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While diet has probably contributed to decreasing longevity in Vilcabamba, other factors like quantity and intensity of physical exercise may be impacting health as well. The rise of tourism in Vilcabamba has provided more jobs for residents as hotel concierges, travel agents, and taxi drivers, positions that tend to have more sedentary lifestyles. The traditional agricultural work provided optimal levels of both cardiovascular activity and resistance; "by working many hours a day, they [kept] their bodies leaner and maintain[ed] muscle mass." Fontana says that because residents are doing less resistance exercise, they may be less physically self-sufficient as they age. This lack of exercise is probably another major factor affecting the population's health.

Dr. Fontana stresses that his studies do not explicitly address obesity. Neither is Dr. Pilco?s problem associated with obese patients. Rather, Fontana asks, "If you are a lean, healthy young person, which are the strategies that allow you to live a longer and healthier life?" Undoubtedly, non-obese people with high levels of visceral fat may experience increased health-related problems. Dr. Fontana cautions that the media sends mixed messages about which foods are slimming versus which are wholesome. Consumers should focus on what is healthy, not necessarily what leads to weight loss. The challenge for Fontana is to "try to come up with some markers of optimal health."

What is to be done about the situation in Ecuador and other developing countries where processed foods are becoming available? Dr. Pilco urged the preservation of places where this "natural miracle" of health still exists. And why not apply such habits to our own lives as well? Although the availability of healthy food may not be favorable in places like the US, there are a growing number of health food stores where decent choices can be found. It is still possible in the developed world, where calories are readily available, to take health into our own hands, thus "becoming" Vilcabambans in our own right.