Michael Kleerekoper, MD, MACE, has joined the faculty at the University of Toledo Medical School where he is Professor in the Department of Internal Medicine and section chief of the Endocrinology Division. The author of numerous journal studies, Dr. Kleerekoper serves on the editorial boards for Endocrine Today, Endocrine Practice, Journal of Clinical Densitometry, Journal of Women's Health, Osteoporosis International and Calcified Tissue International. Dr. Kleerekoper is also a founding board member of the newly formed Academy of Women’s Health.

A heavy football weekend

Growing up as I did with soccer and rugby, the discontinuous tempo of football in America is not my cup of tea. Not that I am uninterested in the outcome — I am an unabashed “homer” and diligently follow the outcome of games involving local professional and college sports. (Case in point — by the time this blog is posted the Tigers will have beaten the Twins for the AL Central pennant. How they will do against the Yankees is a different story.)

The annual Michigan-Michigan State game is an exception with rivalries running hot in our household. It is “against the law” not to watch the game, and at least some of us were happy this weekend.

None of this has anything to do with endocrinology except that as I channel surfed during the numerous stoppages, I was struck by the obesity on the sidelines in both college and professional games. True, these markedly overweight coaches are the minority, but in that circumstance, one is probably one too many.

I have focused on this because of a recent patient who had been a college standout at the wide receiver position (not in Michigan) and almost made the U.S. Olympic track team 20 or so years ago. He was referred for hypogonadism and checked in with a BMI of 36! He feels generally well but reported a decline in libido of about seven years duration. He denied steroid abuse as an athlete or subsequently and is the father of a son and a daughter of whom he is very proud. There is a family history of obesity and diabetes, but he had been checked at his annual physical exam and did not have diabetes — not yet anyway. Physical examination did not reveal any visual field defect, the thyroid exam was normal, he had no gynecomastia, but he did have small testes bilaterally (12-15 cc volume). I politely re-challenged him about testosterone abuse with the same negative response. The laboratory data indicated hypogonadotropic hypogonadism with a normal serum prolactin, and he was started on testosterone replacement intramuscularly.

Over a period of several months, he and I have discussed this “syndrome” of star athletes letting themselves go once their career is over. It is clearly not uncommon and “just happens”! He reasoned that it was a relief to let down after the rigors of heavy training for so many years, and it has been difficult to appreciate this and get back into shape. To his credit, he is on the way back, gradually and not precipitously, and I have every confidence that he will do well long term.

Back to the sideline. This is not an area where I have any expertise, but it is my understanding that a substantial proportion of coaches have previously been star athletes themselves and gone directly from a playing role to a coaching position. If that is so, why did they allow themselves to become obese? The answer, if you have one, may shed some important insight to the increasing prevalence of obesity in our society. There clearly won’t be a single solution to obesity, but every clue can put us on the path to correction.