Here is why you shouldn’t assume a woman is unhealthy or too skinny just because her ribs show.

Many women have ribs that show. Some are undernourished, weak and unhealthy, while others can deadlift 250 pounds, knock off pushups, have all the energy in the world and never feel sick.

As a fitness expert, I’m going to give you my perspective, and then I’ll give you the perspective from an internal medicine doctor whom I interviewed for this article.

If you don’t believe that feats of strength and endurance don’t indicate one’s health status, then consider this:

Many women with visible ribs have excellent cholesterol profiles, a perfectly normal heart and digestive system, low blood pressure, normal blood work and have beautiful skin and strong nails.

A woman who truly is too thin will most often show ribs. However, I’ve seen women, whom I considered underweight, who were not showing ribs.

They were underweight in that they lacked muscle mass and had weak, frail looking arms and legs, and a frail looking torso – but the ribs were not showing in these “skinny fat” women.

If I lift my arms, my ribs will show. If I’m lying on a bench at the gym with my arms upward, and especially up-and-back, boy, do my ribs show.

They also show prominently if I’m leaning against something with my hands, arms outstretched, or if my arms are above me as when I’m in the “up” position of a lat pull-down exercise, or in the hanging portion of pull-ups/chin-ups/hanging leg raises.

However, I’m a physique athlete and avid powerlifter, and even though my ribs are visible, I also have visible muscle mass.

I am not skinny when you look at my entire body in its entire context. To take this up a few notches, think of male bodybuilders. They’re hardly underweight, but you can see their rib cages.

Physique athletes with controlled eating habits have visible ribs.

These kinds of athletes typically are very conscious about the quality of the foods they eat. They normally avoid fast food and other kinds of junk food, eating these items only occasionally.

They snack on healthy foods like fruit, salads and nuts, rather than chips, ice cream, candy and cookies.

They limit white sugar; some avoid it altogether. How can people say these women are not healthy just because their ribs show?

After she lost weight, Nicole Richie became a perfect example: too thin, but also weak, frail and totally out of shape.

Of course, before she lost the weight, she was out of shape, but pre-weight loss, her ribs weren’t showing. And if she starved off the excess pudge, you can bet that valuable muscle tissue came off with it.

“For the average woman, reducing body weight to the lower range of the ‘normal’ scale, say a BMI of 18, may well result in the collar bones and lower rib margins being visible,” says Marc I. Leavey, MD, a primary care physician with 40-plus years of experience, who writes his blog, STRING OF MEDICAL PEARLS.

“With stretching or bending, an overall view of the rib cage, though not being able to walk down individual ribs, may be evident.  Since it is subcutaneous body fat that defines a woman’s curves and masks such structural anatomy, one could conceive that a woman scant on fat, with muscle comprising a higher fraction of the BMI, would have visible ribs. This would be unique to the individual, though, and should not be held as an ultimate goal.”