Body Fat: It’s Importance and Measurement
The importance of body fat and lean body mass has been established as more vital than weight or BMI. I consider body fat % to be the 5th vital sign after temperature, blood pressure, pulse and respiratory rate. Reducing excess body fat is more important from the standpoint of disease prevention and quality of life than any other vital sign.
Cornerstone Wellness utilizes technology that puts it on par with DEXA, the gold standard. Utilizing new algorithms developed at the University of Southern California’s School of Medicine, the Cornerstone Wellness Body Composition IV (BC IV) is within 0.5% of DEXA on average. Its accuracy really shines as one gets into the higher BMIs, where most other bioimpedance devices start to falter. It is also hand held and connects to the Internet so patients and medical weight loss physicians can follow the results online. Because it is Internet based the data can be intercalated with the meal planning program so that patients’ meal plans are customized according to their BMR, as it should be, instead of one-size-fits-all like the older, less cutting edge approaches that put all patients, regardless of size, on a standard caloric intake.
Protein, Carbohydrates and Calories – A Juggling Act
Now that body fat, BMR and calories can be determined, it allows custom individual diet plans to be engaged. The goal again is not weight loss, it is fat loss with maintenance of muscle and BMR. The results of this approach by medical weight loss physicians that utilize the Cornerstone Wellness program are constantly evaluated by frequent follow up testing to make sure values are moving in the right direction. Many patients are so determined to lower their weight, they literally don’t eat as much as is recommended and this results in loss of muscle and BMR. Likewise, we have patients who may have lost a few pounds but they drop several dress or pant sizes due to gains of muscle with loss of body fat.
When not enough calories are consumed, physiologic survival mechanisms (starvation mode) result in a lowering of metabolic rate. This is why mild to moderate caloric restriction diets (like Cornerstone) have been shown to result in better long term results than very low calorie diets or” VLCDs”. STARVATION HAS NO PLACE IN DIETING!!! It is completely counterproductive, dangerous and flies in the face of medical science.
Once LBM and BMR is determined by the Cornerstone BC IV, the patient is put on a calorie intake equal to their BMR minus 10% of their BMR. A 200 lb man, with a BMR of 2000 calories is actually burning about 2700 calories a day when one includes all their activities of daily living, even more if he is exercising. So when he is put on the Cornerstone program he would be eating 1800 calories/day (2000-200), which actually represents a reduction by 33% of what he was eating before (2700 cal). If he were put on a typical “very low calorie diet” like Optifast or Medifast of 800-1200 cal/day he would be reducing his calories by as much as 70%.
Not only is this degree of caloric restriction not necessary, it is potentially dangerous, makes people miserable and is counter to modern principles of metabolism and physiology.
Macronutrient (protein, carbohydrate and fat) proportions are set initially at 35%-35%-30% respectively. Compared to what most people consume this represents a marked increase in protein and reduction in carbohydrate. This conveniently gets most patients up to the 1.4-1.5 grams of protein per kg of body mass, which is necessary for maintenance of muscle with loss of body fat. By maintaining muscle while losing primarily fat, the metabolic rate is maintained so there will be no likelihood of cycling or yo-yoing.
The patients notice the changes in the mirror and in the looseness of their clothes since almost all the fat loss is from the abdominal area. Most importantly, metabolic co-morbidities like hypertension, hyperlipidemia, insulin resistance and diabetes improve more rapidly than one would expect with weight loss alone.