Drawing the Line Between Health, Fitness, and Bodybuilding

Rajiv Ambat
Lifestyle Disorders Coach & Founder – SOLVEMyHealth

I have seen the terms – ‘health, fitness, and bodybuilding’ being used interchangeably in social media posts and conversation by many fitness influencers, as if they all are the same. However, in reality, all these terms are different and have different physiological meanings. Sadly, this confusion between these terms has led many of us to misunderstand what it actually means to be healthy or fit or muscular!

According to the World Health Organization (WHO), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition highlights an important point: health is not simply about looking good or being physically capable. It refers to the overall functioning of the body and mind, including cardiovascular health, metabolic health, hormonal balance, mental wellbeing, and the ability of different organ systems to work efficiently together.

In common understanding, the word fitness carries a slightly different meaning. When people say someone is “fit,” they expect that the person to look in a particular manner – athletic, lean and muscular, and be able to perform strenuous physical activities or yoga poses. Along with this, fitness also subtly carries the expectation that the person looks good physically.

It’s important to note the distinction – ‘Fitness and health are related, but they are not the same thing!’

Now, please do not get me wrong. I’m not against fitness; I myself am a fitness enthusiast and work-out regularly in a gym. It is also a fact that people who exercise regularly and maintain good physical fitness often have a higher probability of being healthy. Regular exercise improves cardiovascular function, insulin sensitivity, muscle mass, and metabolic health. So in many cases, fitness and health do overlap. However, being fit does not automatically mean a person is healthy.

For example, a person may have visible six-pack abs and appear very fit and muscular, but may still have elevated blood pressure, abnormal cholesterol levels, or poor metabolic markers.

The opposite situation can also occur! A person may have normal blood pressure, normal blood sugar levels, and normal cholesterol values, indicating good metabolic health and he can be termed as ‘healthy’. However, ask him to perform ten push-ups on the floor and he may fumble!. In this case, the individual is medically healthy, but physically unfit. Such a person is at a higher risk of future health problems if he continues to be unfit.

This illustrates an important principle often discussed in science and statistics: correlation does not imply causation. Fitness and health are strongly correlated, meaning they often occur together. But one does not automatically cause the other. It is possible that a person can be fit and still be unhealthy, or healthy but physically unfit.

At SOLVEMyHealth, explaining this distinction to our patients and clients is often more difficult than expected. This confusion becomes even more pronounced when we look at the world of competitive bodybuilding. Professional bodybuilders often display extreme muscular development and very low body fat levels, which many people assume represent the highest form of fitness and health. But this is hardly the case.

Is Bodybuilding the Same as Fitness?

And more importantly, is bodybuilding actually healthy?

To answer these questions, it is important to clearly understand the difference between health, fitness, and bodybuilding, and how each of these represents a different objective with different physiological implications.

Bodybuilding, in its basic form, refers to developing the physique through structured resistance training and targeted nutrition. If bodybuilding is practiced using progressive strength training, sufficient protein intake, balanced nutrition, and proper sleep, it can contribute positively to body composition and physical capacity. Increased muscle mass improves metabolic health, insulin sensitivity, bone density, and functional strength. When practiced within reasonable limits, a natural body building along with nutritious diet, and adequate rest and sleep can improve health apart from adding to strength, lean body mass, metabolic rate, and physical function.

However, the term “bodybuilding” in modern popular culture often refers to something very different. In contemporary fitness culture, bodybuilding is frequently associated with extreme muscular size achieved through pharmacological enhancement, particularly through the use of anabolic-androgenic steroids and other performance-enhancing drugs.

As a result, the physiques seen in professional bodybuilding competitions are often far beyond what can be achieved through natural training alone. A substantial number of body building competitions around the world and particularly in India, are done with such unhealthy practices and this is when and how the terms ‘bodybuilding’ and ‘health’ start to imply very different things.

The answer, hence, to the earlier question, is – NO! Bodybuilding and fitness are not the same, and bodybuilding is NOT healthy!

Goals of Bodybuilding

Bodybuilding training focuses heavily on maximizing muscle hypertrophy (muscle growth) and muscular symmetry. Competitors are judged on several visual criteria, including the muscle size and definition, symmetry between muscles, proportion of upper body vs lower body, stage presentation and posing.

Unlike other athletic sports, bodybuilding competitions do not really evaluate functional performance such as strength, endurance, speed, agility, or flexibility. The judging criteria are based almost entirely on visual assessment of muscular development and body fat levels. Because of this, the goal for a bodybuilder is to maximize visual impact rather than improve overall physical function or health.

Fitness requires a person to be not only muscular, but also to have good cardiovascular endurance, flexibility, and muscular endurance. Professional bodybuilding often gives much less importance to flexibility and mobility. As muscle mass increases and training focuses primarily on muscle hypertrophy (growth) and less on flexibility and mobility, range of motion around joints can become restricted.

This has led to a common observation in popular culture where extremely muscular bodybuilders are sometimes unable to comfortably reach certain areas of their body, such as the middle of their back. In fact, it is not uncommon to see jokes about heavily muscled individuals not able to apply soap or lather their own back while bathing! While humorous, this reflects a real issue – professional body building and fitness are not the same; and it is certainly not healthy.

