Disclaimer: InBody devices should be used as an adjunct for clinical decision making and are not intended to diagnose or treat any diseases.

Dr. Adrienne Youdim is a board-certified internal medicine physician and a nutrition specialist and an obesity medicine specialist. Her educational background makes her uniquely qualified to address different aspects of care at her practice.  Previously, Dr. Youdim was the director of the center for weight loss at a nationally ranked hospital in Los Angeles. For over 8 years she used InBody with patients at this facility. When she transitioned to her own private practice, InBody was one of her first purchases.

Her goal with the InBody was to give patients better goals to focus on than weight, monitor progression to body composition, and to use the Result Sheet as a teaching tool to inspire lifestyle changes.  

Building a Therapeutic Bond

Weight loss is a challenge for both the practitioner and the patient. The American Medical Association defines obesity as a chronic disease. Physicians recognize that there are many factors behind obesity including underlying medical conditions, genetics, and environment. But there still exists a stigma that obesity results from laziness and apathy. The negative feelings connected to an obesity diagnosis, like guilt and remorse, can be a barrier to both compliance and commitment.

To help them achieve their goals, Dr. Youdim tries to form a therapeutic relationship with every patient.

She counsels all the patients and addresses every aspect of their care herself. During visits, Dr. Youdim tries to allay her patient’s concerns and fears about treatment while managing expectations. She will dedicate a portion of each session on education and uses the InBody Result Sheet as one of her teaching tools. Dr.Youdim wants her patients to understand that their struggle with weight is physiologic and with the right treatment plan it can be treated.

“Having numbers you can rely on helps validate that obesity is not a failure of character, but it is a medical condition we can treat.”

When It Comes to Treatment, Data is King

For Dr. Youdim, consistent monitoring helps the practitioner stay on top of key metrics and it helps the patient trust the process. It is why InBody and the comprehensive Result Sheet it produces, was a great fit from the beginning.

“Using the InBody helps us achieve that weight loss goal and ensuring, to the best of our ability, that they are not losing muscle in the process. The InBody is a helpful tool for me as a clinician and as an educational piece for my patients.”

InBody helps her achieve her two objectives:

1. Shift the patient’s focus from weight loss to fat loss and muscle maintenance.

2. Monitor her patient’s weight loss to make sure they’re not losing too much muscle.

Dr. Youdim tests her patients on the InBody during the initial consultation and then every subsequent visit. The initial consultation will include an extensive overview of the result sheet. She will then revisit parts of the Result Sheet or its entirety during future visits.

For her, InBody testing is helpful to stay on top of trends and make timely adjustments.    

 “Over time, when we get enough measurements, we can see that trajectory whether they’re gaining muscle mass, which is rare in a weight loss program, but, more importantly, if they are losing muscle mass.”

A feature that Dr. Youdim track on every visit is muscle mass and body fat. Her initial prescription for the patient will base their protein requirement off their lean body mass, which is often 2-3 times their lean mass. The purpose of the high protein requirement is to help maintain muscle.

During subsequent visits, she often finds that patients are not exercising enough or meeting those protein requirements. Tracking lean muscle mass is an objective way to show to patients why he or she needs to fulfill those requirements.

“You can provide the counseling to the patient as to how much activity they need or how much protein they need to consume, but that objective measurement of change in lean muscle mass, and therefore change in percent body fat, really helps to augment the message and the treatment plan.”

Teaching Patients to Be Kind to Themselves

A message that Dr. Youdim stresses to all her patients is that nobody is perfect all the time. Dietary compliance is a struggle for everybody, and emotions play a factor.  When her patients are falling short of their goals, it can be stressful. There’s often already frustration from past failures, and setbacks can lead to a patient giving up.

Dr. Youdim uses this opportunity as a teaching moment. She will compare a patient’s daily caloric intake to Basal Metabolic Rate (using this number to calculate Total Daily Energy Expenditure).

Together, Dr. Youdim and the patient can see what changes need to be made to the dietary restriction and then monitor body fat and lean body mass as a gauge of progress. These numbers can help simplify a difficult process.  Patients understand why they aren’t getting the results they want to see and they get a clear path forward.  

Wrapping it up

It’s almost a cliche to say at this point but obesity is a significant medical problem in the United States and around the world. The evidence is clear that weight management is key to preventing many chronic medical conditions that are on the rise.

To help reverse this epidemic, it will take empathetic health professionals like Dr. Youdim who can use a variety of different strategies and tools to help motivate their patients.

“My goal is to help individuals create lifestyle changes that will prevent disease and improve the quality of their life. When you give people objective information and data, they’re more likely to make changes based on the information.”

Disclaimer: InBody devices should be used as an adjunct for clinical decision making and are not intended to diagnose or treat any diseases.

Dr. Anuruddh Kumar Misra is a board-certified physician specializing in internal medicine and sports medicine and is a medical director at Premise Health in San Francisco. He also serves as a consultant to MLB teams and has had previous experience working with the NFL.

