I recently saw a patient because he “flunked” his sports physical at school for a resting blood pressure of 164/93. He is entering his senior year of high school, and unless I clear him to play football, he won’t make the team. He plays the starting offensive and defensive tackle positions on the varsity squad. By accounts, the kid is a terror on the field. He has lightning-fast feet, instincts that can’t be taught and immense strength for his age.
He also has hypertension and elevated cholesterol. His BMI is 32 – well past the definition of obese and heading toward morbid obesity.
College scouts are taking a serious look at this kid. He comes from a poor, rural community where many don’t make it out of 12th grade. Furthermore, he has solid grades and could succeed in school. His family, with a total of 7 kids, has no way to pay a dime of his college education. And although thousands of promising players eventually fizzle out before they make it to the professional level of football, this kid is well within that elite national group of high-school age talent that every year does have a shot at the big time.
You can’t ask a kid like that to lose weight. In fact, he needs to gain significant weight if he expects to plug up the line against lithe and blistering-fast running backs in college. To gain weight, he needs to eat high-calorie foods, which will invariably blast his cholesterol profile to untold levels. And the hypertension? It’s hard to explain in a 17 year old boy other than his genetic background and the fact that he’s about 50 pounds overweight. It will likely be very difficult to control, especially if he gains weight.
My decision about how to intervene could very well end his football career. If he loses weight, he won’t be competitive against 280 lb. linemen in college. If he sits out his senior year to get his cholesterol and hypertension in line, he won’t get noticed by colleges. He can either go deep into debt, or go to work and make a subsistence-living wage, never escaping his small town. On the other hand, I could let him play. He would power the lines of his senior-year football team, continue turning heads, go to college for free and maybe, maybe, make it to the big league. The money would support his whole family. Singlehandedly, his flashing feet and punishing girth might very well lift an entire community out of poverty and cyclic despair…unless he drops dead before he gets there.
“So, you’re gonna let me play, right doc?”
secretwave101 
Hey, I’m a bit of a lurker but I wanted to ask: If he was 40 what would be the treatment? A statin, a couple antihypertensives and exercise, right? Isn’t varsity football exercise?
In the end though, it probably doesn’t make sense to clear him. I know it’s destroying his football dreams but assuming he does make it onto some college team, their doctor is going to tell him the same thing you’re telling him. In fact, he probably wouldn’t pass the physical to get the scholarship in the first place. It’s a sad situation but this guy needs to hit the books. Football won’t be his way out.
LikeLike
you could treat his medical problems with medications and still let him play
LikeLike
This is absurd. His BMI of 32 is almost certainly inflated by a large amount of muscle mass. Blood pressure and elevated cholesterol may decrease his mortality in the long run, but probably not this football season that you’re clearing him for ( for the record, I’d be suspicious of applying studies on sedentary fat populations to high school athletes). And then, any high powered college football program will have doctors and nutritionists to look after this guy’s health. Probably far better access to health care than his rural town and little money can offer.
But the real kicker is, why can’t an educated and articulate 17 year old make this decision for himself?
LikeLike
Gee, I had the same thing happen to me back in 1978 when I was a Fireballing Lefty in the 10th Grade. My problem was probably my 30 cokes a day habit along with the occasional Amphetamine. Luckily, the Doc let me play, I had one of the worst seasons In California Interscholastic Federation sports history, and realized I better find a different career field. Seriously, I’d check that guy for IHSS. If he keels over running suicides YOU’LL be supporting his whole family. Well your Insurance Carrier will, anyway it’ll suck.
LikeLike
Oh Yeah, you know that guys on the Juice don’t you?
LikeLike
I don’t mean to be hypercritical here, but there is such a thing as being big, lean, and fit.
BMI is useless in well-muscled individuals, which it sounds like this kid is. BMI only works at the population level after all. And with the percentage of the population that is ‘normal weight obesity’ we need to ditch this rubric completely.
I had ‘hypertension’ in HS until someone figured out that the cuff was too small.
And as for eating high calorie foods to get bigger, yes, but if you want to add muscle you don’t eat junk, you eat big and eat clean. High calorie diets do not mean high cholesterol. My 4000 calorie diet nets me an HDL of 50 and an LDL of 65 and there is plenty of junk in it.
There is no reason this kid cannot work on his hypertension and body fat content while staying big and playing football.
LikeLike
If a systolic blood pressure value of >160 or a diastolic blood pressure value of >100, it requires immediate treatment.
LikeLike
Well, these are interesting thoughts. I think they are true. However, everything is
relative and ambiguous to my mind.
LikeLike