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Injury Patterns in Overweight and Obese High School Athletes

In case readers are wondering whether the term “obese athlete” is an oxymoron, it is not: from my own practice I know that there are a number of high-performance athletes out there, who can have significant weight-related health problems including obstructive sleep apnea, hypertension and fatty liver disease. But that is NOT the topic of this post!

This post is about the findings of Ellen Yard and Dawn Comstock from the Centre for Injury Research and Policy, Columbus, Ohio, just published in the Journal of Physical Activity and Health, regarding the the relationship between injury pattern and BMI in US high school athletes.

This question is of considerable interest, as the authors note that about one-third of the over 7 million US high school athletes meet the BMI criteria for overweight or obesity.

The researchers analysed data from 100 nationally representative US high schools, which submitted athlete exposure (AE) and injury information during the 2005 to 08 school years via High School RIO (Reporting Information Online).

A total of 13,881 injuries during 5,627,921 athlete-exposures (2.47 injuries per 1000 AE) were reported, representing an estimated 4,339,247 injuries sustained nationally during the 2005–08 school years, for an average of 1,446,416 injuries sustained annually.

Injury rates were higher in competition (4.65 per 1000 AE) compared with practice (1.65 per 1000 AE).

Injury rates were highest in football (4.32 per 1000 AE), wrestling (2.43 per 1000 AE) and girls’ soccer (2.40 per 1000 AE). Injury rates were lowest in baseball (1.13 per 1000 AE), softball (1.19 per 1000 AE), and volleyball (1.39 per 1000 AE).

Two-thirds (61.4%) of these injuries occurred in normal weight athletes, with the exception of football, where 54% of injured athletes were overweight or obese. Specifically, in football, the majority of injured defensive tackles (65.2%), offensive tackles (64.7%), centers (63.1%), and offensive guards (58.4%) were obese.

Sport-specific overweight and obesity prevalence was also high in wrestling (31.7%), baseball (28.6%), and boys’ basketball (19.3%). Conversely, injured girls’ soccer athletes were least likely to be overweight or obese (13.5%). Other sport-specific positions with large proportions of obese athletes included first basemen in baseball (20.5%) and softball (17.2%).

The most common injury diagnoses were incomplete ligament sprains (28.2%), incomplete muscle strains (14.0%), contusions (13.2%), fractures (9.8%), and concussions (9.2%), with one in twenty (5.9%) injured athletes requiring surgery.

Compared with normal weight athletes, obese athletes sustained a larger proportion of knee injuries and their injuries were more likely to have resulted from contact with another person.

Interestingly, compared with normal weight athletes, underweight athletes sustained a larger proportion of fractures and a larger proportion of injuries resulting from ‘illegal’ activity.

With regard to the high prevalence of obesity amongst football players, the authors note:

“Although the use of BMI instead of body fat percentage may have classified some very muscular football players as overweight or obese, these findings are consistent with the previously reported epidemic of overweight and obesity in football. Football culture not only accepts but often encourages large body size, particularly among offensive and defensive linemen.

These results point to important differences in the pattern of injuries incurred by heavier compared to normal or underweight athletes – some of which may be accounted for by the propensities of heavier athletes to participate in different types of sports than their leaner counterparts.

While this study does not support the notion that higher BMI athletes are at greater risk for injury (reported in previous studies), it may point to an increased risk in underweight athletes:

“With high school athletes being bigger and faster today than in previous years, collisions between mismatched athletes may be putting smaller, underweight athletes at greater risk for severe injury.”

What the paper does not discuss is the long-term risk of athletics for future weight gain, in overweight and obese athletes who retire due to injury or other life events. As blogged before, there seems to be no shortage of patients in my adult bariatric clinic, who report having been competitive athletes in younger years.

Edmonton, Alberta

Yard E, & Comstock D (2011). Injury Patterns by Body Mass Index in US High School Athletes. Journal of physical activity & health, 8 (2), 182-91 PMID: 21415445


  1. I am exactly one of those athletes who had an injury and afterwards the weight got out of control …. thanks to weight wise clinic & surgery I am back on track 🙂

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  2. I know that there are a number of high-performance athletes out there, who can have significant weight-related health problems including obstructive sleep apnea, hypertension and fatty liver disease.

    WHY did you feel it was necessary to insert this? It’s almost as if in admitting that there are fat athletes, you wanted to make sure that you weren’t giving the impression that they might be healthy!

    (and, obviously, thin athletes can have health problems too, some of which might even be related to their low weight – poor bone density and infertility, for example. So, what was the point, again?)

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  3. I was classified by my friends, my teammates, my coaches, opposing teams that I was a fatty, an overweight kid who excelled in hockey, baseball, football, and track & field in high school and for years growing up. Played Junior B hockey and 1 game of Junior A which I was brought up for added muscle for an away game. If it wasn’t for two people who saw past the weight and saw my skills I would never have had the opportunity to play Junior Hockey.
    In baseball I was a hitter for average and power, I passed all the requirements that the Detroit Tigers had for criteria to make it to the pros. Pittsburg Pirates bought in one of their Top prospects to pitch to me, I knock him out of the park and once I realised he had a forkball I own him. They said they would get back to me with an offer. Never Came. I was hand picked Junior team called Toronto Nationals to play in an eastern United States triple AAA baseball tournament in Pennsylvania. I played in the first two games of the tournament which we won, the when we moved to the big stadium I never left the bench after hitting .425 in the first two games we ended up third in the tournament. Weight bias and discrimination, from that time on I was told I was good enough to play in the Major league but I was built like a football player.
    Growing up I played every sport that was going, my parents friends and doctor couldn’t understand why I kept all the weight on because I was so active. My injuries I never had until football in High School and it healed quickly.
    The next year the high school league school board talked to my head coach about banning me from the league as I was bigger and faster than my opposition players and that I might hurt someone.
    Bias and discrimination again my coach said that Alan can’t help that he is a large athlete and his intentions are to not hurt anyone but remove the ball from their arms or tackle them.
    I healed as fast as anyone with the same injury, but no injury is identical so I may sprain my ankle but it is worse because of tearing of tissue.
    The studies are full of huey.
    If they found a overweight kid to play football that is non athletic then maybe he has the probablity of being injury prone.

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  4. an addendum to my comments Obese footbal player are more prone to ankle and knee injuries because they play in Valley of death where the linemen take no prisoners in football. In a 3 yard area on either side of the line of scrimmage the linemen can’t hold you but they can clip you from behind, dive into your knees, roll onto the back or sides of your legs thus more knee and ankle injuries

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