I do not care what you weigh, but I do care how strong you are!
Updated: Jan 24
It’s true! As a dietitian, I really do not care what your total body weight is, but I definitely care about the amount of muscle you have. Low muscle mass is an independent predictor of mortality, and I want you to live a long life. Further to living a long life, I want it to be good quality of life where you are independent and without the functional disability that often comes with age - it doesn’t have to! I plan on being able to lift, play and go places with my grandkids. I need muscle to reach these far-off grandma goals given that I’m currently kid-less heading into my 30s...
#newfienangoals- who’s with me?! The featured picture for this blog is one of those strong, independent Newfoundland Nans, and I’m proud to call her my mother. She tackled the 3-4 day Long Range Traverse hike in Western Newfoundland without a hitch - just one of her many accomplishments!
Ok, where was I? Ahh yes. We need to look beyond assessing total body weight, height and BMI, and consider ones body composition. If you are only using the scale you can never know whether it’s muscle, water, or fat that is fluctuating. You may lose weight, receive praise (face palm- see previous blog), but you’ve actually lost muscle, and as such that weight loss may be detrimental to your health. The scale doesn’t really tell us much other than total body weight, but it’s used in clinical settings because it’s cheap, accessible, and helps us track trends overtime.
Have you ever had a health care professional discuss your body fat or muscle mass? Or just a discussion (welcomed or not) about the number on the scale?
Well this dietitian is different. When deciding to move into private practice I knew I had to have a way of measuring body composition- fat mass, skeletal muscle mass, fat free mass, body water. I thought maybe I would get certified with skin callipers but decided against this because who wants to be poked and pinched in their sensitive spots while minimally clothed? After much reading I decided to purchase an Inbody 270 which uses non invasive bioelectrical impedance analysis to measure the resistance of water, tissue and muscle to determine ones body composition and segmental lean mass.
For more information on what InBody 270 testing will show you check here.
What do I plan on doing with such results?
Nutrition plays a crucial role in preventing and reversing low muscle mass. Unfortunately nutrition is often under used in this area, yet there are many nutrients that are vital to muscle including, protein, specific amino acids, HMB, creatine, long chain omega 3 fatty acids, vitamins and minerals, etc. So whether you want to improve your health, or improve your physique (knowing the two are not synonymous), then body composition analysis and working with a dietitian can help you get there.
How does body composition relate to health?
Having measures of body composition can help dietitian's monitor nutrition interventions and their impact on disease progression (i.e, cancer). Consequences of low muscle mass have been well studied for its role in cancer, especially in cancer prognosis. Low muscle mass and/or excess adiposity is associated with longer hospital stays, more complications and increased risk of death in males and females undergoing surgery for stage I - III colon cancer. Is it excess adipose tissue (fat) or lack of skeletal muscle mass that leads to disease and poorer health outcomes? There are arguments to be made for both, but ultimately increasing strength can improve outcomes and decreasing fat could also come with a damaging muscle mass loss if you do not have solid nutrition plan in place.
Let’s also consider an endurance athlete with a low body fat percentage that puts them at risk for dysfunction in metabolic, physiological, endocrine, immunological, cardiovascular, etc health. By knowing specific body fat percentage, it allows me to create a meal plan that provides adequate energy (calorie) restoration to correct for the aforementioned dysfunction. Guessing and using prediction equations based on weight, age, sex and height may not cut it and thus why my nutrition prescriptions are based on your individual body composition.
Body Composition in Older adults:
First, can we please stop telling older adults to lose weight? How about changing the language to “increase protein intake, focus on timing and high quality protein sources, consider supplementation and engage in resistance training?” - not as sexy as keto or intermittent fasting?!
Muscle mass in older adults is associated with greater longevity and lower risk of death from multiple causes and low muscle mass is an independent risk factor for mortality in older adults. Remember that weight loss can be (and likely is) muscle loss when it comes to older adults and may be detrimental to health! Especially if they are sedentary! I’m not the dietitian who try’s to play the role of the human kinetics experts. There are enough kinesiologist, physiotherapist, chiropractors, exercise physiologists, qualified trainers, etc. around that I am happy to refer to. Don’t get me wrong, I am an athletic dietitian who moves daily, but that doesn’t make me an expert in movement. And just because one of the disciplines noted above eats daily, doesn’t make them an expert in nutrition either. Let’s stick to our respective disciplines and promote strength across the life span #dreamteams #interdisciplinarycare.
If you are wondering, does increasing muscle mass in older adults translate to improved physical performance? Yes! A large scale systematic review and meta analysis showed improvements in physical performance and strength testing. Muscle mass can be manipulated at any age and it’s never too late to move your body and manipulate your daily diet to see gains in muscle.
Think “well I’m not old” so this doesn’t apply? Remember that with every second, you are certainly getting older. Much can be said about disease, injury, illness in relation to body composition in younger people as well, but there is only so much people will read on a blog with minimal followers- LOL.
Bottom line in regards to body composition:
The long term success of a diet depends on ones consistency and compliance, and working with a dietitian over the long term will help create a sustainable plan that fits your goals and way of life.
Fat loss requires a sustained caloric deficit - the extent of the deficit depends on baseline body fat percentage. Muscle gains require a sustained surplus of calories with high protein intakes and you have to be engaging in resistance training. Body weight loss can be obtained through dehydration, lower carbohydrate intake, restrictive calories, or taking a poop, but this doesn’t tell us whether you lost water, fat, feces, muscle or a combination. Preventing muscle mass loses or maintaining muscle mass requires macronutrient manipulation and supplementation may augment the effects. The body requires anabolic stimuli on a regular (?daily) basis. Both food and activity can provide that anabolic stimuli.
As clinicians, we need to do better than just body weight.