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In the summer of 2020, Grace Wu was on a quiet car ride to visit her in-laws in Burlington, North Carolina, when a passing thought sparked a profound realization. At the time, her husband was temporarily training as a police cadet, and the stress of the job — paired with irregular mealtimes — caused him to binge on sweets and comfort foods during his days off.

“It was the most stressful time of our lives,” Wu recalls.

As a wife, she was worried about his long-term health. Diets like this can lead to obesity, diabetes, and heart disease.

But as an eating disorder researcher and biobehavioral scientist at UNC-Chapel Hill, Wu saw something more than individual risk at work. Could high-stress occupations, like law enforcement, be linked to overeating behaviors? And if so, do those behaviors contribute to the high rates of cardiovascular disease often seen in these professions?

As she gazed out the car window and saw a patrol car speeding by, she began to connect the dots. Diets and daily stress weren’t the only factors. At the time, anti-police sentiment was surging in the wake of the George Floyd protests. Officers were under pressure from every direction.

Wu wondered: Was anyone studying this?

That question sparked a new sense of purpose — and the Carolina Blue Project was born.

Launched in 2023, the project aims to understand the unique health challenges faced by police officers across North Carolina. Through surveys and physical assessments — including blood pressure checks and body measurements — Wu and her team have partnered with local law enforcement agencies to build a comprehensive health profile of officers statewide.

“Law enforcement officers experience life-or-death situations daily,” Wu says. “But we don’t talk about how that stress affects when they eat, what foods they choose, and how that impacts their cardiovascular health.”

From nurse to researcher

Wu’s research career didn’t appear with that same flash of insight. It’s rooted in a life that began far from North Carolina.

Originally from Taiwan, she attended professional school and became an emergency room nurse at one of the country’s top hospitals when she was just 20 years old. After earning her bachelor’s degree, she spent 11 years as a full-time nurse, teaching evidence-based practices to her colleagues.

She also saw firsthand how Taiwan was grappling with the highest obesity rate among Asian nations, with over 45 percent of the population classified as being overweight or obese —  a health crisis that motivated her interest in the field of obesity research.

Her passion for research deepened during her master’s program, when she interned at a weight-loss center to study nutrition and exercise with the goal of maintaining weight loss. Patients often confided in her, sharing painful stories of verbal abuse from loved ones because of their size.

“They’ve been told, ‘all you need is a little willpower, you’d be so beautiful if you just lost 10 pounds,’ or, ‘you are fat because you are lazy,’” Wu explains. “I don’t know about you, but if I heard those negative comments directed toward me, I’d find that stressful.”

In 2013, she came to the U.S. to begin her PhD in nursing at Carolina, focusing on how weight stigma influences behaviors like binge eating.

Cortisol, a key stress hormone, regulates metabolism, blood sugar, and inflammation, and is released during periods of physical or emotional stress. But chronically high levels can lead to weight gain, high blood pressure, and mood swings.

To investigate her question, Wu collected hair samples from overweight participants who faced weight stigma. Hair cortisol served as a biomarker for long-term stress. She found that frequent experiences of weight stigma correlated with higher cortisol levels, which were also associated with increased binge eating symptoms, growing her interest in biobehavioral research.

Now a UNC School of Nursing professor, Wu studies disinhibited eating — overeating to cope with stress or negative emotions — which can lead to obesity, diabetes, and high blood pressure. She also researches triggers, consequences, and prevention of disinhibited eating, emphasizing that timing and context are as important as nutrition and food choices.

“I want to know why we eat, especially if it’s to respond to stress and emotion rather than hunger cues,” Wu says.

Partnering with law enforcement

While many studies have examined stress among law enforcement officers, Wu saw a gap: the interplay between stress, unhealthy eating habits, and heart health. To fill it, she began recruiting officers for the Carolina Blue Project.

Participants first completed an online survey designed to capture stressors unique to law enforcement: concerns about dying on the job, attitudes toward anti-police sentiment, and perceptions of community distrust. The survey also asked about eating behaviors like overeating and binge eating.

Next, officers underwent health screenings at the UNC Biobehavioral Laboratory. The research team assessed their glucose and cholesterol levels and recorded their height, weight, waist and hip circumferences, and blood pressure.

Each officer received a detailed explanation of their results and personalized lifestyle recommendations. For instance, if high cholesterol was detected, Wu and her team discussed dietary habits — such as red meat or cheese consumption — and offered practical suggestions for improvement.

“We received an overwhelming response,” she says. “There were more volunteers than we could accommodate, and some traveled two to three hours just to participate.”

To meet this demand, Wu and her team began conducting on-site screenings at law enforcement agencies across 13 counties, bringing all the necessary equipment with them.

One officer from Stokes County shared: “No research team ever cares about us or comes to our county for research because we are so remote. Your team is the first to make the effort to help us.”

Broadening research reach

By the end of 2023, the first phase of the project revealed stark numbers: About 60% of participating officers were obese, and nearly one in five had high blood pressure.

The study also found that officers experiencing strong anti-police sentiment and higher levels of police-related stress, PTSD, and fear of victimization were more likely to engage in binge eating and loss-of-control eating.

“Emotional eating in response to anger and depression was associated with higher weight, blood pressure, and lipid profiles in law enforcement officers,” Wu shares.

In the future, Wu hopes to launch Carolina Blue Project 2.0 to examine whether disinhibited eating patterns differ between law enforcement officers and civilians.

She’s currently working to fund this second phase, which would expand research operations to five sites across the state to make participation more accessible and ensure findings represent officers statewide. The plan also includes creating a five-person advisory board of active-duty officers to guide the project.

For Wu, this work is about more than data. It’s about shifting the focus of cardiovascular research in law enforcement and developing targeted interventions that go beyond what to eat — to when and how to eat.

“Our ultimate goal is to add more tools to the toolbox for our health care system,” Wu says. “And to offer a new perspective, not just on cardiovascular health, but on obesity research as well.”