On the field of play, Olympic athletes appear to be superhuman ― stronger, faster, and fitter than the rest of us ― and in picture-perfect health. But off the field, the reality is not so simple.
Many of the world's elite athletes deal with the same health problems as the rest of us ― from depression and anxiety, to eating disorders and drug abuse, to chronic conditions and infectious disease.
Olympic competition may even increase the risk for some of these issues, with intense psychological pressures and challenging physical demands putting enormous strains on the minds and bodies of these remarkable competitors, experts say.
Now, with the Tokyo Olympic Games just days away, COVID-19 infection has joined the long list of potential health risks to the world's top athletes.
"Being an Olympic athlete certainly means you are generally in exceptional health and are probably tending to your health and well-being more than the average person," says Leana Wen, MD, a public health policy professor at George Washington University. "That said, you could still very well be at risk for infectious diseases, for cancers and, importantly, for mental health issues as well. There are many illnesses that can affect everyone."
Annie Sparrow, MD, a professor of population health, science, and policy at the Icahn School of Medicine, Mount Sinai, agrees, but notes that many athletes face unique challenges as well.
"The stress of competing at the highest level can put enormous strain on the body; training restrictions and lack of support to mental well-being" are also health risk factors, she says.
Athletes Who've Opened Up
The list of athletes who've gone public with their health struggles is long and growing. Take gold medalist Michael Phelps, the most decorated Olympian in history, for example. The pro swimmer revealed his mental health challenges in The Weight of Gold, a recent HBO documentary. He says he had suicidal thoughts even at the peak of his swimming career and calls depression and suicide among Olympic athletes an "epidemic." Other Olympians who detailed their own struggles in the film include skier Bode Miller, speed skater Apolo Anton Ohno, snowboarder Shaun White, hurdler Lolo Jones, and figure skater Sasha Cohen.
Just weeks before her Olympic debut in Tokyo this month, Japanese tennis champion Naomi Osaka produced a moving first-person essay for Time magazine about her social anxiety, titled "It's O.K. Not to Be O.K." She writes: "It has become apparent to me that literally everyone either suffers from issues related to their mental health or knows someone who does."
And then there's American marathoner Molly Seidel, who has been candid about her eating disorder, recently telling ESPN: "Instead of competing in the Olympic trials in the summer of 2016 and signing a pro contract, I entered into a treatment program for my eating disorder. That's how horrible things had become." U.S. swimmer Dara Torres, who won 12 Olympic medals over a 25-year career, and Canadian diver François Imbeau-Dulac have acknowledged facing similar issues.
Simone Biles, too, has not shied away from discussing the trauma and PTSD she has, as the only U.S. gymnast still competing from the days when Larry Nassar, former team doctor for USA Gymnastics, sexually assaulted generations of girls.
Citing Biles's courage and candor, Jessica Bartley, director of mental health services for the U.S. Olympic and Paralympic Committee, says: "We're having to change the definition of mental toughness."
And mental health struggles aren't the only challenges Olympic athletes confront.
American track and field sprinter Gabby Thomas ― whom the media has dubbed the world's fastest epidemiologist because she is working toward a master's degree in epidemiology ― qualified for the Tokyo Games a month after doctors found a benign liver tumor.
Tennis superstar Venus Williams was diagnosed with Sjogren's syndrome, an autoimmune disease, but it didn't stop her from competing in the 2016 Rio de Janeiro Olympics.
Shannon Boxx played through the fatigue, joint pain, and muscle soreness caused by the inflammatory disease lupus. She helped the American women's soccer team win Olympic medals in 2004, 2008, and 2012. Today, she works with the Lupus Foundation of America to raise awareness about the condition.
These elite athletes are only a sampling of Olympians who have turned their health struggles into inspiring public awareness campaigns, following in the footsteps of high-profile competitors like Lance Armstrong (testicular cancer), Greg Louganis (HIV), and Peggy Fleming (breast cancer).
What is so compelling about their stories is that they seem so unlikely. But they also underscore the fact that no one is immune from acute and chronic mental and physical ailments.
