Weight Gain and Health Affliction Among Former National Football League Players



      Professional American-style football players are among the largest athletes across contemporary sporting disciplines. Weight gain during football participation is common, but the health implications of this early-life weight gain remain incompletely understood. We sought to define weight trajectories of former professional American-style football athletes and to establish their relationship with 5 common health afflictions (cardiovascular disease, cardiometabolic disease, neurocognitive impairment, sleep apnea, and chronic pain).


      A health survey was distributed to former National Football League (NFL) players. Former players reported body weight at 4 time points (high school, college, professional, and time of survey response) as well as maximal retirement weight. Logistic regression was used to assess associations between weight gain during football participation and health affliction.


      In this cohort of former NFL players (n = 3,506, age 53 ± 14 years), mean weight increase from high school to time of survey response was 40 ± 36 pounds, with the majority of weight gain occurring during periods of football participation (high-school-to-college and college-to-professional). The prevalence of health afflictions ranged from 9% (cardiovascular disease) to 28% (chronic pain). Weight gain during football participation was independently associated with risk of multiple later-life health afflictions in models adjusted for football exposure, lifestyle variables, and post-career weight gain.


      Early-life weight gain among American-style football athletes is common and is associated with risk of adverse health profiles during later-life. These findings establish football-associated weight gain as a key predictor of post-career health and raise important questions about the central role of targeted weight gain in this population.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mez J
        • Daneshvar DH
        • Kiernan PT
        • et al.
        Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football.
        JAMA. 2017; 318: 360-370
        • Baron SR
        • R. NIOSH Mortality Study of NFL Football Players: 1959-1988
        Cincinnati, OH: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health;.
        1994: 1-13
        • Albuquerque FN
        • Kuniyoshi FH
        • Calvin AD
        • et al.
        Sleep-disordered breathing, hypertension, and obesity in retired National Football League players.
        J Am Coll Cardiol. 2010; 56: 1432-1433
        • Schwenk TL
        • Gorenflo DW
        • Dopp RR
        • Hipple E
        Depression and pain in retired professional football players.
        Med Sci Sports Exerc. 2007; 39: 599-605
        • Kim JH
        • Zafonte R
        • Pascuale-Leon A
        • et al.
        American-style football and cardiovascular health.
        J Am Heart Assoc. 2018; : 7
        • Miller MA
        • Croft LB
        • Belanger AR
        • et al.
        Prevalence of metabolic syndrome in retired National Football League players.
        Am J Cardiol. 2008; 101: 1281-1284
        • Elliott KR
        • Harmatz JS
        • Zhao Y
        • Greenblatt DJ
        Body size changes among National Collegiate Athletic Association New England Division III football players, 1956-2014: comparison with age-matched population controls.
        J Athl Train. 2016; 51: 373-381
        • Anzell AR
        • Potteiger JA
        • Kraemer WJ
        • Otieno S
        Changes in height, body weight, and body composition in American football players from 1942 to 2011.
        J Strength Cond Res. 2013; 27: 277-284
        • Harp JB
        • Hecht L
        Obesity in the National Football League.
        JAMA. 2005; 293: 1061-1062
        • Basra SS
        • Pokharel Y
        • Hira RS
        • et al.
        Relation between playing position and coronary artery calcium scores in retired National Football League players.
        Am J Cardiol. 2014; 114: 1836-1840
        • George CF
        • Kab V
        • Kab P
        • Villa JJ
        • Levy AM
