The Struggle is Real! The Difficulties of Discussing Obesity with Your Patients

discussing-obesity-with-patients-image2Discussing weight issues with a healthcare provider can be uncomfortable; especially when you are being seen by your physician for an unrelated issue and neither party knows how to approach the topic. However; it is important for people suffering from obesity and other weight related issues to receive the proper individual treatment they need. With two-thirds of American adults being classified as overweight or obese, that conversation becomes even more vital. Being overweight increases your risk of diabetes, heart disease, and a slew of other medical problems. Often, people who are overweight are concerned about  their health, but find it difficult to talk about the subject. As a medical doctor you must treat your patient as a partner and speak to them in a caring matter about the subject.

Regularly checking your patient’s BMI is a great segue into discussing maintaining a do-image1healthy weight and further evaluation using body composition analysis.  It is recommended you discuss weight loss with your patient if they have a BMI of 30 or above, a BMI between 25 and 30 with additional health issues, or a waist size of 40 inches (men) or 35 inches (women)1.  While BMI is a great starting point, it doesn’t tell the whole story and can often have false positives with fit patients, false negatives with TOFI patients – leading to misdiagnosis.  Using medical body composition analyzers such as the seca mBCA 514 and mBCA 525, you can measure multiple parameters (i.e., fat and fat-free mass, skeletal muscle mass, visceral adipose tissue (VAT), intra and extra-cellular water) giving you and your patient a comprehensive look at the composition of their body.

An essential component to assist with weight discussion is the seca directprint 284 or 286.  Both offer a completely integrated system, measuring height and weight, then automatically printing a custom BMI report. The easy-to-read document outlines the nutritional condition of the patient based on her BMI and provides tips on maintaining a healthy weight.  The report takes a short time to print, fitting in the clinician’s workflow and facilitates as an ice breaker to help with bringing up the topic of weight.  If you determine that a patient needs assistance, start the conversation by listening2. For many, they may have never discussed their weight before and may even be unaware of the potential risk factors that they could be at risk for. Others may have been criticized in the past about their weight making it a sensitive subject to talk about. Its best to start from a place of empathy and even ask for permission to talk about the issue. Many healthcare providers worry about offending their patients during this discussion. The best way to be sure is to avoid passing judgement, eliciting confrontation, and giving  advice. Allow the patient to see that change is possible and educate them on the importance of measuring body composition to help with achieving realistic weight loss goals.

 

[1] Puhl, Rebecca, PhD. “Talking with Patients about Weight Loss: Tips for Primary Care Providers.” National Institute of Diabetes and Digestive and Kidney Diseases. National Institute of Health, Nov. 2012

2Milken Institute School of Public Health. WHY WEIGHT? A Guide to Discussing Obesity & Health With Your Patients. Washington: Milken Institute School of Public Health, 2014. StopObesityAlliance. George Washington University

The Importance of Nutrition Screening for Wound Care Patients

It is reported that as many as 35% to 55% of patients entering acute hospitals are at risk of malnutrition. Malnutrition is defined as an imbalance of nutrition1. This includes both under and over-nutrition. Under-nutrition is often seen in developing countries while over-nutrition is more common in developed nations. Malnutrition can develop as a result of a lack of proper nutrition, poor absorption resulting from an illness, excessive nutrient losses, and an increase in nutrition requirements from a disease1. Malnutrition can have disastrous consequences for hospitalized patients including increased hospital stay, higher infection rates, muscle loss, increased morbidity and mortality, and impaired wound healing1. Often times patients are admitted into hospitals already malnourished from their condition. Since undernourishment is difficult to detect, it can go a long time before being discovered.

Malnutrition and the Hospitalized Wound PatientThe best thing a hospitalist can do in this regard is administer a nutrition risk screening. Body composition analyzers such as the seca mBCA 525 (or for patients able to stand, the mBCA 514) should be used for  these screenings to detect undernourishment. Other parameters that can also be identified are losses in lean body mass, skeletal muscle mass, and measuring total body water (hydration) status. These analyzers are also capable of measuring a patient’s phase angle, which can indicate a low range of body cell mass (BCM), pointing to poor nutrition status, or potentially the need for further testing (such as a blood panel for example) to check for other underlying health conditions that may be causing it.

