As the health coach, you will follow a four-step process in dealing with adverse body composition scenarios or changes in their body composition fall outside the range of expected results for the program. Follow the process by addressing one step at a time until the desired outcome is reached. An adverse body composition scenario can be defined as:
- No weight loss or increasing percent body fat (PBF)
- Increase in extracellular water (ECW)
- Extracellular water (ECW)/total body water (TBW) ratio >0.400
- Excessive weight loss (>10 lbs per week)
- Loss of >15% BMR in 1 month (excessive loss of lean muscle tissue)
The 4-Step Process
- Step 1: Ensure InBody Testing Accuracy
- Step 2: Challenge Patient Compliance
- Step 3: Diet/Lifestyle Modifications
- Step 4: Additional Testing
Step 1: Ensure InBody Testing Accuracy
Was a testing precautionary step not followed properly? Review the steps to maximize InBody testing accuracy.
- Complete test before eating – In cases where the examinee has already eaten, the test should be put off at least for two hours after the meal. Food mass will be included in the subject’s weight resulting in measurement errors.
- Stay hydrated throughout the day but not before testing – Adequate hydration throughout the day is important, however, fluids consumed directly before testing will create an inaccurate increase in total body weight as well as an increase in fat mass. It is encouraged that examinees drink half their body weight (lbs) in ounces during the 24 hours prior to the test.
- Use the bathroom before testing – Waste is not included in the body composition reading, but the volume of urine and excrement is included in the total weight measurement resulting in measurement errors.
- Stand upright and still for at least 5 minutes before testing – Conducting the test immediately after lying in bed or sitting for a long period of time might result in a slight change in the test results. This is because the body water tends to move to the lower extremities of the body as soon as one stands or gets up.
- Do not exercise right before testing – Strenuous exercise or sharp movements can cause temporary changes in body composition.
- Do not conduct the test right after a shower or sauna – These activities may lead to dehydration, which will inaccurately show higher body fat levels than what are actually present. This ultimately will skew the muscle/fat ratio and inaccurately lead to a lower BMR reading on the report.
- Measurements will not be accurate during the menstrual cycle – Females should still complete the test during the menstrual cycle but it is important to note they will hold excess fluid increasing fluid levels and weight.
- Conduct the test at normal temperatures (68 -77 °F ) – While the human body is stable at normal temperatures, body composition is susceptible to temporary change in hot or cold weather.
- If a retest is carried out, make sure to conduct the test under constant conditions – This includes testing at the same time of the day, wearing similar clothing and testing before eating or exercising. This is extremely important in order to assure the accuracy of the test results.
* Individuals with medical implant devices such as pacemakers, or essential support devices such as patient monitoring systems, must not take the test.
Step 2: Challenge Patient Compliance
Is the participant adhering to their individualized recommendations? Do you believe they are honest with their reports? Pay attention to your participant’s nonverbal cues, such as how they sit, stand or look at you when you are communicating with them.
Evaluate the participant’s food diary for adherence of caloric intake and distribution of macronutrients. Also challenge the participant on their accuracy of documentation. If the participant is not adhering to caloric intake levels and distribution of macronutrients, identify if a knowledge deficit exists. If so, educate and refer participant to resources including appropriate portion control tools (measuring cups, food scales, etc). If you suspect pure non-compliance and lack of motivation, refer back to the participant’s Life Effect and handle any objections or emotional blocks to compliance.
It is critical to communicate to your participants the detrimental outcomes of deviating from the dietary protocol. Simply eating one brownie or cookie can shift the body’s metabolism back into glucose or sugar burning mode and away from burning stored body fat, hindering progress. It may take as long as 3-4 days to reverse this metabolic shift.
Step 3: Diet/Lifestyle Modifications
Diet will be modified on a customized basis depending on the particular outcome of the body composition. In most cases there will be a simple substitution of macronutrient units. The following scenarios should occur infrequently during the program; however, if they do arise, potential solutions are provided. The intention is to provide the participant detailed recommendations for a specific length of time.
- No weight loss or increase in percent body fat (PBF). The initial step in addressing this adverse scenario (after ensuring an accurate body composition and confronting patient compliance) is to address lifestyle factors that may be having an impact on the participant’s results including exercise and sleep.
- Exercise: Have participant work up to performing 30 minutes of cardiovascular exercise 4-6 days per week and 15-30 minutes of resistance exercises 2-3 days per week if not already doing so. If the participant is exercising already, look for signs of overtraining and extreme exercise regimens. This can elevate stress hormones and decrease the body’s ability to burn fat.
- Sleep & Stress Reduction: Ensure the participant is getting quality sleep. Eliminate caffeine within six hours of sleep, implement relaxation techniques (yoga, meditation) and utilize additional Aceva® products such as Relax and CalmTM as necessary. Reassess the participant after one month.