For this reason, Wen suggests that high-profile athletes ― as well as others in the public eye ― may have a greater impact on some people than even their own doctors.
"When they share their stories of early diagnosis and treatment, it might motivate others go get screened and potentially save their lives," says Wen, who is also the former Baltimore health commissioner and a practicing emergency medicine doctor. "So many people look up to athletes and the athletes that are open about their own health struggles, they are really potentially saving and changing others' lives.
"They are able to reach people who doctors may not be able to. There are a lot of people, for example, who don't have a primary care physician, or even if their doctor tells them to go for a [cancer screening], they might not do it. But if they see that, wow, this has happened to an Olympic athlete ― to [their] favorite athlete! ― they might be motivated to get that screening."
Wen speaks not only as a doctor and public health specialist, but from personal experience as well.
"I really applaud the courage of the athletes who have been open about sharing their stories," she says. "And I say this not as an Olympic athlete but as someone who had cervical cancer in my 20s. So, I feel strongly about sharing my own journey and very much appreciate the stories being shared by others, including people with big platforms like many Olympic athletes."
What Can Olympians Teach Us About Health?
So, what do these experiences tell us in terms of public health lessons ― what can the rest of us learn from the challenges that elite Olympic athletes face?
For one thing, they spotlight the need to watch out for unusual health signs and symptoms of potentially serious physical and mental health conditions, experts say.
They also spotlight the importance of getting regular health checkups, taking preventive measures, and adopting healthy habits and lifestyles.
"We know the importance of physical exercise, good nutrition and a balanced diet, safe water, sufficient sleep, not smoking, limited alcohol, etc.," says Sparrow.
But, she notes, "knowing isn't enough. It requires trust, which in turn needs to be earned, at a time when there is a widespread distrust of authorities, a wealth of misinformation ― and the global shortage of trust shouldn't be a surprise. The best vaccines and treatments won't catch on without social traction."
Sparrow is particularly critical of the International Olympic Committee for not doing more to address the mental health issues spotlighted by Phelps, Osaka, and others, which she terms a "big concern" that is getting short shrift.
"Mental health is a prerequisite to physical health," she says. "A hot line as the only measure in place by the IOC shows they do not take it seriously."
She argues that child and youth athletes are most vulnerable to mental health issues and are also more likely to lack support and representation.
"Footballers, tennis players, basketballers, have unions, [but] divers, swimmers, and gymnasts don't," she says.
Wen says Phelps, Osaka, and other Olympic athletes who are shining a light on psychiatric issues are doing a valuable public service that will have an impact that goes far beyond the reaches of sports and the 2021 Tokyo Games.
"We, in society, stigmatize mental health. We do not see mental health in the same way that we see physical health," she says. "So, when Naomi Osaka or Michael Phelps or others speak about their own challenges with mental health or substance use or something else that's related … it really helps to destigmatize, remove fear and shame, and encourage others to seek treatment, too."
Another Olympic Challenge: COVID-19
But no one ― not even the fittest Olympic athlete ― is immune from COVID-19.
Both Wen and Sparrow are deeply concerned about COVID-19 risks during the games ― not just to 11,000 Olympic competitors from more than 200 countries, but also the 4,000 or so support staff who will gather in Tokyo.
This month, Sparrow co-authored an article published in The New England Journal of Medicine urging the World Health Organization to "immediately convene an emergency committee" to advise on risk management for the Olympics.
The article's authors criticized a series of COVID-19 "Playbooks" the IOC developed for the Tokyo games that call for mask-wearing, personal hygiene practices, social distancing, daily testing, and other measures, such as having athletes travel only in dedicated vehicles and eat in certain locations.
"The Playbooks have been developed based on science, benefiting from learnings gathered during the evolution of the COVID-19 pandemic," according to a joint statement by the IOC and other Olympics and government officials.
The authors of the New England Journal of Medicine article argued those plans are "not informed by the best scientific evidence" and called for stricter measures, including more frequent testing and tracking pre-symptomatic or asymptomatic cases.
