a generic statin costing $10 every three months. The officer’s LDL dropped more than 1,200 points to ideal levels.
|SPECIALTY HEALTH ||2/1/11||6/6/11||4-MO. RESULT|
|Insulin Resistance Score||73||51||16|
Case two. This case is a six-year follow-up on a 52-year-old police officer. He lost 40 pounds (including five inches from his waist) and corrected almost all of his numbers including four of the markers that diagnose him with metabolic syndrome. He went from having five out of five metabolic markers to one out of five. His overall risk dropped precipitously, and his triglycerides went from 270 to 38. These results were achieved by the same basic approach that was used in case one but with more pharmaceuticals. The corrections are sustainable. ♦
|SPECIALTY HEALTH||2/1/06||2/10/12||6-YEAR RESULT|
|Insulin Resistance Ration||7.1|| .7|| 6.4|
1John M. Volanti, Dying from the Job: The Mortality Risk for Police Officers (Elmira, Ore.: Law Enforcement Wellness Association, 1996).
Please cite as:
Steven Pitts, James Greenwald, and Robb Wolf, "Resiliency as a Path to Wellness," Officer Safety Corner, The Police Chief 79 (December 2012): 18–24.