BY Frank Spinelli, M D
April 15 2010 2:30 PM ET
Every physical exam should include a nutritional assessment. Currently, over 58 million Americans are clinically obese. A sedentary lifestyle and a poor diet contribute to obesity. I often wish I had a dollar for every time I heard someone tell me that the reason they are fat is because they have a thyroid or “glandular” problem. For the majority of people this is a falsity. Eating poorly and not exercising makes you fat. True, there is some validity that obesity has a genetic component, but there are things you can do to achieve a healthier body.
A nutritional assessment consists of the patient’s height, weight, and blood chemistries. For most people, stepping on a scale is torture. However, for those who struggle with weight, it is important to know that monitoring trends is more valuable than any one particular measure.
Ideal body weight for a man is estimated as 106 pounds for the first five feet and then six pounds for every inch over that. For example, a 5- foot, 7- inch man should weigh approximately 148 pounds. However, there is a range of roughly 20 percent above and below this number, depending on bone structure and muscularity, that would still be considered normal. A very muscular male will weigh more because muscles carry more mass then fat. In order to assess if an individual is obese or underweight, it is better to use the body mass index, or BMI, which measures weight in kilograms divided by height in meters squared: BMI=kg/m2. These measurements may be reserved for extreme cases, especially HIV- positive men who also need input from a nutritionist. In HIV-positive patients BMIs have become a very useful tool because in advanced cases, patients lose lean muscle mass, and as a result standard weights are not completely accurate to assess for wasting.
Furthermore, bioelectrical impedance analysis (BIA) is another simple technique used to determine body composition. Four electrodes are attached to the patient’s wrist and ankle on the same side of the body while a painless alternating current is passed through him. From the BIA, it is possible to estimate body cell mass, fat-free mass, and other useful parameters.
In assessing nutritional status, a conversation about a patient’s diet and exercise regimen should be established. A major concern for most men over forty is getting their bodies back into shape. Relevant lifestyle modifications can be discussed, but it is essential that in order to achieve a better body that you understand the basics.
No discussion about your physical well-being can begin without asking a patient what it is about their body they are not happy with. For the majority it means either losing weight or gaining muscle mass. In order to do this, you need to establish realistic goals. Losing ten pounds in one week is neither realistic nor healthy. Most become frustrated at the thought of changing their bodies. Many people are scarred by memories of extreme diets and torturous exercise plans. The important thing to remember before you begin any program is that this is not supposed to be a painful journey. Changing your body requires learning healthier habits. Lifestyle modification has to be your mantra. You are embarking on a new way of life, not a crash course in body shaping.
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