The seca mBCA 525 is  the mobile version of the mBCA 514 that requires the patient to be measured in the supine position, optimal when dealing with bedridden, acute, and wound healing patients under the care of a treatment team that includes a registered dietitian. The healing process slows down significantly with the absence of proper nutrition. The body is incapable of supporting itself without proper nutrients. That is why it’s important for newly-admitted patients to be screened for malnutrition as soon as they are admitted to their acute care facility.

[1] Barker, Lisa A., Belinda S. Gout, and Timothy C. Crowe. “Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System.” International Journal of Environmental Research and Public Health 8.2 (2011): 514-27. National Institutes of Health. Web. 17 Aug. 2016.

Leininger, Susan. “How to Help Wounds Heal.” Ed. Helen Lippman. RN Magazine 1 Aug. 2004: n. pag. Print.

Anorexia Nervosa: How Early Detection Can Save A Life

Anorexia Nervosa is a serious eating disorder that is seen in both men and women,Anorexia Nervosa Picture encompassing multiple age groups. It is characterized by these key factors; unwilling to maintain a normal body weight, irrational fear of weight gain, and a highly distorted body image1. This eating disorder stems from the fear of looking fat. This makes eating an anxiety filled, highly stressful undertaking1. Thoughts of diet and exercise will begin to consume your thoughts, taking these normal practices to an extreme and dangerous place.

Symptoms of anorexia nervosa include; cutting down food intake to lose excessive weight, obsessive compulsive behavior to prevent weight gain, poor self-esteem, and the inability to grasp the severity of the situation2. Unfortunately, many of these symptoms are difficult to detect and easy to hide. This is often the case with someone who suffers from anorexia. This eating disorder has such an overwhelming, negative effect on psychiatric well-being, that people try to hide their condition or are in complete denial. It is common for patients to wear baggy clothing to hide their slender appearance, keep weights in their pockets during physical exams, and lie about how much they’ve been eating in order to maintain control over their bodies.

It is important to keep your eyes and ears open when dealing with this disease. Adopting strict low-calorie meal plans or skipping meals altogether, covering up in layers of clothing, exerting body dysmorphia and refusing to eat in public are all red flags of anorexia3. It’s important to seek help if you notice any of these warning sights, as it can save somebody from a slew of health problems.

Most health problems related to anorexia stem from malnutrition4. Not giving your body proper nutrition can negatively effect multiple organ systems like the cardiovascular, endocrine, renal, reproductive, and metabolic just to name a few4. This can result in serious health concerns such as hypothermia, osteoporosis, hypokalemia, hyponatremia, and hypoglycemia4. The disease can be fatal as a result of health complications. It is reported that 1 in 200 women will get anorexia, 5 – 20% of these people will die from it and of half will be from suicide1.

The best way to overcome anorexia nervosa is a combination of medicine, psychotherapy, and family therapy5. A big obstacle in the fight against this disease and eating disorders in general, is identifying if someone is actually battling the disease. As mentioned earlier, people with anorexia often try to hide the fact that they even have it. Half of those with an eating disorder are diagnosed by their primary care physician6. Patients with this disorder often go to see their primary care doctor more than their peers for reasons not related to the condition6. It often takes several doctor visits before their eating disorder is recognized. Unfortunately, this delay in diagnosis can have detrimental effects on the patients health. So how can physicians pick up on anorexia before it turns fatal? Use a body composition analyzer such as the seca mBCA 514 or mBCA 525 to monitor decreased fat and muscle mass, or detect a low phase angle that may be caused by irregularities in somatic cells. These devices are proven to provide accurate measurements for a variety of parameters, giving healthcare professionals the data they need to better assess their patients. Early detection of these signs can make treatment and recovery that much easier, it can even save a life.