- Increase extracellular water (ECW) – When the participant does not experience weight loss and their extracellular water increases, the participant may be consuming high levels of sodium or they may be toxic and need to complete the Ultimate Body Cleanse. If the participant is consuming high levels of sodium, reduce sodium to 2,400 mg or less for seven days to see if there is a reduction in extracellular water. If they are continuing to lose weight, then it is recommended to complete the Ultimate Body Cleanse after they complete the MetaLife program to handle the increased extracellular water. If the participant did the Fat Fast and Oil Change prior to beginning the program, they do not need to do the Oil Change again as part of the Ultimate Body Cleanse.
- Extracellular Water (ECW)/Total Body Water (TBW) ratio >0.400 – Water is extremely vital to cells. It nourishes the cells both directly and indirectly, as it is a carrier of vital nutrients into the cellular environment. Water should be present in much higher concentrations in the intracellular environment compared to the extracellular environment. The ECW/TBW ratio provides insight into how much water is present in the intracellular environment (available to the cells) compared to the amount of water in the extracellular environment (outside of the cellular environment and unavailable to cells). An optimal ratio of ECW/TBW is around 0.380, with the normal range falling between 0.360 to 0.390. The number will decrease (desirable) as intracellular water (ICW) and/or Lean Body Mass (LBM) increases, resulting in nutrients being retained in the cell. The ratio will increase (undesirable) as fat mass, inflammation and/or edema increase and when dehydration occurs. If the participant is consuming high levels of sodium, it may be leading to edema. Have the patient reduce sodium to 2,400 mg or less for seven days to see if there is a reduction in extracellular water. An ECW/TBW ratio >0.400 could indicate severe inflammation, edema and/or dehydration. If the participant’s ECW/TBW ratio >0.400, it is recommended to refer the participant to their physician, as this could indicate a severe problem. They can continue the program pending their physician’s findings.
- Excessive weight loss (>10 lbs per week) – If the participant loses ten pounds or greater in the first week and adhering to their recommended caloric intake and macronutrient ratio, it is unlikely a cause for concern. It is not uncommon to lose a significant amount of water weight in the beginning stages of a lower carbohydrate, low processed food diet. If this degree of weight loss continues with an extreme reduction in Basal Metabolic Rate, then retest the participant’s basal metabolic rate (BMR) with the InBody Machine. If the weight loss is coupled with a reduction in BMR >15% over the course of one month, see recommendations below.
- Reduction in BMR >15% over the course of one month – If this occurs, the participant is losing excessive lean muscle tissue which decreases the amount of calories they burn at rest. Please instruct the participant to increase one calorie level for the next month of the program. This is a necessary step to ensure that the participant does not continue to lose precious lean muscle tissue.
Step 4: Additional Testing
The goal of this step is to discover if an underlying problem exists that is inhibiting success. In most instances, participants will receive results from the MetaLife system without modification. Those that need further customization will usually experience results in the first three steps of modification. If the first three steps did not provide the desired outcome, additional lab testing may be warranted to further investigate whether an underlying problem exists that is inhibiting results.
Aceva has partnered with Evexia Diagnostics, an industry-leading lab provider, in order to provide its practitioners with additional laboratory testing options. Customized profiles have been created for you to save you time in deciding which lab values to test. If you have yet to establish a laboratory account with Evexia Diagnostics, click on the following link to learn more and get started. Below you will find a few categories of testing options that you may want to further investigate.
- Hormone Testing
- If diet/lifestyle modification steps 1-3 did not produce improved weight loss, you may consider assessing sex hormone, adrenal, thyroid and sleep hormone status to check for an imbalance. Click on the “Aceva Salivary” link in your account under the “Specialty Tests” section for excellent options that should meet your testing needs.
- Adverse Food Reaction Testing
- Food Sensitivities (Non-Ig-E mediated): These types of tests can further customize your participant’s diet by providing a list of foods that they are “reactive” to and may be causing inflammation and inhibit program results. It’s not only poor quality foods that can cause an immune reaction when consumed but high-quality foods such as lettuce and berries can too.
- These sensitivities are not as common and the majority of your participants should experience exceptional results on the program and not have any reactions to the allowed foods but you have an option to test for more complex cases. The Evexia Diagnostics platform offers a test called the “Fit 22 Food Inflammation” test that is a good option.
- Digestive Testing
- Small Intestinal Bacterial Overgrowth (SIBO) Test: This is a simple breath test to see if abnormal bacteria is living in the upper GI tract.
- Microbiology Tests: These are stool tests that will help assess the global view of the patient’s intestinal microbiome and may provide insight into the levels of important digestive enzymes and inflammatory markers in the intestines. It is important that there are sufficient levels of beneficial bacteria and low levels of potentially pathogenic strains of microorganisms. There are many tests on Evexia Diagnostics platform that can be ordered to obtain this insight. Click on the “Comprehensive Stool Analysis (Microbiology)” link on Evexia’s website to learn more about these testing options.