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Terms and Measuring Sticks
In this section we will review the measurement methodologies used in the practice of Bariatric Medicine
Body Composition Analysis (BCA)
Body Mass Index (BMI)
Scale weight can be misleading. A 6' man might be underweight at
150 lb., while a 5' women of the same scale weight would be obese. BMI
corrects scale weight for height, and provides a better measure of
"overweightness". BMI can be calculated by hand, using the
BMI
nomogram, or go to www.nhlbisupport.com/bmi/ to use an
on-line calculator provided by the NIH.
Descriptor | BMI | Units | Formula and Calculation |
Underweight | < 18.5 |
Metric |
Formula: weight (kg) ÷ [height (m)]2 Example: Weight = 68 kg, Height = 165 cm (1.65 m) |
Normal Weight | 18.5 - 24.9 | ||
Overweight | 25 - 29.9 |
English |
Formula: weight (lb) / [height (in)]2 x 703 Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiply by the conversion factor of 703. Example: Weight = 150 lbs, Height = 5'5" (65") |
Obese | ≥ 30 |
Body Composition Analysis (BCA)
We're not interested in weight loss. We are interested in fat loss, coupled with initial preservation, and later gain, of muscle mass. Strict calorie restriction as a mono-therapy leads to fat loss and muscle loss. Fat is metabolically inactive. Loss of fat has little affect on your basal metabolic rate (caloric demand). In contrast, muscle is metabolically active. Loss of muscle mass through caloric restriction leaves you with a reduced metabolic rate, a lower caloric demand, and hence a propensity to weight regain. Remember, within our theory, the hypothalamus thinks that you gained your excessive weight in preparation for famine. She doesn't want you to die of starvation, so she will do everything within her power to maintain your "essential fat stores". So when you begin to "starve yourself" with a program of caloric restriction, she responds by reducing your muscle mass, thus reducing your caloric demand, thus reducing our eventual weight loss and increasing the likelihood of weight regain. From the hypothalamus' perspective, this all makes sense. From your perspective, this hypothalamic regulatory activity keeps you from losing weight. We feel that we can overcome this "survival mechanism" by signaling the hypothalamus with HCG. OK, this is our theory, and it seems to work, but we should monitor for muscle loss during your HCG-assisted weight loss program, or for that matter if you chose any other approach to weight loss.
We have a bariatric scale. This scale directly measures body weight, and utilizing the principle of electric bioimpedance indirectly measures body fat, muscle, and water mass. From these measurements we can calculate percent body fat, muscle mass, and body water. We expect to see a reduction in body fat and percent body fat. We expect to see no significant reduction in muscle mass, and we should also see a slight rise in percent muscle mass. Percent body water will increase. This does not represent edema fluid, but rather water associated with muscle. If we see a reduction in muscle mass, that would be a signal to increase your protein intake. We can also use body composition analysis in predicting outcome with different weight loss strategies (if your percent muscle mass is quite low then diet and exercise alone are not likely to work). Thus we will weight you on our bariatric scale and use the results to guide your individual treatment program. One caveat, your scale weight, on our scale or any other scale, will vary a little depending on the time of day, as your body water content varies with salt intake, water loss via perspiration, and voiding pattern. The most accurate weight measurement remains the one you take at home, first thing in the morning after voiding. Thus we will use your first AM weight as our absolute measure of weight loss, and our bariatric scale readings to determine what percentage of weight loss was fat or body water.
Home Scale Weight refers to your weight, on your home scale, first thing in the morning after voiding, either undressed or wearing your underwear of night gown. This is the most accurate and reproducible scale weight that we can obtain. Your scale weight obtained at other times of the day will be influenced by variations in body water. Your intake of fluids may vary from day to day, as may the amount of fluid that you release via perspiration. Variations is salt intake, tissue building, or tissue repair activity will influence the amount of water released through your kidneys throughout the day. Therefore our yardstick will be your first AM weight. Obviously, you will need a dependable scale, preferably one that measures in tenths of a pound. We ask you to keep a dairy of your AM scale weight.