Metabolic vs Aesthetic Metrics

My clinical practice is focused on diabetes and heart disease prevention and reversal through lifestyle changes, yet I often see patients whose primary goal is aesthetics. Their metabolic numbers are within range, but they are not satisfied with the look and shape of their body. This self-body shaming and unhappiness with one’s physical appearance is not a new phenomenon, but I would say there are some key factors that are making this much more severe in today’s society.

3 Factors to Consider

1. Social Media

There are many health leaders on social media who pose shirtless, in bathing suits, minimal clothing, etc. who claim that they have a simple approach (“30 day Fat Burn,” etc.) that will get you to look more like them.

The amount of time and money they spend on exercise and recovery using all types of equipment, support staff (personal trainers, massage, etc.) and in many cases performance enhancing supplements and drugs, is not how a common person can get by.

Endless exercise routines and regimens are often followed by sauna, ice bath, massage therapy, etc. Photoshopping and now AI-based image enhancement technologies will make it even easier to airbrush off some fat and adjust lighting and shadows to make these leaders appear even leaner, while ChatGPT or a similar tool will instantly write up a catchy post with hashtags.

2. Legitimate Health Influencers Being Influenced

I think it’s great that physicians and scientists have crossed over from their clinics and laboratories into the public through social media, podcasts, Youtube, etc. to get their message and research out to the masses. The net benefit from these prominent health influencers is definitely positive. However, once you cross over into the public/digital realm, all of a sudden you get swept into non-clinical metrics like numbers of followers, affiliate sponsors, clicks, etc. Pitching and promoting expensive products, supplements, and complicated daily rituals and routines can often feel overwhelming to many individuals.

The road to optimal health is often much simpler, intuitive, and economical than even the most prominent health experts might claim.

3. Genetics

Do not ignore the fact that most of the health leaders who are showing rippling 6-packs and enviable physiques have been gifted with advantageous genetics which provide them with the body frame, body composition, and metabolism to stay lean and add on lots of muscle. Some are former athletes, models, movie stars, etc. who decide to enter the field of health and wellness and sport their near-perfect physiques as a testimony to their simple lifestyle approach, overlooking what a big role genetics and their prior profession played in them achieving their appearance.

The task of gaining significant amounts of muscle, while losing body fat is not a simple task for most individuals. You need calories to “grow muscle,” and you need to to reduce calories to lose body fat. Trying to do these things simultaneously can be easy at first if you are overweight and have not put much time into nutrition and exercise. However, after the initial weight loss, it becomes increasingly challenging to thread this needle .

Metabolic Goals are Generally Easier to Achieve

The good news is that achieving optimal metabolic health does not require you to achieve that elusive ideal physique. I have plenty of patients who reverse their diabetes, cholesterol, fatty liver, etc. who may still be 20 or 30 pounds “overweight” based on some predetermined table, but they have great energy, are eating healthy, and enjoying life. At that point frankly my job is done. I don’t have the clinical resources or team to provide the supervision and coaching necessary for them to lose that additional body fat, and for many of my patients it may not be worth the sacrifice.

A few years ago I was able to hit my personal record low body fat percentage through frequent fasting and ketosis, aerobic exercise, weightlifting, and additional practices like Wim Hof breathing. I looked lean, but my face was gaunt, my sleep suffered, and although my glucose levels on my CGM (continuous glucose monitor) were low, I did have lots of variability with elevated morning glucose levels due presumably to excess cortisol from overtraining and work stress, and some low glucose episodes in the afternoon and occasionally at night. I gave up on that overly restrictive lifestyle and now have found a much better balance where I’m stronger, more energetic, sleeping better, and not worrying about my increased body fat since my metabolic numbers are within range.

I now embrace some of that extra subcutaneous fat, which is a physical reminder that I’m not torturing myself into a physique unnecessary for me to lead a long and healthy life.

If you look at individuals living in the longevity blue zones, I assure you that most of them are not walking around with chiseled 6-pack abs and Instagram-perfect bodies.

Closing Thoughts

This post is not meant to demotivate you. I just want you to realize that the body image being sold on social media, Youtube, and on the cover of health books and magazines, is not attainable by most of us normal folks who have busy day jobs that don’t allow us to train and recover as a full time profession. Be kind and gentle to yourself, be proud of the improvements you’ve been able to make with your health in the context of your genetics and being a busy non-fitness professional, parent, etc., and consider unfollowing health content that might make you feel overwhelmed, insecure, and inadequate. I’ve personally done that myself!

The goal is maximizing metabolic health by improving your internal metabolic numbers (lipids, glucose metrics, blood pressure, etc.), by setting realistic body composition goals based on your genetics and your work/life demands, focusing on other health metrics like strength, balance, and endurance, and then making sure you are balancing training and recovery to optimize your overall mood and energy levels.