Over the years, Jamie Dukes, a former NFL offensive lineman, has watched friends, former teammates and colleagues -- most of them black men and all of them overweight -- die from heart attacks, diabetes and other maladies related to their weight.
There have been seven teammates who he can name off the top of his head. All died before the age of 45. The list begins with Reggie White, the Hall of Fame defensive end who died the day after Christmas in 2004 of cardiac arrhythmia and sleep apnea. He was 43 years old and at least 100 pounds overweight.
White's death was a "scared-straight" moment for Dukes, who had ballooned to nearly 400 pounds after his playing career, full of years of burning excess calories on the field and in the weight room, had ended. He had both high blood pressure and high cholesterol. And his doctors offered a grave diagnosis: morbid obesity.
Dukes had good cause for fear. A string of recent deaths of former athletes and entertainers, including the rapper Heavy D, the comedian Patrice O'Neal and former NFL All-Pro defensive tackle Chester McGlockton, highlight what doctors have called a full-blown crisis in the black community and specifically among black men: obesity.
"The biggest health care crisis we are facing as a community is the crisis of obesity," said Dr. Mwata Dyson, a health care consultant based in New York City. "We are behind the eight ball."
Obesity in the black community has reached epidemic levels, health professionals say. Thirty-seven percent of black men over the age of 20 are obese, according to the Center for Disease Control. The number is even higher for black women: More than half of black women in the same age group are obese. The excess weight can exacerbate other health conditions such as stroke, heart and cardiovascular disease, high blood pressure and diabetes.
And the economic costs of obesity are startling.
Overall obesity-related medical care costs in 2008 for U.S. adults were estimated to be as high as $147 billion, according to the CDC.
Dyson said the past decade has seen an obesity explosion in the black community, and that the number of obese African Americans -- and all Americans for that matter -- is expected to continue to climb over the next 10 years as well.
He said there are many reasons for the widespread obesity among black Americans, from misinformation about food choices and lack of access to fresh produce to a number of cultural factors, such as collective body image.
"Within the black community we appear to gauge being overweight as being sexy, as in this is just my blackness -- We have hips and have curves and are not trying to be like these European models," Dyson said. "Heavy D was the overweight lover, which is fine for marketing and selling records, but unproductive for sending images that tell black men to live healthier lives."
Heavy D reportedly died of complications related to pneumonia. O'Neal died of complications related to stroke, and he had been public about living with diabetes. The reason behind McGlockton's death has yet to be determined, but since leaving the NFL he had struggled to maintain a healthy weight. In 2007 he underwent Lap-Band surgery, which limits the amount of food that one can consume. Toward the end of his playing career, McGlockton was listed at 335 pounds.
Dukes, who spent the majority of his 10-year career with the Atlanta Falcons, faced a critical moment when his doctor delivered his diagnosis: If he did not change his ways, he could die. The message rang crystal clear. He had friends who were dying off. His wife and children feared the worst. So he decided to take action. He started exercising again, adopted a healthier diet and controlled his portion sizes. In 2008 he underwent a procedure similar to McGlockton's. Since then he has lost well over 100 pounds.
"We're dying at an unprecedented rate," said Dukes, now an analyst with the NFL network. "The problem is we are dying from things we don't have to die from."
These days, through his Put Up Your Dukes Foundation, Dukes is tackling obesity head on, advocating healthy living for families, former athletes and black men in particular, who suffer and die disproportionately from what he calls "the diseases of excess weight."
BIG MEN, BIG PROBLEMS
For former athletes, the struggle to maintain a healthy post-playing weight can be particularly tough.
A number of other former NFL players, all of whom were celebrated during their careers for their super-sizes, have recently died, including Orlando Brown, who passed away two months ago at the age of 40 due to complications with diabetes. Former NFL player-turned-actor Bubba Smith overdosed on diet pills this summer at the age of 66.
According to a recent study conducted by the Associated Press and reported in The New York Times, the NFL had only one player that weighed 300 pounds in 1970. That number grew to three in 1980, 94 in 1990, 301 in 2000, 394 in 2009 and according to reports, 532 at the start of 2010 training camp. The rationale: the bigger the body, the better the blocking.
But once players leave the game and continue to eat the way they had when they were burning thousands of calories a week in practice and during games, their health can suffer.
Studies have shown that retired professional football players are at greater risk of obesity, high blood pressure and sleep apnea than the general public. For retired linemen, some of the largest men on the field, the mortality rates are higher than for the general public.
Former NFL lineman, Nate Newton, who won three Super Bowls with the Dallas Cowboys, went from 325 pounds during his career to about 400 after he retired.
Fearing he might die before his youngest son graduated from high school, Newton underwent a vertical gastrectomy surgery in 2010, a procedure that removed 75 percent of his stomach.
"My baby boy said, 'I'm going to be like dad, I'm going to be built like dad,' " Newton said during an episode of HBO's Real Sports with Bryant Gumbell earlier this year. "I looked in the mirror an said, 'I'm 396 pounds and my kid wants to sit up here and eat himself to death ... that's when I knew it can't be like this.' "
A year later he was more than 175 pounds lighter.
The rapper Fat Joe, known for his massive figure, also dropped a significant amount of weight recently, losing 100 pounds. In 2000, one of Joe's closest friends, the rapper Big Pun, who tipped the scale at 698 pounds, suffered a fatal heart attack and respiratory failure. He was 28.
"I lost like six friends last year to heart attacks," Fat Joe, 41, told Vlad TV recently. "All of them younger than me."
LIFE AFTER THE BIG TIME
Dukes, who played the bulk of his career with the Atlanta Falcons and retired in 1996, splits his time these days between his work with the NFL Network and recruiting star athletes to work with his foundation, teaching youth and families how to eat, live and play in healthy ways.
He said his foundation will kick off an initiative in January with Johnson & Johnson and the Atlanta public school system to raise awareness about obesity among students and their families.
"We want to go right after the diseases masked in all of these inner cities, starting in Atlanta," he said of his efforts in his hometown. "For us, education is the primary issue. We just don't know, we don't get the solutions that our Caucasian counterparts often get."
Solutions, he said, include making better food choices and finding fun ways to exercise. He said people need to understand how their own bodies work -- including the role of genetic predispositions to diabetes and other common ailments -- and how healthier choices can blunt the impact of biological factors.
He has traveled a long road since his days throwing his weight around in the NFL. And he said he knows all too well how tough it can be, especially for former athletes, to tamp down old habits.
"I've probably lifted over 2 million pounds worth of weight, God knows how many miles I've run and walked. Then real life sets in," Dukes said. "Your body is used to consuming 5,000 calories or 10,000 calories a day to maintain your body mass. Shutting that off isn't easy."