Health Risks Associated with Professional Bodybuilding

The health risks in modern competitive bodybuilding arise largely from the use of anabolic-androgenic steroids and other performance-enhancing drugs such as growth hormone, testosterone derivatives, and stimulants. These substances significantly alter normal physiology and can affect multiple organ systems.

Some of the commonly observed medical risks include:

• Increased Packed Cell Volume (PCV) / Hematocrit: Anabolic steroids stimulate erythropoiesis, which increases the production of red blood. This raises the packed cell volume (PCV), also called hematocrit, which is the percentage of blood made up of red blood cells. When PCV becomes elevated, the blood becomes more viscous (thicker). Thicker blood increases the risk of blood clots (thrombosis), which can lead to many conditions such as deep vein thrombosis, pulmonary embolism, heart attack, or stroke.

• Adverse Changes in Cholesterol Levels: Steroid use typically raises LDL (“bad”) cholesterol and lowers HDL (“good”) cholesterol. This imbalance accelerates atherosclerosis, the process where fatty plaques build up in blood vessels. Over time this significantly increases the risk of coronary artery disease and heart attacks.
• Cardiac Structural Changes: Long-term steroid exposure can cause left ventricular hypertrophy, meaning the heart muscle becomes abnormally thick. Steroid-induced enlargement can impair the heart’s ability to relax and pump efficiently, increasing the risk of cardiomyopathy, arrhythmias, and sudden cardiac death.
• Suppression of Natural Testosterone Production: External anabolic steroids suppress the hypothalamic–pituitary–gonadal axis, which reduces the body’s own testosterone production. This can lead to testicular shrinkage (hypogonadism), reduced sperm production, infertility, gynecomastia (man boobs), and long-term hormonal imbalance after steroid use stops.
• Liver Stress and Toxicity: Many oral anabolic steroids are hepatotoxic. Prolonged use can cause elevated liver enzymes, cholestasis (reduced bile flow), and in some cases even liver tumors.
• Psychological and Behavioral Effects: Steroid use has been associated with mood instability, irritability, aggression, anxiety, and depressive symptoms. Many individuals develop psychological dependence on anabolic steroids, and they severely impact their mental health.

Life Expectancy and Mortality in Bodybuilders 

Several studies have examined the long-term health outcomes of competitive bodybuilders and reported that professional bodybuilders had significantly higher cardiovascular mortality compared with the general population. They all highlight

that long-term anabolic steroid users had an increased risk of cardiovascular disease, sudden cardiac death, and psychiatric disorders.

There have also been observational reports showing that the average age of death among professional bodybuilders is lower than that of the general population, with cardiovascular complications being one of the most commonly reported causes.

A study presented at the American Urological Association reported that the mean age of death among bodybuilders in the dataset was approximately 47.7 years, which is considerably lower than the life expectancy in the general male population. More recent research analyzing over 20,000 male bodybuilding competitors also found that sudden cardiac death and cardiovascular disease were among the most common causes of mortality in this group. These findings do not imply that all bodybuilders face premature death, but they highlight the potential long-term risks associated with extreme muscle development, very low body fat levels, and the widespread use of anabolic steroids and other performance-enhancing drugs in competitive bodybuilding.

Conclusion

Let me reiterate – I am a strong supporter of resistance training and building muscle through exercise. Strength training has several well-established health benefits. Increased muscle mass improves glucose uptake, insulin sensitivity, metabolic rate, and functional strength. Skeletal muscle also plays an important role in metabolic regulation and healthy ageing, helping preserve mobility, bone density, and independence as people grow older. In that sense, going to the gym and building muscle through natural training is beneficial for health.

My disagreement is not with weight training or muscle building. It is with the form of bodybuilding that relies heavily on anabolic steroids and other performance-enhancing drugs to achieve extreme levels of muscularity.

Whenever this topic is discussed, it often triggers strong emotional reactions, particularly from some gym trainers and steroid-using bodybuilding enthusiasts. The common responses are predictable. Someone will point to examples such as Arnold Schwarzenegger and say that he is still alive and doing well. Others argue that steroids alone do not build muscle and that achieving such physiques still requires discipline, motivation, and years of hard training.

Both statements are technically true, but they miss the central point. Steroids may not replace hard work, but they fundamentally change the physiological limits of muscle growth and introduce health risks that natural training does not.

There is also a well-known psychological phenomenon at play here called Survivorship Bias. People tend to focus on the few visible success stories like that of Arnold, while ignoring the many individuals who suffer health complications but remain unnoticed. When someone points to one successful bodybuilder who appears healthy, they are often overlooking the broader data showing increased cardiovascular risk and premature deaths in that population.

Muscle built through natural training, proper nutrition, and adequate sleep & recovery, supports health and longevity. Muscle built through pharmacological enhancement may produce impressive physiques, but it does not necessarily translate into better long-term health.

Understanding this distinction is important. The goal of exercise should ultimately be a body that functions well for decades, not just a physique that looks impressive for a short period of time.

Pic Courtesy: pegasus/ images are subject to copyright