Body Composition Analysis Adds Big Value To Supervised Weight Loss Programs

Weight management and the “Five A’s”

More than two thirds of Americans are overweight or obese.  A popular discussion framework used by clinicians to discuss the issue with patients is the “Five A’s” (Ask, Advise, Assess, Assist, and Arrange).  Originally used for smoking cessation, the model is also applied to weight management discussions.   (1) Asks about weight, nutrition, and/or exercise, (2) Advises on topics of nutrition, physical activity, or weight, (3) Assesses readiness to change, (4) Assists in setting goals, and (5) Arranges for follow-up via physician visit, nutrition visit, or telephone contact.   However, data indicates that overweight and obese patients want more help with weight management than they are getting from their primary care physicians.

Adding value beyond the conversation

Body composition analysis, in contrast to simply monitoring patient weight and BMI, provides both clinician and patient key insights such as initial baseline values of Skeletal Muscle Mass and Fat Mass.  These and other BCA indicators can be recorded at the start of a managed weight loss regimen and progress can be easily monitored and graphically rendered, including trend plotting, with each assessment performed.  Using this approach patients gain actionable feedback along with their doctor about precisely how their Lean Mass and Fat Mass values are changing in response to their treatment program of diet and exercise, particularly when strength training to increase lean mass.  Going well beyond simple conversations of weight and BMI alone, patients now have actionable insight, and accompanying increased motivation as they observe their progress, to persevere and comply with their care plan to achieve above-average results.

One example device in the field of body composition analysis that makes it easy to implement by clinicians is the seca mBCA 514 body composition analyzer.  The device uses bioelectrical impedance analysis (BIA) to perform actual measurements (not simply mathematical presuppositions in the form of algorithms) to precisely determine patient Fat Mass, Fat-Free Mass, Skeletal Muscle Mass, Resting Energy Expenditure (REE) / Total Energy Expenditure (TEE), Total Body Water, Extracellular Water / Intracellular Water, along with Phase Angle, a direct indicator of nutritional status based on measurement of cellular capacitance.

Precise measurement of body composition and patient compliance

For a use-case illustration of what can be done with BIA technology now available, in the case of the seca device for example, validation studies were done that demonstrated a repeatable correlation of results within approximately 2 percentage points for Fat Mass and Fat-Free Mass between the seca device and the ideal “gold standard” methodology used with the                       4-compartment model of body composition (volume, weight, bone minerals, and total body water).   The word “ideal is a meaningful qualifier because actually using the gold standard, a combination of four labor and time-intensive measurement methods (Air-Displacement, Deuterium Dilution, Dual-Energy X-Ray, and Sodium Bromide Dilution) is prohibitively complex and costly for all four processes to be used in typical primary care and family practices.  In contrast, with its use of BIA technology in place of the former methods, the seca mBCA device can perform a patient analysis in 20 seconds with the patient free-standing on the platform, clothed, with bare feet and hands positioned on the device electrodes.  Immediate graphical and chart feedback is available on the device touch screen (about the size of an iPad) and results are available in report form that can be wireless transmitted to a PC and the accompanying analytical software that comes bundled with the device.

In this case the validation on a scientific basis by comparison of the bioelectrical impedance analysis (BIA) method against the 4-compartment gold standard methodology involved four clinical studies.  The primary areas of study focused on:

Generation of predictive formulas for analysis of BIA.

Adaptation of body composition formulas to different ethnicities.

Generation of normal ranges of body composition analysis of adults.

Identification of patients with abnormal body water levels.

The outcome of the comparison between the seca mBCA 514 and corresponding gold standard methodology resulted in a Standard Estimation of Error (SEE) as follows.

seca mBCA Standard Estimation of Error (SEE):

Fat Free Mass (FFM 4C)   1.8%

Extracellular Water (ECW NaBr)   0.73%

Skeletal Muscle Mass (SMM MRT)   1.2%

 

In summary, the new advances in BIA technology such as presented in the above use-case example indicate an opportunity for clinicians to provide more compliant and effective physician-assisted weight loss programs.  In addition to improving patient satisfaction with the guidance they are being given by their doctor, it also serves as a value differentiator in the local community where many fitness and health spa businesses offer less substantial methods of body composition analysis such as hand-held devices like skin fold calipers for example, which lack the precision and validation of medical-grade bioelectric impedance analysis solutions on the market.

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