Bigger isn't better, especially post-career

Updated: January 31, 2006, 12:49 PM ET
By Lee Bowman | Scripps Howard News Service

It's part of the American persona to be big, larger than life -- robust in that Paul Bunyan, Davy Crockett, John Henry sort of way. Heroic dimensions fit a heroic country.

But over the past few decades, Americans have been living ever larger in ways that may not be so good for us. Measured by the scale of body-mass index, the weight-to-height ratio that's the foundation of most obesity studies, 65 percent of Americans are considered overweight or obese.

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Estimates of how significant those extra pounds are to health vary, however. A 2004 study by the federal Centers for Disease Control and Prevention calculated that obesity contributes to as many as 400,000 premature deaths each year in the United States. A statistical re-check of that study a year later rolled that toll all the way down to 26,000 a year.

The updated study confirmed the long-held view among obesity experts that being at least 50 pounds overweight is hazardous, but also found that being as much as 40 pounds overweight actually seems to protect people from early death.

Many experts say ranking high on the BMI scale may not reflect how "fat'' someone really is or to what extent his or her weight represents an increased risk for various medical problems or premature death today or years later.

"No one has ever suggested that BMI is the only criterion to use, because it clearly is not,'' said Dr. George Bray of the Pennington Biomedical Research Center in Baton Rouge, La.

Factors like a person's age, level of physical activity, rate of weight gain, blood pressure and cholesterol levels also have to be taken into account in measuring an individual's health, he added.

Some researchers prefer to consider how much fat is under the skin in select spots; other recent studies suggest that waist size is the telltale statistic. By that standard, people should watch out if it's greater than 40 inches for men or 35 inches for women, studies show.

The different standards bring mixed results, particularly when athletes are measured. For instance, one 2003 study involving 53 players on the Indianapolis Colts found that while the BMI showed many of the players to be overweight, their percentage of body fat was well below the 25 percent range that marks obesity. But another study, done with Division I college football players the same year, found that offensive and defensive linemen were, on average, carrying greater than 25 percent body fat.

Still another 2003 study found increasing rates of sleep apnea and high blood pressure among pro-football players and especially among the biggest linemen.

There's lots of evidence that being fit can trump bulk when the relative risk of developing diseases ranging from heart disease to cancer is analyzed.

"We've studied this from many perspectives in women and in men, and we get the same answer: It's not the obesity, it's the fitness,'' said Steven Blair, president and chief executive of the Cooper Institute for Aerobic Fitness in Dallas.

At the same time, being big may take a toll on systems from bones and joints to the liver and hormonal system that regulates glucose levels in the bloodstream, which influences not only the heart and blood vessels, but also body systems that regulate cell division and increase the odds for cancer.

Obesity produces hormonal and metabolic changes that make it easier for cancer to gain a foothold. "Overweight and obesity has a very broad impact on cancer across most cancer sites,'' said Eugenia Calle, a researcher with the American Cancer Society.

And to the extent that many athletes use anabolic steroids to bulk up, they also increase their risk for a variety of health problems, ranging from blood clots and muscle injuries to premature heart attacks and strokes.

Ruth Wood, a professor of neurobiology at the University of Southern California, has found increasing evidence in animal studies that steroids may be physically as well as psychologically addictive for athletes. But she also noted that her research and that of several other scientists confirms that taking large amounts of steroids can produce more aggressive behavior.

While there have been many individual reports of steroid abusers having episodes of "'roid rage'' in recent years, Wood said the fact that athletes "feel better when they're taking them than when they're not'' suggests that people taking the drugs may feel invulnerable and thus more prone to take risks in general.

And studies with hamsters by Richard Melloni, a behavioral neuroscientist at Northeastern University in Boston, have found that steroid use may influence players long after they stop taking the drugs: "What we know at this point is that aggressiveness doesn't simply cease after the ingestion of steroids does.''

Just old-fashioned physical training causes endurance athletes' hearts to actually enlarge to handle the added aerobic burden they put on their circulatory systems. But those thicker heart muscles can sometimes also mask and make worse a genetic heart defect that puts people at increased risk of sudden cardiac death, which has been identified as the cause of death for several pro players in recent years.

Still, many medical experts say the greatest risk for big men like football linemen and basketball centers probably doesn't confront them while they're still playing, but later on, after they stop.

"Guys in their 20s and 30s can handle it, but by the time they're in their late 30s and early 40s, they get a large amount of joint pain, arthritis,'' said Dr. Shawn Bonsell, an orthopedic surgeon at Baylor University's Medical Center in Dallas. "On the medical side of things, it's even more serious -- diabetes and an elevated risk of heart disease and heart attack.''

Contact Lee Bowman at BowmanL@SHNS.com