This paper performs integrated performance evaluation, including preamble detection in the Smart Body Area Networks (SmartBAN) physical layer (PHY). The system specifications for a PHY and media access control layer (MAC) in SmartBAN, which is a standard for medical and health care advanced by the European Telecommunications Standards Institute (ETSI), were issued in April 2015. In the PHY, the packet structure has a two-octet preamble, which is used, e.g., for timing synchronization. However, it is considered that the current preamble structure is not appropriate for handling medical and healthcare data that are required to have high reliability because of the too simple structure. Therefore, we propose adding a start frame delimiter (SFD) to correctly detect the header position. Computer simulations indicate that preambles with an SFD consisting of an orthogonal maximal length sequence (M-sequence) perform better than SmartBAN and similar approaches, particularly when transmitting over the IEEE model CM3. In addition, the packet error ratio (PER) and energy efficiency are evaluated in an integrated manner while taking preamble detection into consideration. The numerical results from computer simulations indicated the best performance with respect to PER was achieved using a preamble with orthogonal M-sequences of 4 octets. However, for energy efficiency, better results were obtained using a preamble with orthogonal M-sequences of 2 octets. Additionally, the theoretical analysis found the optimum length of the PHY packet to achieve the maximum energy efficiency with PER less than 10−2.