 

1Smith, Melinda, and Lawrence Robinson. “Anorexia Nervosa Signs, Symptoms, Causes, and Treatment.” HelpGuide.org Trusted Guide to Mental, Emotional & Social Health. Ed. Jeanne Segal. HelpGuide.org, 15 May 2016. Web. 15 Aug. 2016.

2Hamilton, Caitlin. “Anorexia Nervosa.” NEDA Feeding Hope. National Eating Disorder Association, 21 June 2014. Web. 15 Aug. 2016.

3Hensrud, Donald, Jennifer Nelson, and Katherine Zeratsky. “Anorexia Nervosa.” Mayo Clinic. Mayo Clinic, 4 Jan. 2016. Web. 15 Aug. 2016.

4Bernstein, Bettina. “Anorexia Nervosa.” Practice Essentials, Background, Pathophysiology. Ed. Caroly Pataki. MedScape, 23 May 2016. Web. 15 Aug. 2016

5Ehrlich, Steven. “Anorexia Nervosa.” University of Maryland Medical Center. VeriMed Healthcare Network, 23 Apr. 2015. Web. 15 Aug. 2016.

6Surgenor, Lois, and Sarah Maguire. “Assessment of Anorexia Nervosa: An Overview of Universal Issues and Contextual Challenges.” Journal of Eating Disorders (2013): n. pag. BioMed Central. Springer Science Business Media. Web.

The Dangers of The Female Athlete Triad

Female Athlete Triad TriangleThe Female Athlete Triad is a health concern for active females who are driven to excel in sports.  It involves three distinct and interrelated conditions:[1] energy deficiency, amenorrhea (irregular or missed menstrual cycles), and osteoporosis (weak bones) causing fractures and density irregularities1. While having just one of these components is bad enough, these conditions can often lead to a domino effect of health concerns.

tired woman runner taking a rest after running hard on city road

Women often face social and coaching pressures to stay skinny and lean for their sport, in addition to the unspoken competitiveness’ that adds pressure to be thin. This has been shown to be a major factor in the development of an eating disorder2. Eating disorders are chronic physical and psychological illnesses that require immediate attention. Anorexia and bulimia can cause death resulting from heart attack, blood electrolyte disorders, suicide, and many other conditions resulting from not eating2.

While most athletes do not fit the exact definition of an eating disorder, many follow the same habits. Binge eating and purging, starvation, and the use of diet pills will cause the person to worsen the energy deficiency condition. Participating in these deadly practices does not leave your body with enough energy to perform its normal functions, including menstruation. Any female who has missed three consecutive cycles should be evaluated immediately2. Leaving a condition like this unattended can cause infertility. It has been shown that menstruating athletes gain about 2 – 4% of bone mass per year, whereas amenorrheic athletes can lose 2% of their bone mass4. Low estrogen levels, a direct result of amenorrhea (menstrual abnormalities), can cause the deterioration of bone structure (osteoporosis)2. This comes as a direct result of lack of menses. A women in her early 20’s suffering from this condition can have a bone structure equivalent to that of a 70 year old women2.Ostheoperosis

Possibly the biggest problems physicians and specialists face when dealing with the female athlete triad is the initial diagnosis of the condition3. Ideally, screening for elements of the female athlete triad should happen at annual check ups or preparticipation screenings. It is important for female athletes to be knowledgeable about the causes and symptoms relating to the condition. Be sure to consult a primary care physician and a registered dietitian that incorporates body composition analysis into their assessment. Analyzers such as the mBCA 514 and mBCA 525 have been proven to give  precise body composition measurements that will aid healthcare professionals by providing an in-depth assessment. Parameters such a body fat, visceral adipose tissue (VAT), skeletal muscle mass and body water can be evaluated and monitored to assure that the best dietary game plan is in place.  While there may be some reluctance to seek care, it’s important to remind the athlete that medical advice and proper nutrition may enhance performance and their overall well-being.

