Archive for the 'Clinical Nutrition' Category

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

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.

 

Body composition and metabolic changes following bariatric surgery

basal-metabolic-rate

A quick summary about interesting research results in regard to basal metabolic rate differences in pre and post-operative bariatric surgery patients.

Body composition analysis using convenient, clinical-grade bioelectrical impedance analysis (BIA) technology can provide clinicians and researchers accurate, medically-validated measurements of patient basal metabolic rate (BMR), percent fat, fat mass in absolute values, and lean body mass among others.

These measurements are very helpful to know prior to surgery, with a view to post-surgical care, planning and nutrition counseling. A recent study looked at the Analysis of Variance using the general linear model with a research cohort of bariatric patients1. Prior to surgery the baseline values were measured in a rapid, non-invasive manner by means of BIA.  After  surgery the same measurements of BMR, fat mass and lean mass were taken at intervals of 1, 3 and 6 months. The resulting analysis showed significant changes in all body composition measures, including lean body mass, and an average reduction in BMR for the cohort in a range of 330-440 kcal one month after surgery.  This is an expected and significant reduction in BMR, and points to it being helpful to measure a patient’s score in regard to post-surgical nutrition counseling as it applies to total daily caloric intake.  Subsequent measures at the 3 and 6-month intervals showed no significant changes in BMR, indicating no adaptation of an energy-conservation mechanism in the cohort patients.

 

Citations

1Body Composition and Metabolic Changes Following Bariatric Surgery: Effects on Fat Mass, Lean Mass and Basal Metabolic Rate  Daniel Gene Carey, German J Pliego, Robert L Raymond, Kelley Brooke Skau  Obesity Surgery April 2006, Volume 16, Issue 4, pp 469-477