The study results published in the American Journal of Medicine add to the concerns over the short- and long-term health risks of the game, the authors write.
The retired players reported putting on an average of 40 pounds between their high school football days and the end of their professional careers. For every 10 pounds gained between high school and college playing days, or between college and the height of a professional career, a player's risk of heart disease rose by as much as 14 percent compared with players whose weight didn't change much over the same period.
With every 10 pounds gained in those early years, came an additional 15 percent to 25 percent risk of sleep apnea, as well as added risk of chronic pain and neurocognitive impairment, the study found.
"We think this data suggests that football players, their physicians and their families should have an active discussion about the role weight gain plays in their health and football careers," lead author Timothy W. Churchill of Massachusetts General Hospital in Boston, said in a phone interview.
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"An action item for former players who had a great rapidity in weight gain is they might want to go back and have a general health check-up and consider overall health maintenance," Churchill told Reuters Health.
The results are based on episodic surveys of more than 3,500 former NFL players participating in the Harvard Football Players Health Study, which is supporting research on the health of current, former and future NFL players.
The former NFL players were, on average, 53 years old when they responded to the survey. More than one-third were black and more than one-third played linemen positions. The average duration of their professional careers was seven years.
In addition to answering questions about their current overall health and health history, the retired players were asked about their weight at specific points in their lives: at the conclusion of high school football participation, the conclusion of collegiate football participation, during their professional career and during retirement.
Twenty percent of the ex-players reported having chronic pain, 25 percent reported having been diagnosed with cardiometabolic diseases such as diabetes or high cholesterol, 22 percent reported having sleep apnea, 17 percent reported neurocognitive impairment and 9 percent reported having cardiovascular disease such as atherosclerosis or history of heart attack or stroke.
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Weight gains between the end of high school and the end of college playing days, and gains between the end of college and the prime of a player's professional career were independently associated with increased risk of these health conditions later in life, the study found.
The timing of weight gain might matter, said Marion Nestle, Paulette Goddard professor of nutrition food studies and public health, emerita, at New York University in New York City. "High weight gain early has longer to exert metabolic problems," she noted in a phone interview.
"This is another piece of evidence that football is a high-risk sport," said Nestle, who wasn't involved in the research.
"These results seem to be consistent with what we have seen previously in young adults. We know that people who tend to be obese have a higher risk of cardiovascular disease," said Charlotte Pratt of the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.
"We know that early life exposures to unhealthy behaviors have an impact on cardiovascular risk factors like high blood pressure and high blood lipids. We need to start early to reduce these risk factors," Pratt who was not involved in the study, said in a phone interview.
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The study was not designed to prove that weight gain is the cause of players' later health problems. Another limitation is that since surveys asked players to recall information from the past, the data may be subject to recall bias, the authors note.
Pratt said she hopes that future research with NFL players will focus on clinical research and interventions to reduce health risk factors in athletes.