"Although young, fit athletes are a low-risk group, testing positive means being excluded from competition, as the IOC hasn't built in flexibility or extended the duration to allow to proper testing and isolation," Sparrow says.
"But for Olympians, who have worked for this their entire lives, the risk of COVID-19 pales in comparison with the risk of never having [Olympics] after their name. [And] we should keep in mind that athletes aren't the ones at greatest risk from COVID ― those at greatest risk are the workers and officials and volunteers."
She notes that the IOC says only 84% of athletes and others living in the Olympic Village will be vaccinated, which poses a significant risk ― particularly in light of new coronavirus variants that are easier to spread.
Wen says she was pleased to see the move to bar spectators in Tokyo but agrees that more could be done to require routine testing, indoor masking, and other measures.
"I wish that the athletes were able to be vaccinated in advance of going, but of course that was not possible because they're coming from many parts of the world where vaccines are not accessible," she says. "But in lieu of vaccination, there are other procedures that can reduce the likelihood of coronavirus spread at the Olympics, including regular testing and indoor masking."
Raising Concerns, Awareness
Many Olympic athletes who've gone public with their own health struggles say they were motivated by a desire to raise awareness and make clear that elite competitors aren't invincible to the issues that we all deal with.
As Osaka notes in her Time magazine article, the decision to go public with such a personal story wasn't easy.
But she says it's important to get the word out that health problems can strike anyone, including the world's top athletes.
"I feel uncomfortable being the spokesperson or face of athlete mental health, as it's still so new to me and I don't have all the answers," she says. "I do hope that people can relate and understand it's OK to not be OK, and it's OK to talk about it. There are people who can help, and there is usually light at the end of any tunnel.
"Michael Phelps told me that by speaking up, I may have saved a life. If that's true, then it was all worth it."
Annie Sparrow, MD, professor of population health, science, and policy, Icahn School of Medicine, Mount Sinai.
Leana Wen, public health policy professor, George Washington University.
The Washington Post: "Michael Phelps says Olympians face greater mental health risks. Does the USOPC care?" "Naomi Osaka breaks her silence in new essay, saying her intention 'was never to inspire revolt,' " "Olympians are crying out about their mental health challenges. We should listen."
Akron Beacon Journal: "Olympic athletes open up about suicide, depression in new doc."
Time: "Naomi Osaka: 'It's O.K. Not to Be O.K.,' " "The 100 Most Influential People of 2020," "Meet 6 Heroes Who Helped Battle COVID-19 Before Competing in the Tokyo Olympics and Paralympics."
NikkeiAsia.com: "Mental health of athletes becomes concern at pandemic Olympics."
International Olympic Committee: "Ahead of Naomi Osaka's Olympic debut, IOC & Osaka unveil inspiring first-person narrative, challenging stereotypes and embracing differences," "Joint statement by the IOC, IPC, Tokyo 2020, Tokyo Metropolitan Government and the Government of Japan."
NHCPS.com: "You Won't Believe These 10 Athletes With Health Issues."
Olympics.com: "Tackling mental health in Olympic sport."
Verywellhealth.com: "10 Famous Olympic Athletes Diagnosed With Cancer."
Olypica.ca: "Team Canada athletes share their mental health challenges."
Healthline: "Famous Athletes Who Battled Disease."
The New England Journal of Medicine: "Protecting Olympic Participants from Covid-19 ― The Urgent Need for a Risk-Management Approach."
CNN: "US health experts say Tokyo Olympics plans not informed by 'best scientific evidence' "
ESPN: "How Olympic marathoner Molly Seidel found a way to run again."
Running magazine: "Molly Seidel says eating disorder remains a struggle."
CTV News: "Canadian diver Imbeau-Dulac battled eating disorder ahead of London Olympics."
WBUR: "The Comeback Story Of Olympic Swimmer Dara Torres."
IVXhealth.com: "Olympic athletes who compete despite chronic illness."
Lupus.org: "Shannon Boxx: I want a cure."
TOC Photo Credit: The Yomiuri Shimbun / AP Images
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Cite this: Olympic Athletes Vulnerable to Everyday Health Risks - Medscape - Jul 16, 2021.