[1]Emily Southmayd. The Female Athlete Triad. Salt Lake City: Emily Southmayd, n.d. Print.

2Annie Spencer. ACSM Information On… The Female Athlete Triad. Indianapolis: Annie Spencer, n.d. Print

3Nazem, Taraneh G., and Kathryn E. Ackerman. “The Female Athlete Triad.” Sports Health 4 July 2012: 302-11. Print.

4Gottschlich, Laura M. “Female Athlete Triad.” MedScape. Ed. Craig C. Young. WebMD LLC, 17 Dec. 2014. Web. 8 Aug. 2016.

 

Can it be Possible to be Fit but Unhealthy?

The words “fit” and “healthy” are usually synonymous. When you think of someone who is fit, most people picture someone who is healthy and vice versa. However, this is not always the case. Remember Ryan Shay? For those who don’t, Ryan was an Olympic marathon runner who passed away during the U.S. Olympic Marathon trial1. He died at age 28 from a heart attack1. In order to prevent such untimely and tragic occurrences you must first understand why “fit” and “healthy” are not always indicative of the other.

Being fit is the ability of our body to perform based on things like strength, stamina, and body composition2. The basic definition of good health is the absence of disease2. However, it has come to mean more than that. It now includes Fit But Unhealthy Picyour ability to handle stress and your psychological well-being2. Pushing your body passed an appropriate physical stress level can often cause poor health. Symptoms include but are not limited to Bradycardia, autonomic imbalance, thyroid disease, adrenal disease, hypertension, inflammation, malnutrition, increased oxidative damage, and anemia3. All of these ailments can hide just below the surface of a seemingly healthy individual.

All is not lost, there are things you can do to check and alleviate these potential problems. The first step is start by monitoring your body composition using seca mBCA 514 or seca mBCA 525. Many of the aforementioned symptoms can be spotted when you get routine assessments from these devices. Second, many diseases stem from stress, both physical and mental. So just relax! Overtraining and mental fatigue will lower your body’s ability to fight off harmful bacteria. Lastly, remove highly processed foods from your diet. Doing so will help you achieve optimal fat oxidation and keep you both fit and healthy4.

 

[1]Maffetone, Philip. Athletes: 
Fit 
But
 Unhealthy Is 
death
 Part
 Of
 The
 Game? Publication. Dr. Philip Maffetone, 2008. Web. 28 July 2016. (1)

[2]Lee, Lexa W. “Can a Person Be Physically Fit and Still Unhealthy?” Chron 2016 (2)

[3]Maffetone, Philip B., and Paul B. Laursen. “Athletes: Fit but Unhealthy?” SpringerOpen. Springer International Publishing Ltd, 26 May 2016 (3)

[4]Maffetone, Philip B., and Paul B. Laursen. “Can an Athlete Be Fit but Unhealthy?” Competitor.com. Competitor Group Inc., 27 May 2016. (4)

Sick Fat and How it is Affecting You

Adiposopathy also known as “sick fat” is defined as the dysfunction of fat cells partially responsible for harmful metabolic conditions and related to obesity[1]. Basically, when fat cells become bloated during positive caloric balance, they run the risk of negatively effecting how your body functions. Adiposopathy contributes to adverse endocrine and immune responses that may promote cardiovascular disease¹.

AdiposopathyThe lack of definitive, defining pathology makes identification of adiposopathy difficult at best. People as late as the 1980’s were still apprehensive about accepting that adipocytes were more than just fat storing cells[2]. Increased amounts of body fat were not considered to contribute to metabolic disease2. It wasn’t until it was accepted that fat tissue is an active hormone and immune organ, that people saw the dangers of excess fat tissue. People often see excess visceral fat as a cosmetic issue, one that effects your ego more than your health. What they don’t realize is that excess build up of fat will cause cells to swell. This contributes to insulin resistance, high blood pressure, and dyslipidemia2. All of these conditions are directly related to metabolic disease.

