Obesity in Football: Bigger not necessarily Better

Written by Bruce Greene, MD, MHA

According to a recent NFL survey, the body weight at each football position has increased approximately 20 – 25 pounds. over the last twenty years. College players are becoming larger as well. We are aware of the health effects of obesity in lay people. Are athletes any less spared? There is new evidence that overweight athletes are at risk for sleep apnea, cardiovascular disease, arrhythmia and premature death. 


In discussing obesity, we need to discuss body mass index. Body mass index is calculated as the weight of the player in kilograms divided by the height of the player in meters squared. Since muscle mass is included in the body mass index, sports experts argue about whether or not an elevated BMI is more reflective of increased muscle or fat.

Is there a correlation between performance and player body mass? Bigger seems to be considered better among the majority of NFL, Collegiate and High School coaches, especially at the offensive and defensive lineman positions. However there has been no positive correlation between a team’s average BMI and its success.

According to a recent article in the Journal of the American Medical Association, and utilizing BMI as a basis to calculate obesity, the NFL has twice the incidence of obesity when compared to the general population. Sleep apnea has been found to have an increased incidence among professional football players. Even though BMI includes muscle or fat, a positive correlation has been found between large body mass and sleep apnea.

Additionally, a 2003 study in the New England Journal of Medicine noted an 85% incidence of sleep distorted breathing in offensive and defensive lineman. The altered breathing patterns were accompanied by elevation of systolic and diastolic blood pressures. This may lead to serious cardiovascular disease. Hypertension, cardiovascular disease, and diabetes have become valid concerns for the “super-sized” athlete as they age.  There have been over 3,800 deaths in professional football over the last 100 years. Upon further investigation, it was apparent that if an athlete had a BMI greater than 35 he was twice as likely not to reach his 50th birthday. Heart disease alone was responsible for over 20 percent of deaths. In addition, the incidence of premature arthritis in overweight individuals is clearly elevated. Physical collisions and aggressive weight training will undoubtedly accelerate degenerative change in these individuals already at risk.

To summarize, the average body weight of an NFL lineman has increased from 280 pounds to 320 pounds over the last twenty years. Although large size or obesity is not the only risk factor for cardiovascular disease and sudden death, we need to make high school and college players aware that becoming a 300 pound lineman may have medical consequences.  Bigger may not be better when it comes down to these athletes enjoying a long and healthy life.



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  • George CF, Kab V, Levy AM. Increased prevalence of sleep-disordered breathing among professional football players (letter). N Engl J Med. 2003; 348: 367-368