Body positive enthusiasts insist it’s impossible to tell a person’s health and fitness by their looks.

A person’s looks mean more than just size when it comes to estimating their health and fitness level.

In other words, even a woman with a size 8 body can have a very unfit physical appearance.

Likewise, a man who stands 5’10 and weighs 160 – though nowhere near obese – can still look very out of shape.

People do not need to be morbidly obese or anorexic-thin to look (and be) “unhealthy” or be in lousy physical condition.

The woman pictured above may not be all that large, but…her body composition looks like simply walking outdoors on a summer day is draining.

However, the woman below appears to be the same dress size, but her body composition is markedly different:

So then, IS it possible to tell a man or woman’s health by their appearance?

“I try not to make snap judgements about a patient’s health just by what they look like,” begins Susan L. Besser, MD, with Mercy Medical Center, Baltimore; Diplomate, American Board of Obesity Medicine and board certified by the American Board of Family Medicine.

“That said, I can learn a lot about them from their appearance,” continues Dr. Besser.

What does appearance mean for purposes of this article?

• Strictly a man or woman’s looks.

• Estimated health does not refer to what that person is doing such as chain smoking.

How can anyone believe that, based on looks alone, it’s impossible to say that the couple below has superior overall health and fitness compared to the couple at the top of this post?

However, there’s a stealth disease running amok that’s notorious for randomly striking people who’ve “done everything right” with their bodies: cancer.

For all we know, that physically fit looking man with the washboard abs who runs and trains with weights was just diagnosed with leukemia — a disease that’s not associated with poor diet or lack of exercise.

But then again…it’s a safe bet that he’s in excellent musculoskeletal shape (e.g., strong core, strong back muscles, sturdy knee joints).

Meanwhile, his paunchy, flabby brother who smokes may have just had a normal routine physical. Though he’s free of cancer, diabetes and hypertension (currently)…he also just threw his back out picking up a box of kitty litter.

You can’t see the cancer in Mr. Fitness, but you can see the weak, doughy muscles in Mr. Dad Bod.

About that Cancer…

Anyone walking around can have cancer. But many cancers are not “brought on” by poor lifestyle choices nearly as much as the following conditions are:

  • Heart disease
  • High blood pressure
  • Weak, slow-moving, sluggish body that tires quickly from routine daily activities
  • Chronic low back pain
  • Chronically stiff and/or aching joints
  • Getting easily short of breath

It also depends on how you define health.

I might say that my flabby neighbor looks like she wouldn’t last five minutes clipping hedges in the heat. She has zero muscle tone but wears a size 8.

But I can’t see the insides of her coronary arteries – which may be squeaky clean for all I know. She might also have normal blood work.

Muscle tone and body shape aren’t the only tip-offs to health. “For example, skin color can be an indicator of certain illnesses (think jaundice for example),” says Dr. Besser.

Pale skin can indicate anemia, and swollen, purplish lower legs can indicate venous insufficiency.

What’s very worth noting is that every single person I’ve ever seen with the swollen, purplish lower legs had a doughy flabby physique and was at least moderately overweight. I’ve never seen this lower extremity phenomenon on a buff physique.

The Physique

Perhaps the biggest tipoff to poor health and fitness – but especially fitness – is the physique.

An arm that doesn’t get worked out means the rest of the body likely gets no workouts. How can anyone who never works out be physically fit?

“Muscle tone — not just tone but loss of muscle (atrophy) — can indicate problems,” says Dr. Besser.

“Obviously, if someone is heavy I would be concerned about underlying health issues.

“If they walk in the office panting, or are unable to get up and down from the chair or exam table, I would be concerned.”

I have NEVER seen a woman or man, who looks like the couple in the top photo, doing any of the following:

•    Moving quickly without panting or sweating
•    Jogging, let alone running
•    Effortlessly doing things like taking out garbage, walking through snow, hurrying through rain, carrying luggage or small kids, doing pushups, walking lunges, stepping exercise, powerlifting, playing pickup volleyball or basketball, or doing more than “warmup” work at a gym.

Though some powerlifters have excess body fat, they certainly don’t have excess FLAB or look doughy. The woman below can stand to lose quite a bit of weight, but let’s admit it: She has a firmness about her from powerlifting training.

“And of course, on the flip side, if they are too thin I would worry about an illness,” says Dr. Besser.

How thin, obese or “out of shape looking” must a person be before we can declare with 100% certainty that they’re either in poor health or crummy physical condition?

Additional Visible Indicators of Likely Bad Health

  • Lower leg edema (swelling but normal skin color)
  • Thin with a hump back (osteoporosis)
  • Disproportionately fat in the middle (predictor of excessive fat around the organs)

“This is just the start of what I look for when I examine a patient, but yes, their appearance can definitely be an indicator of some chronic health conditions,” adds Dr. Besser.

Hopefully this article has cleared up some aspects over the controversy of telling a person’s current health and fitness, and future health and fitness, by just their appearance alone.

Dr. Besser provides comprehensive family care, treating common and acute primary conditions like diabetes and hypertension. Her ongoing approach allows her the opportunity to provide accurate and critical diagnoses of more complex conditions and disorders.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building and fitness.