Years ago I had a client send me, what was intended to be, an inspirational video to the theme of “fighting obesity.” The narrator spoke powerfully and convincingly about our war against obesity and taking charge of our health. If memory serves, I mostly agreed with his message. But what concerned me was that it was set to a video that repeatedly contrasted severely obese individuals to extremely “ripped” lifters. You’d see an obese person struggling to walk then a jacked male raging on a pair of dumbbells. I remember specifically mentioning that I liked the narrated message but found the contrasting populations to be questionable. Are “bodybuilder-looking” individuals on the opposite end of the spectrum of health to obese persons? Or maybe a better question should be; is a bodybuilder, in their most shredded form, the epitome of health?
The first task would be to define health. This is a little more complicated than it might seem. Health and wellness has been defined in many ways, but I commonly refer my clients to “the six dimensions of health” developed by Dr. Bill Hettler (National Wellness Institute). This model addresses the fact that we are all multi-dimensional beings that require more than physical fitness to be considered “healthy/well.” Individuals should give care and consideration to their social, intellectual, spiritual, emotional, occupational and physical health. Despite an individual having the best health markers and a striking physique, they could still be very unhealthy. But, for the purpose of this article I’ll focus on physical health and specifically as it pertains to to indices of health and disease. These indices include markers such as hormone levels, triglyceride levels and sensitivity to insulin, among others.
The first task would be to establish if bodybuilders are healthy. Granted, bodybuilders go through phases of caloric increases and restriction and each carries different implications. Moving forward we will be referring to competitive bodybuilders that are at or near competitive leanness. In order to reach a competitive level of leanness, these athletes must adhere strictly to dietary prescriptions for long periods of time in an effort to attenuate muscle loss during prolonged caloric restriction. These long periods of restriction can lead to physiological outcomes that are undesirable and point towards diminishing health. Fagerberg (2018) argued that during natural contest prep and prolonged deficits bodybuilders can experience muscle loss, and negative cardiovascular system affects. It was seen in research by Mitchell et al. (2018) that natural male bodybuilders dropped total testosterone levels by 75.5% amongst other hormonal imbalances. Keeping in mind the six dimensions of wellness, Fagerberg (2018) also reported major mood disturbances amongst the restricted bodybuilders that indicate anything but overall health. It should be mentioned that the majority of these studied natural bodybuilders returned to baseline levels after 6 months of competition. But, during that “very-lean” time period that oftentimes gets idealized by fitness culture and casual gym-goers, these individuals are far from peak physical health. Another point that contradicts health would be the culture of steroid use within the bodybuilding community. Brennan et al. (2017) reported high use of image and performance-enhancing drugs (IPED) amongst bodybuilders despite a lack of medical training and education on proper dosing and health implications. The risks of using IPEDs may undermine the health benefits gained from increased physical activity.
A common line that gets drawn, not only within the fitness community but in society at large, is the correlation between fatness and fitness. Individuals who display fat are often thought to be less healthy than leaner-looking persons (Clark, 2012). But does the mere presence of fat tissue itself cause someone to be unhealthy? The reality is its much more complex than that, and there are actually many beneficial roles that fat tissue plays in our bodies. Brown adipose tissue (BAT) can actually enhance thermogenesis and glucose metabolism (Kiefer, 2017). Fat tissue also functions as an endocrine organ that metabolizes and produces a multitude of hormones like leptin, adiponectin and resistin (Kershaw & Flier, 2004). Norgan (1997) argued that women need around 22% body fat just for normal menstrual cycles. Further, gluteofemoral fat helps new mothers meet the energy demands of lactation.
Knowing that fat tissue actually plays some healthy roles within our body, a point should be further explored. As mentioned, worldwide there is an idea that the presence of fat means that an individual is unhealthy, but this isn’t always the case. Clark (2012) argued that fat gain itself does not develop the “lifestyle diseases” such as cardiovascular disease and metabolic syndrome, even though these are a root for health issues for over-fat people. Its suggested that it might have more to do with the changes in hormone and cytokinine signaling related to the changes in fat mass. Clark (2012) further speculates that fat tissue may have upstream regulatory signals that effect downstream tissues like muscle, liver and bone tissues. These negative effects are thought to compound with the aggregation of more fat mass over time, and thus increase the persons risk for disease further. But, as mentioned, similar issues and indices for disease can be seen from having too little body fat. For this reason Clark (2012) suggests seeing fatness as a continuum. The farther the person deviates from a normal body fat, the higher the likelihood of disease (see figure 1).
Clark (2012) also relates fitness to a continuum. An active lifestyle being the starting point for decreasing risk for disease as we progress towards more activity. As expected, the less active we are, the more risk we have of disease (see figure 1). Whats most interesting about the fitness continuum is that it works independent to fat mass. Obese individuals have been shown to return to metabolic flexibility, reduce chronic inflammation and increase lean mass from resistance training far before they reached their ideal body fat percentage (Clark, 2012). In fact, acute responses and changes to signaling processes were changed even during single bouts of exercise.
Given this research it can easily be inferred that physical fitness and health can be achieved even at higher body fats since fitness tends to work on an independent continuum from fatness. Although individuals will continue to see reductions in their risk for disease as they approach a normal body fat percentage, they should take heart knowing that their short-term lifestyle changes are already improving their health markers. Furthermore, we can conclude that the ultra-lean state of a competitive bodybuilder shouldn’t be looked at as the gold-standard for health on many fronts. As mentioned, many of these competitors will return to normal health after their competition and the intention of this paper is in no way to discourage or shame anyone for participating in a sport that they enjoy. But expectations should be managed by competitors and outsiders in regards to what a healthy body could look like and that fatness isn’t always a great indicator of physical health.
Clark, J. E. (2012). An overview of the contribution of fatness and fitness factors, and the role of exercise, in the formation of health status for individuals who are overweight. Journal of Diabetes and Metabolic Disorders, 11, 19.
Fagerberg, P. (2018). Negative consequences of low energy availability in natural male bodybuilding: A review. International Journal of Sport Nutrition & Exercise Metabolism, 28(4), 385-402.
Kershaw, E. E., & Flier, J. S. (2004). Adipose tissue as an endocrine organ. The Journal of Clinical Endocrinology and Metabolism, 89(6), 2548-2556.
Kiefer, F. W. (2017). The significance of beige and brown fat in humans. Endocrine Connections, 6(5), R70-R79.
Mitchell, L., Slater, G., Hackett, D., Johnson, N., & Oconnor, H. (2018). Physiological implications of preparing for a natural male bodybuilding competition. European Journal of Sport Science, 18(5), 619-629.
National Wellness Institute. (n.d.). Six Dimensions of Wellness. https://nationalwellness.org/resources/six-dimensions-of-wellness/