Have you ever looked at a person and thought to yourself, “wow they’re really fit (aka healthy)”? Or maybe the inverse has happened where you’ve looked at someone less fit and made the judgment that they were unhealthy. Don’t worry if you have, it’s pretty normal and you are not alone in this regard.
There’s this misguided ideal that you can tell whether a person is “healthy” from the way they look. See a fat person = unhealthy. See a skinny person = healthy. See a fit person = super healthy. While size, shape and/or look can sometimes give insight to health, it isn’t the sole determinant of health and there’s so much that goes on beneath the surface.
Size doesn’t show how active a person is, whether that person smokes or drinks excessively, or the general lifestyle that a person lives. Size doesn’t tell you whether that person is living with an illness or disease, or whether they’re happy or sad. And most of all, size doesn’t tell you how dedicated vs lazy a person is. Weight and size only tell you that, weight and size.
Someone told me something that put things into perspective in this regard. Imagine driving along and noticing somebody walking down the street. This person is noticeably overweight. Many people would look at that person and follow a train of thought similar to the opening paragraph. The person was unhealthy and unfit, maybe going so far as to call them lazy or uncaring about their health. What you may not realize, or may not be able to tell from looking at them, is this person has been on a weight loss and health focused journey for some time, losing 100lbs already. They’ve been active during their daily life, spending 3-4 days per week in the gym, and have improved many of their lifestyle habits to improve their health. So, while their physical appearance may not show it (or tell the whole story), they are living an active and healthy lifestyle that has led to marked improvements in their health. Remember that the next time you make a snap judgment about someone based on the way they look (and remember that it’s ok, judging is natural but we should be mindful of and redirect those judgments).
Now, I want to point out that there’s a lot of research that points to the contrary, making weight and thus, size, the sole predictor of health. Head over to PubMed and check out the meta-analysis (data gathered from numerous studies/research following certain criteria for accuracy to weight a large bulk of evidence) titled: The Medical Risks of Obesity. In it they have gathered data from numerous studies between the years of 1995 and 2008 to draw a clearer picture on the risks of excess weight and disease (one portion of health). The stats are staggering, showing that the risk of nearly every disease is increased with an increase in BMI (body mass index) past a “healthy range”. This study, along with numerous others, paints a pretty clear picture: obesity is linked to health risks and disease. 
The problem with BMI is that it’s a very basic and simple formulation for generating a number on health, which is anything but basic or simple. Health is a culmination of so many variables, including but not limited to, how active a person is, how much stress they have and how well they manage it, a person’s nutrition and hydration, how well a person sleeps, overall mental health, and much, much more. To sum up health with a number that is based entirely off of weight in comparison to height, while necessary for the medical and research fields, is a bit flawed.
For instance, I am 6 feet tall and currently weight about 213lbs. That puts my BMI at 29, making me “overweight” and just short of the “obese” cutoff of 30. Anyone who knows me or takes a look at me (there we go with judging a book by its cover again), would laugh at me being classified as overweight, much less nearly obese.
In fact, for me to get into the “normal” BMI classification I would have to lose nearly 30lbs and get down to 184lbs. Not only would this be terribly unhealthy in practice, it’s likely impossible without losing about 5-10lbs of muscle, which would mean losing a vital component to health. Muscle aids in metabolic function (improving insulin resistance and sensitivity, and increasing caloric expenditure), reduces the likelihood of osteoporosis, and increases chances of survival from critical illness or injury, like cancer or extreme burns. So, while losing weight may be a good thing, losing muscle certainly is not. [1,4]
While BMI can give us some indication on overall risk of disease and health, it’s not a conclusive depiction and thankfully, researchers have realized this and found alternative ways to measure health. In another meta-analysis, researchers looked at a different variable on the link to risk of disease: cardio-respiratory fitness. And what they found was interesting. Through the analysis researchers found that cardio-respiratory fitness was a better predictor of disease risk than BMI. In fact, “compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals“.  What this means is that regardless of size, those who were considered fit from a cardio-respiratory aspect had less risk of disease than those who were “normal weight” individuals but lacked cardio-respiratory fitness. In other words, playing the part of health and fitness proved more important than looking the part.
It’s hard to say which basis of information is right. Is health a result of your weight or your cardio-respiratory fitness? The truth is, it’s a combination of the two with lifestyle factors and environment playing a large role as well. That’s why it’s important to remember that health is extremely nuanced, and rarely a black and white topic. The most important point to remember when it comes to health it isn’t so much about what you look like, but rather it’s more about the actions that you take, the habits you maintain, and the lifestyle you live. So, rather than worrying about looking a certain way, or being a certain weight for health purposes, focus on living a healthy life, which includes:
- Eating a diet rich in whole foods like lean proteins, whole grains, fruits, vegetables and healthy fats
- Exercising and moving in your daily life. Aim for at least 3 days of specific exercise each week (45+ minutes), and move throughout the day.
- Drinking plenty of water and stay adequately hydrated throughout the day. Your pee should be a lightl yellow color most of the day.
- Sleeping at least 6 hours a night. 7-9 is the preferred range, but anything less than 6 comes with increased health risks.
- Managing stress. Read, go for a walk, listen to or play music, draw, meditate, etc. Find activities that help you reduce and manage stress and make sure you do them frequently.
If you’re looking to improve your health in a safe, healthy and manageable way, something that you can enjoy and sustain for life, send an email to firstname.lastname@example.org to discuss a plan that will help you feel your best, be your healthiest, and enjoy your life to the fullest!
 Abramowitz, M. K., Hall, C. B., Amodu, A., Sharma, D., Androga, L., & Hawkins, M. (2018). Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study. PloS one, 13(4), e0194697.
 Barry, V. W., Baruth, M., Beets, M. W., Durstine, J. L., Liu, J., & Blair, S. N. (2014). Fitness vs. fatness on all-cause mortality: a meta-analysis. Progress in cardiovascular diseases, 56(4), 382-390.
 Pi-Sunyer, X. (2009). The medical risks of obesity. Postgraduate medicine, 121(6), 21-33.
 Wolfe, R. R. (2006). The underappreciated role of muscle in health and disease. The American journal of clinical nutrition, 84(3), 475-482.