If after hearing this you are doing some self-analysis and thinking,  “Oh no! What can I do to reverse the effects?!”  Fear not, there are steps you can take to repair not only your self-esteem, but your health as well. Integrating a healthy diet and daily exercise into your routine can make all the difference in the long run. It is important when doing this that you shed the fat in a healthy way. It is all-to-easy to lose weight and then realize what you have been losing is mostly water weight and muscle mass. Not only is this counter-productive, it also does not improve your health.

So how do you make sure you’re losing fat and not muscle? Start by keeping track of your healthy weight loss and body composition using seca mBCA 514 or seca mBCA 525. Look beyond a scale and obtain an in-depth look at what makes up your body and allows you to see how much fat you are shedding as well as the amount of water and muscle you have in relation to everything else. Quantify your visceral adipose tissue (VAT) in absolute values expressed in liters.  These measures make it easy to understand what you have to do to regain your health. A balanced diet, routine exercise, and monitoring your body’s composition are the best tools to defend yourself from the dangers presented by “sick fat.”

[1] Litwin, Sheldon E. “Good Fat, Bad Fat: The Increasingly Complex Interplay of Adipose Tissue and the Cardiovascular System.” Journal of the American College of Cardiology 62.2 (2013): 136-37. Web.

[2] Bays, H. Curr Atheroscler Rep (2014) 16: 409. doi:10.1007/s11883-014-0409-1

 

What are cachexia and sarcopenia, and how do they differ?

Cachexia and sarcopenia are similar conditions. Sarcopenia is actually considered to be part of the same pathology as cachexia. Both conditions elicit similar symptoms including; muscle loss, bone loss, fatigue, weakness, and a loss of appetite.

CachexiaCachexia is the more serious of the two conditions. It usually is associated with HIV/AIDS, congestive heart failure, Crohn’s disease, and many different types of cancers. What makes cachexia a serious problem is the fact that you can not reverse the syndrome with just nutritional support. The treatment of cachexia comes mostly from the treatment of the underlying issue. There is no set cure for the treatment of cachexia specifically. Today’s healthcare professionals use methods ranging from steroids to non-drug therapies to medical marijuana. Accurate body composition measurement with the seca mBCA assists with detecting cachectic states. Examination results allow you to monitor and adapt nutritional state during therapy in order to reduce mortality.

Aging process - very old senior woman hands wrinkled skinSarcopenia is the loss of bone and muscle due to aging. The body begins to become more frail as we age so this condition is fairly common. The biggest factor contributing to the onset of sarcopenia is the absence of healthy diet and regular exercise. Maintaining a healthy lifestyle will drastically reduce the onset of the aging process and subsequently sarcopenia. Exercise allows your muscles and bone to synthesize important proteins in your body. This in turn strengthens your muscles and bones, counteracting the effects of sarcopenia. Segmental analysis of muscles with seca mBCA, helps to define specific physiotherapy treatment and monitors the effectiveness of hormone replacement therapy. Growth hormones and steroids have been investigated to determine their effectiveness in reversing this condition, yet no pharmaceuticals are approved for the treatment of sarcopenia.

One of the key differences between cachexia and sarcopenia is what causes them. Cachexia comes from underlying medical conditions, whereas sarcopenia comes with age. Another difference is how the conditions are diagnosed. Since cachexia is associated with other diseases, that is where the diagnosis comes from. Sarcopenia is diagnosed after administering a walking test and analyzing the patient’s body composition. If the person has a low muscle mass and a low gait speed (depending on their sex and ethnic background, respectively), then they are considered to have sarcopenia. The treatments of the two conditions can vary or overlap depending on the underlying causes. The main treatment difference is that exercise can be effective against sarcopenia where it is not against cachexia. Symptoms have a little variance between the two depending on the source of the issue. However one prevalent difference comes from the absence of malaise from sarcopenia. Malaise is a general feeling of uneasiness or discomfort/ pain felt throughout the body.