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?”