Nutritional Assessment

By Frank Spinelli, M D

Originally published on Advocate.com 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. The best way to reshape and sculpt your body is through weight training. Aerobic exercise will help you lose weight, but weight training is what promotes fat loss. Joining a gym is imperative before you begin any workout program. You may prefer working out in public as opposed to your home because a gym is highly motivating. Being around other people will push you to work out harder. If you have sufficient funds, it is wise to obtain a personal trainer. Trainers will be able to show you the basics of working out. Learning good habits early will help you to avoid injuries in the future. Also trainers are highly motivating and get you to work out harder than if you were by yourself. Working out with a partner is a good alternative if you can’t afford a trainer. Remember to start your workouts slowly at first and build up over time. Most people have a tendency to overwork their bodies and this can lead to injuries. Learn to listen to your body. You should become familiar with how your body responds to weight training and aerobic exercise. Once you have established how much you can lift, set a realistic goal to increase the weight over a period of time. Some trainers recommend keeping a workout journal to monitor your progress.

Gaining muscle mass in a specific area requires training with weights to apply tension to that muscle. The muscle fibers will respond by growing, or going into “hypertrophy.” Over the course of time, increasing weights will increase muscle size. Once you have achieved the desired effects, maintaining muscle size requires regular weight training in that muscle group. Most trainers recommend exercising one or two muscle groups in a workout session, for example biceps and triceps on the first day, followed by back, chest, shoulders, and legs. It may be advisable, for instance, to alternate workouts with abdominal crunches and aerobic exercise three times a week.Most body- builders do very little, if any, aerobic exercise because this has a tendency to diminish muscle size.

Aerobic exercise is very important, especially as you age, because it improves your overall cardio pulmonary performance. Once you have established your goal weight and you are content with the amount of lean body mass you have achieved, it is appropriate to add aerobic exercise to your program. It is recommended that you introduce about twenty to thirty minutes of aerobic exercise a week using a treadmill, the elliptical machine, or the stationary bicycle, preferably on an empty stomach to increase fat loss. You can alternate machines with aerobics classes, jogging, or riding a bicycle when the weather permits. Ultimately, the most efficient way to improve muscle tone, increase cardiopulmonary performance, and increase metabolism is through physical activity like sports, such as volleyball, tennis, and swimming. Maintaining muscle requires energy. To build a lean healthy body requires eating right. Depriving yourself of food does not result in weight loss. When you starve yourself, your body catches on, and quickly compensates by slowing down your metabolism. Energy is then mobilized from lean muscle, the same muscle you have worked so hard to gain. The result is a tired, weak body that has a suppressed immune system as a result of inadequate nutritional intake. In addition, hungry people are very cranky. The best way to lose weight is to maintain a healthy diet that is high in protein and low in carbohydrates. Carbohydrates are like Chinese food. They are delicious, addicting, and in twenty minutes you want more. Protein requires more energy to metabolize and asa result it sustains you for longer periods of time.

Protein-rich foods include chicken and turkey; fish, such as salmon, tuna, and snapper, are also high in protein, except when deep- fried. The number one source for protein is egg whites, which are very popular for weight trainers; however, avoid the yolk, which is high in cholesterol. Red meats are also a good source of protein. Contrary to popular belief, lean cuts of sirloin, round, and chuck have less then 7 percent fat.

Since most people argue that their diet is adequate, try keeping a food journal for twenty- four hours. Write down everything you eat and the time at which it was consumed. Afterward, review the journal with your doctor to see exactly what your diet consists of.

Maintaining a routine diet and exercise regimen is a great way to keep in shape. Do not get obsessed with weight itself. It’s better to rely on how well your clothes fit then an actual number.

Finally, no gay health assessment would be complete without a thorough review of how you envision yourself. Gay men are particularly prone to issues concerning body image. Body Dysmorphic Disorder (BDD) is an unhealthy preoccupation with one’s appearance that can interfere with daily life, creating anxiety and depression. The result is a compulsive concern over the slightest defect in one’s own appearance. This can lead to eating disorders, anabolic steroids use, and plastic surgery.