Advances in sensor networks enable pervasive health monitoring and patient-specific treatments that take into account the patients medical history, current state, genetic background, and personal habits. However, sensors are often battery power limited and vastly differ in their application related requirements. In this paper, we address both of these problems. Specifically, we study IEEE 802.15.6 ultra-wideband (UWB) wireless body area networks (WBANs) that use impulse radio (IR). We formulate the joint optimization of the payload size and number of pulses per symbol to optimize the energy efficiency under the minimum rate constraint. The proposed algorithm, cross-layer optimization for energy efficiency (CLOEE), enables us to carry out a cross-layer resource allocation that addresses the rate and reliability trade-off in the physical (PHY) layer as well as the packet size optimization and transmission efficiency for the medium access control (MAC) layer. Simulation results demonstrate that CLOEE can provide an order of magnitude improvement in to static strategies.