Maryland health centers take more personalized approach to weight loss
Using better technology and addressing emotional factors help industry move beyond one-size-fits-all approach
Sharlene Fair breathes into a tube during metabolic testing at LIfebridge Health. The machine tells how fast person burns calories so a eating plan can be tailored to that person. (Lloyd Fox, Baltimore Sun / January 17, 2012)
It was an irritating 10 minutes of breathing, but one that Fair said ultimately helped her drop what she calls the equivalent of a "small child" in pounds.
The tube was connected to a machine at LifeBridge Health & Fitness in Pikesville that used Fair's breath to measure her metabolic rate, or how fast she burns calories while resting. Her personal trainer used the data to help determine the exact number of calories Fair should be eating to lose weight and then tailored an eating and exercise plan to fit her body composition.
"I have definitely seen the difference," Fair said during a recent follow-up visit. "The pounds have come off."
The weight-loss industry in recent years has moved beyond a one-size-fits-all approach in developing eating and exercise plans that once relied solely on a person's weight and height.
For years, doctors have used the standard body mass index, which plugs a patient's height and weight into an equation, to help determine the person's health. But more are steering away from that because it isn't personalized enough. Under the BMI method, athletes like Ravens linebacker Ray Lewis would likely be considered obese because they have so much muscle that it causes them to weigh more than they look.
Weight-loss experts, nutritionists and trainers instead are increasingly taking into account a person's entire body composition, including the amount of fat and muscle that person has and how fast he or she burns calories. A person with a lot of lean muscle will burn calories faster than a person with more fat. The technology to measure these components has been used by hospitals and professional athletic teams for years but only recently has become more advanced and readily available to the general public.
Early methods of measuring metabolic rate involved dunking people in water. The idea was based on an old principle that "fat floats and all the rest goes to the bottom," said Dr. Benjamin Caballero, a professor of nutrition and pediatrics at the Johns Hopkins Bloomberg School of Public Health. "The more fat the person has, the less it would weigh down the water."
The newer machines use methods such as air displacement and electric currents to determine body composition. Caballero said they are not only more accurate, but they can be used by more people. An elderly person who can't stay underwater long or someone who is claustrophobic might not be a good candidate for the water test.
LifeBridge Health & Fitness is using a device once found only in hospital settings. It also looks at a person's eating preferences, exercise habits and health history in coming up with a final plan. The machine offers nearly 40 meal plans, including low-carb, vegetarian and Caribbean variations, in an effort to please different palates.
Ellensue Levinson-Jeffers, a personal trainer at LifeBridge, said the test often finds that people aren't eating enough calories to keep up with the pace at which their bodies burn calories. Their bodies then try to conserve the calories that are coming in, resulting in slower weight loss.
"Our bodies are complex machines, and what we eat really affects us," she said.
Matt Bender, who owns a metabolic rate machine called a Bod Pod, said that how much you eat can also determine whether you lose fat or muscle. If you start to lose muscle, your weight loss will slow because muscle burns calories faster than fat. Bender said people often pay attention to the number on the scale, which isn't the most important factor.
"We want to make sure we're feeding our resting metabolic rate," Bender said. "That information by far is the most useful for a person taking a fit test. We are addressing the biggest equation in weight loss, which is calories."
The Bod Pod has been around for more than a decade, but Bender introduced it to the area four years ago and brings it to area gyms in a camper. The machine, in which a person sits for several seconds, uses air displacement to help figure out a person's body composition. Bender said people should be tested again after they lose weight because as their bodies change, so do their metabolic rates, and a new eating plan may be needed. A person with more muscle might need to eat more, he said.
The focus on body composition is part of a holistic approach to weight loss that is starting to take hold. Lynne Brick, owner of the Brick Bodies chain of gyms, said emotional issues, stress, hormones and body composition should all be considered.
"It is really critical if you're going to lose weight that you do a major self-assessment and have a professional guide you," Brick said.
The holistic approach is one the Johns Hopkins Weight Management Center has used for years. The center, which works mostly with extremely obese patients, does a full work-up with new patients that includes not only a physical assessment but a look at what behavioral and mental aspects of their lives may be affecting weight gain. The center looks at eating habits and what may trigger binges. The program also uses a body scanner to determine metabolic rate.
"I see people who have the same height and weight, but if you talk to them and exam them more extensively, they're far from the same," said Dr. Lawrence J. Cheskin, director of the center.