        Sleep and breathing in professional football players.
        Sleep Med. 2003; 4: 317-325
        • Croft LB
        • Belanger A
        • Miller MA
        • Roberts A
        • Goldman ME
        Comparison of National Football League linemen versus nonlinemen of left ventricular mass and left atrial size.
        Am J Cardiol. 2008; 102: 343-347
        • Madala MC
        • Franklin BA
        • Chen AY
        • et al.
        Obesity and age of first non-ST-segment elevation myocardial infarction.
        J Am Coll Cardiol. 2008; 52: 979-985
        • Burke GL
        • Bertoni AG
        • Shea S
        • et al.
        The impact of obesity on cardiovascular disease risk factors and subclinical vascular disease: the Multi-Ethnic Study of Atherosclerosis.
        Arch Intern Med. 2008; 168: 928-935
        • Jensen MD
        • Ryan DH
        • Apovian CM
        • et al.
        AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
        J Am Coll Cardiol. 2014; 63: 2985-3023
        • Global BMIMortalityCollaboration
        • Di Angelantonio E
        • Bhupathiraju Sh N
        • et al.
        Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents.
        Lancet (Lond). 2016; 388: 776-786
        • Danaei G
        • Ding EL
        • Mozaffarian D
        • et al.
        The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors.
        PLoS Med. 2009; 6e1000058
        • Mosteller RD
        Simplified calculation of body-surface area.
        N Engl J Med. 1987; 317: 1098
        • Weiner RB
        • Wang F
        • Isaacs SK
        • et al.
        Blood pressure and left ventricular hypertrophy during American-style football participation.
        Circulation. 2013; 128: 524-531
        • Lin J
        • Wang F
        • Weiner RB
        • et al.
        Blood pressure and LV remodeling among American-style football players.
        JACC Cardiovasc Imaging. 2016; 9: 1367-1376
        • Li X
        • Li S
        • Ulusoy E
        • Chen W
        • Srinivasan SR
        • Berenson GS
        Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study.
        Circulation. 2004; 110: 3488-3492
        • Reis JP
        • Loria CM
        • Lewis CE
        • et al.
        Association between duration of overall and abdominal obesity beginning in young adulthood and coronary artery calcification in middle age.
        JAMA. 2013; 310: 280-288
        • Juonala M
        • Magnussen CG
        • Berenson GS
        • et al.
        Childhood adiposity, adult adiposity, and cardiovascular risk factors.
        N Engl J Med. 2011; 365: 1876-1885
        • Kozak AT
        • Daviglus ML
        • Chan C
        • Kiefe CI
        • Jacobs Jr, DR
        • Liu K
        Relationship of body mass index in young adulthood and health-related quality of life two decades later: the Coronary Artery Risk Development in Young Adults study.
        Int J Obes (Lond). 2011; 35: 134-141
        • Franks PW
        • Hanson RL
        • Knowler WC
        • Sievers ML
        • Bennett PH
        • Looker HC
        Childhood obesity, other cardiovascular risk factors, and premature death.
        N Engl J Med. 2010; 362: 485-493
        • Kishi S
        • Gidding SS
        • Reis JP
        • et al.
        Association of insulin resistance and glycemic metabolic abnormalities with LV structure and function in middle age: the CARDIA study.
        JACC Cardiovascular Imaging. 2017; 10: 105-114
        • Biro FM
        • Wien M
        Childhood obesity and adult morbidities.
        Am J Clin Nutr. 2010; 91: 1499S-1505S
        • Reis JP
        • Hankinson AL
        • Loria CM
        • et al.
        Duration of abdominal obesity beginning in young adulthood and incident diabetes through middle age: the CARDIA study.
        Diabetes Care. 2013; 36: 1241-1247
        • Arnold M
        • Jiang L
        • Stefanick ML
        • et al.
        Duration of adulthood overweight, obesity, and cancer risk in the Women's Health Initiative: a longitudinal study from the United States.
        PLoS Med. 2016; 13e1002081
        • Laurson KR
        • Eisenmann JC
