If you've watched a sporting event lately – and especially if you've ever bet on one – odds are you already know how radically sports gambling has changed in recent years.

"It's not even the same world," said Dr. Timothy Fong, a professor of psychiatry at the University of California, Los Angeles.

Twenty years ago, if you wanted to legally bet on sports, you'd have to go to a casino in Las Vegas or Atlantic City, "and that's about it," said Fong, co-director of the UCLA Gambling Studies Program. Today, thanks to legal changes and mobile tech, "you never have to leave your couch."

Thanks to the hundreds of millions of dollars the gambling industry has spent on advertising, even casual sports fans know where to place a bet. But few are probably aware of the ways such gambling could be connected to their health.

"We just think, 'Oh, it's completely separate,'" Fong said. "It's not separate. It's completely intertwined with our physical health states."

The research isn't extensive, and the connections are not always clear-cut. Most adults in the U.S. have gambled, and most people gamble without developing problems, said Dr. Marc Potenza, a professor of psychiatry at Yale University School of Medicine. "So we want to be careful not to stigmatize everyday behavior or to overly pathologize what people enjoy doing."

What is clear is that the United States has experienced a sports-betting boom since a 2018 Supreme Court ruling struck down the federal law restricting such gambling. Today, 38 states and the District of Columbia have legalized it in some form, according to the American Gaming Association, which said a record $119.8 billion was legally wagered on sports in 2023.

Some of those bets would have been unimaginable a generation ago, Fong said. Back then, if he'd wanted to place a legal bet on a baseball game at a casino, he could have wagered on whether his team won or lost, or perhaps how many runs would be scored. "Now, I can bet on every single pitch. Is it a ball? Is it a strike? I can bet on the total number of bases the player achieves in one game. I can bet on whether the ball in between innings lands on the mound or on the grass."

And instead of having to wait for the weekend's football games, anybody can be a click away from betting on Polish table tennis, British darts or Japanese badminton.

That's exciting for gamblers and great news for the industry in the U.S., which reported $10.9 billion in revenue in 2023. But there's a troubling side to all that access, said Potenza, who also is director of Yale's Center of Excellence in Gambling Research and a professor in the Child Study Center and of neuroscience.

"The ways in which people gamble have changed substantially, and we're concerned that this may have an impact on people gambling problematically," he said. As a sign of such problems, he noted that in Connecticut, requests to the state's gambling helpline jumped 91% in the year after sports betting was legalized there in 2021. Most of the requests were from college-age men betting on sports, or from their families.

Other states have reported similar experiences.

Much of the research on how health and gambling are linked involves people designated as problem gamblers. According to the National Council on Problem Gambling, about 1% of U.S. adults would meet the criteria for a severe gambling problem each year, and an additional 2% to 3% have a mild or moderate problem.

Fong said researchers were seeing that if you have a gambling disorder, "it's clear you've got other medical problems. You don't sleep as well. You go to the ER more. You're less likely to have insurance, or you're less likely to do the healthy self-care stuff, like exercise and eat healthy foods." People with gambling problems also are more likely to smoke tobacco, drink excessive amounts of alcohol or use cannabis.

Potenza was co-author of a study, published in the Journal of Addiction Medicine in 2013, that looked at data from 10,231 people 55 or older, of whom 2.8%, or 269, were considered at-risk, problem or pathological gamblers. They had shared information as part of a large study conducted in the early 2000s.

After three years of follow-up and adjusting for factors such as sociodemographic characteristics and body mass index, people with gambling problems were more than twice as likely to develop arteriosclerosis, where plaque builds up on artery walls. They were 53% more likely to develop any type of heart condition.

A 2023 study on Swedish gamblers found that problem gamblers had higher rates of cardiovascular and respiratory problems, as well as higher rates of diabetes than participants without a gambling disorder.

Much of the research on gambling's health effects predates the current sports-betting boom, and few studies have looked at the effects of different types of gambling. Researchers are just starting to collect data on that, Potenza said, and "there are reasons to suspect that it might be different in some important ways."

For example, a study published earlier this year in JAMA Network Open found that people who bet on sports were more likely than non-gamblers and non-sports gamblers to be binge drinkers.

Fong agreed that research hasn't parsed out details about sports betting. "We haven't taken people into the lab and hooked them up to machines and brain scans to say, 'Is there a different part of your brain getting activated with the betting on sports versus when you're playing poker?'"

But the underlying processes and effects would be the same, he said.

At its root, gambling is about taking risks and getting rewards. Weighing risks is a basic human activity, Fong said. "Do I take this job? Do I date this girl? What TV show do I watch tonight? Those are all just different types of gambling behavior."

The excitement of gambling triggers the release of brain chemicals that bring pleasure. In problem gamblers, the response is akin to what's seen in people with an addiction to alcohol.

It also is inherently stressful. Stress has been associated with health issues, and Fong said it can affect gamblers of any kind. "A lot of my patients say, 'I've never been inside a casino.' But they tell me they still have the same kind of stress-related physical damage – they don't sleep, don't eat well or are constantly preoccupied by the need to gamble," he said.

Modern sports betting, Fong said, can be similar to playing a slot machine, where people sit motionless for hours on end, anticipating the next bet.

Potenza noted research that has found higher levels of stress-related chemicals in the blood of people who are gambling in casinos, and people with gambling problems show differences from people without gambling problems with respect to how their stress systems are affected.

The response to that feeling helps delineate a problem gambler from a casual one, Fong said.

Think of roller coasters. They are, by design, stressful, even for the people who love them. If you visit an amusement park occasionally and ride the roller coaster once or twice, that's probably fine, Fong said. But if you did it all day, every day, even after it starts to hurt, "that's not entertainment anymore. That's a harmful compulsion. That's an addictive behavior."

Most people who gamble see it as a form of entertainment. Some use it as a way to socialize. In a 2022 Harris Poll, 42% of sports bettors did so because their friends were doing it.

A 2004 study in the American Journal of Psychiatry even associated recreational gambling with better health in older adults, although Potenza said it wasn't clear whether that might have been because people who were healthier were simply more likely to have been able to go out to a casino, for example.

But while Fong said "there's never been a case that I'm aware of where someone's death certificate listed death by gambling," he also has had patients whose gambling disorder was so severe that they reached a point of crisis and died of suicide.

Data he provided from the California Gambling Education and Treatment Services (CalGETS), which offers help to people with gambling problems, showed that among gamblers entering outpatient care, about 19% reported suicidal thoughts in the previous week. That's 10 times higher than the rate of other Californians who reported having such thoughts in the previous year.

Fong and Potenza said that gambling can be safe for people who can regulate their betting. "If they see gambling as a form of entertainment, like going out to the movies, and bring a certain amount of money and say, 'This is the amount of money that I'm going to spend, this is the amount of time that I'm going to spend,' that's not a problem," Potenza said.

But if someone is gambling in a secretive fashion or lying to themselves or loved ones about how much they are spending, "those are all signs of concern," he said.

"It's important to, at the early stages, reach out for help," Potenza said, and Fong agreed.

"By the time people come see providers like me, things are really, really severe," when thousands of dollars have been lost or a crime was committed, Fong said.

Many questions remain unanswered about how sports betting affects health, he said. "We've learned quite a bit in just four or five years. But there's certainly a lot more to uncover."

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For people who need help with problem gambling, the National Council on Problem Gambling has a helpline that can be reached by calling 800-GAMBLER (800-426-2537), by texting 800GAM or through chat at ncpgambling.org. If you're having suicidal thoughts, call or text 988 for the 988 Suicide & Crisis Lifeline.

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American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved.