Twelve high school and college athletes will die of football-related injuries and illnesses next season.

That might seem like a scary prediction, but it is a realistic one based on historical data. A new study in the May 2013 issue of the American Journal of Sports Medicine offers data from the National Center for Catastrophic Sports Injury Research. Between 1990 and 2010, 243 high school and college football players died in the United States. On average, 12.2 young football players lost their lives due to football each year.

As shocking as those numbers might be to parents of young athletes, they are equally disturbing to sports medicine physicians. A sizable percentage of these deaths could be avoided.

When looking at the specific causes of football deaths, the researchers found that cardiac events were most frequent. Brain injuries were the next most common deaths, followed by heat illness.

Screening for different heart-related risks of sudden death or ways to decrease brain injuries in football could be topics for future columns. The third risk — heat — is worth discussing, however. Even here in the South, deaths due to heat stroke are unacceptable.

They are completely preventable.

A total of 38 kids died of heat-related illnesses in that 20-year period, with 63 percent of those deaths occurring in the South. All of them occurred in July, August or September. In cases where the practice schedule was known, 83 percent of the heat-related deaths were found to have occurred during two-a-day practices. In fact, 44 percent happened on the first day of summer practice.

I wrote a column last year applauding the South Carolina High School League for adopting measures to try to prevent heat illness in young football players. Among the changes that went into effect last season were guidelines to gradually transition players from helmets and shorts to pads to full uniforms, as well as mandating alternating short and long practice sessions in the first weeks of practice.

Those practice changes are terrific steps. I hope all states adopt similar guidelines. But the football players and their parents have a crucial role in this battle as well.

The authors of this study found that the average body mass index of the high school and college football players who died of heat stroke was 33.9. Healthcare professionals usually classify adults with a BMI greater than 30 as obese. So this problem is largely one that affects obese football players.

I wanted to write this column now and not in early August because the kids and their parents have two months to prepare. If your sons are overweight and out of shape, have them start training now. Encourage them to start running now to develop better cardiovascular conditioning. Help them drop the extra pounds before summer practice starts. Healthier athletes are less likely to suffer heat illness.

While the practice changes are steps in the right direction, 7 to 10 days might not be enough time for some players to adjust to the brutal August heat here in Charleston. But they can use the next two months to gradually increase their training outside to be ready on the first day of summer practice.

The lead author of the study, Barry P. Boden, MD, summarized the problem. “The heat illness deaths are completely preventable by eliminating practices on excessively hot days with high humidity, making sure the athletes are properly acclimatized to the hot weather, and monitoring carefully and checking obese athletes during these conditions.”

Preventing heat deaths will require cooperation of everyone involved. Coaches and athletic directors must follow guidelines for practices and weather conditions. Athletic trainers — assuming schools have athletic trainers at practices — must help athletes stay hydrated and carefully observe all players for signs and symptoms of illness. And players need to arrive in shape and ready for high temperatures for the first snap.

Twelve fatalities might not seem like a large number to some people. But if some simple steps can keep a few of those kids alive, I think we owe it to them to try.

Dr. David Geier is an orthopaedic surgeon and Director of MUSC Sports Medicine. For more about football injuries and other sports medicine topics, go to Dr. Geier's blog at