        Prevalence of overweight among high school football linemen.
        JAMA. 2007; 297: 363-364
        • Gomez JE
        • Ross SK
        • Calmbach WL
        • Kimmel RB
        • Schmidt DR
        • Dhanda R
        Body fatness and increased injury rates in high school football linemen.
        Clin J Sport Med. 1998; 8: 115-120
        • Kim JH
        • Hollowed C
        • Patel K
        • et al.
        Temporal changes in cardiovascular remodeling associated with football participation.
        Med Sci Sports Exerc. 2018;
        • Mathews EM
        • Wagner DR
        Prevalence of overweight and obesity in collegiate American football players, by position.
        J Am Coll Health. 2008; 57: 33-38
        • Tucker AM
        • Vogel RA
        • Lincoln AE
        • et al.
        Prevalence of cardiovascular disease risk factors among National Football League players.
        JAMA. 2009; 301: 2111-2119
        • Gentry JLC,D
        • Joshi PH
        • Maroules CD
        • et al
        Ascending aortic dimensions in former National Football League athletes.
        Circ Cardiovasc Imaging. 2017; 10: e006852
        • Kim JH
        • Sher S
        • Wang F
        • et al.
        Impact of American-style football participation on vascular function.
        Am J Cardiol. 2015; 115: 262-267
        • Kim JH
        • Hollowed C
        • Irwin-Weyant M
        • et al.
        Sleep-disordered breathing and cardiovascular correlates in college football players.
        Am J Cardiol. 2017; 120: 1410-1415
        • Trexler ET
        • Smith-Ryan AE
        • DeFreese JD
        • Marshall SW
        • Guskiewicz KM
        • Kerr ZY
        Associations between BMI change and cardiometabolic risk in retired football players.
        Med Sci Sports Exerc. 2017;
        • Dutton GR
        • Kim Y
        • Jacobs Jr., DR
        • et al.
        25-year weight gain in a racially balanced sample of U.S. adults: The CARDIA study.
        Obesity (Silver Spring). 2016; 24: 1962-1968
        • Yoon SS
        • Dillon CF
        • Illoh K
        • Carroll M
        Trends in the prevalence of coronary heart disease in the U.S.: National Health and Nutrition Examination Survey, 2001-2012.
        Am J Prev Med. 2016; 51: 437-445
        • Song Y
        • Liu X
        • Zhu X
        • et al.
        Increasing trend of diabetes combined with hypertension or hypercholesterolemia: NHANES data analysis 1999-2012.
        Sci Rep. 2016; 6: 36093
        • Li C
        • Ford ES
        • Zhao G
        • Croft JB
        • Balluz LS
        • Mokdad AH
        Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, 2005-2006.
        Prev Med. 2010; 51: 18-23
        • Nahin RL
        Estimates of pain prevalence and severity in adults: United States, 2012.
        J Pain. 2015; 16: 769-780
        • Boudreau D
        • Von Korff M
        • Rutter CM
        • et al.
        Trends in long-term opioid therapy for chronic non-cancer pain.
        Pharmacoepidemiol Drug Saf. 2009; 18: 1166-1175
        • Prince M
        • Bryce R
        • Albanese E
        • Wimo A
        • Ribeiro W
        • Ferri CP
        The global prevalence of dementia: a systematic review and metaanalysis.
        Alzheimers Dement. 2013; 9: 63-75e62
        • Jonnalagadda SS
        • Rosenbloom CA
        • Skinner R
        Dietary practices, attitudes, and physiological status of collegiate freshman football players.
        J Strength Cond Res. 2001; 15: 507-513
      1. Demirel E. Daily Beast. College football fattens players up and then abandons them. Available at: Accessed September 9, 2018.

        • Okura Y
        • Urban LH
        • Mahoney DW
        • Jacobsen SJ
        • Rodeheffer RJ
        Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure.
        J Clin Epidemiol. 2004; 57: 1096-1103
        • Provencher MT
        • Chahla J
        • Sanchez G
        • et al.
        Body mass index versus body fat percentage in prospective National Football League athletes: overestimation of obesity rate in athletes at the National Football League Scouting Combine.
        J Strength Cond Res. 2018; 32: 1013-1019