As a medical student, Dr. Misra felt that there was too much focus on disease treatment instead of disease prevention. He wanted his practice to not only treat the sick but show them how to improve their health through lifestyle changes. That is why he decided to take on a subspecialty of Sports Medicine after his residency in Internal medicine. During his sports medicine fellowship, Dr. Misra gained expertise in exercise physiology, nutritional dietary practices, and exercise prescription.

Today at Premise Health San Francisco, he uses his well-rounded knowledge base to optimize the health of his patients. InBody has helped Dr. Misra elevate the patient visit by allowing him to give objective, instant feedback , and personalized recommendations. Patients leave his clinic feeling empowered and motivated to improve their health.    

Sparking an Honest Conversation About Health

“How do I optimize an individual’s baseline of health?”

That’s the question Dr. Misra runs through before each appointment with a patient. In his San Francisco practice, Dr. Misra wants to go beyond reactive medicine and practice preventative healthcare. With his expertise in fitness, nutrition, and internal medicine, Dr. Misra is uniquely qualified to provide his patients with a comprehensive course of action that will improve their lives. The first step in that process is to begin an honest conversation about health.  

The problem is that most patients don’t visit a doctor unless there is something wrong. Patients don’t treat their primary care provider as a source for preventive care.  

One issue in a traditional preventive health exam, which should be a great way to build a relationship with your doctor, is that a lack of immediate significant feedback exists.

During a typical exam, a doctor may order a variety of blood tests and other screenings, check your vitals, and calculate your BMI. The blood tests and screenings require repeated visits– time that many working adults and students don’t have. If you don’t a need for these tests, the only information you may get from your visit is your BMI.

For a patient who is overweight or obese, BMI is not going to reveal anything new. On the flip side, patients have both a normal weight and BMI may have hidden health risks such as excess visceral fat, increased risk of cardiovascular disease, and more due to BMI’s inability to distinguish between muscle and fat.

InBody Result Sheet displays an individual with a normal BMI of 22.5 but an elevated body fat percentage of 35%

Instead of relying on BMI to direct patient health, Dr. Misra wanted to incorporate body composition analysis to relay relevant health information and guidance his patients otherwise wouldn’t have access to: muscle mass measurements, body fat percentage, basal metabolic rate, and body water analysis. On the advice of a trusted colleague, he decided to try InBody. The overwhelming response from his patients became an “a-ha” moment and confirmed that

Dr. Misra and his staff decided to invite patients to try the InBody device as part of a wellness challenge. The response was incredibly encouraging. As the team was testing and interpreting results for the high volume of patients, it became obvious to him that he was making a difference in these patients’ health because InBody documented the actual health improvements patients were making.

After an InBody Test and consultation, a patient leaves Dr. Misra’s clinic with a detailed assessment of their health standing, specific areas to work on, and personalized recommendations on how to improve.  

In an area like downtown San Francisco, where people have come to expect cutting-edge technology and innovation, InBody is a tool that helps his clinic go the extra mile to guide and improve the health of his patients.

“It’s very fast. It’s non-invasive … and it gives you very specific data points where you can immediately give feedback to people about what they need to pay attention to. [InBody] is something I find ideal as I have a high-volume, busy practice.”

Using Body Composition Analysis to Combat Insulin Resistance

Today, Dr. Misra has patients who look forward to their InBody results. They feel comfortable admitting “Doc, I haven’t been that good over the last three or four months. I know this isn’t gonna look good. But I gotta know where I’m really at.”

Dr. Misra uses the InBody Result sheet to give very refined, targeted recommendations based on different data points. He finds that most of his patients can benefit from at least one of three interventions: modifying their baseline nutrition, improving their exercise prescription, and optimizing their metabolic profile with intermittent fasting. Each intervention requires a lot of dedication from the patient, but body composition analysis helps Dr. Misra motivate them to follow his protocol.

“Someone may not be too keen on fasting. They may not like lifting weights. They may not want to change their diet. But if I’m able to motivate them based on InBody results, and the plethora of other medical data points I have, now I’ll get them doing what they wanted to achieve and that is very powerful.”

The section of the result sheet that Dr. Misra find the most actionable is the visceral fat score, which has a direct correlation to “insulin resistance”, a precursor to prediabetes. The higher the score the higher the risk of developing insulin resistance.

A Visceral Fat Score over 10 cm² increases an individual’s risk for developing metabolic disorders.

When Dr. Misra sees a patient with an elevated score, his first course of action is to learn what their dietary practices are. What do they eat? How often do they eat?

In many patient cases, Dr. Misra likes to recommend monitored intermittent fasting because he believes that intermittent fasting is the single, most powerful therapeutic metabolic intervention a physician can do for a patient.

In between lab work, Dr.Misra will also test his patients on the InBody to track and monitor progress while they are on this program.  

“I don’t need to keep on checking labs on people if I can document progress in a different way. If I’m able to show a progressive decrease in the visceral fat score over the course of three to six months I am even able to reduce their lab draws. InBody becomes a great tool to give patient feedback and it helps the practitioner optimize their patient’s internal medicine issues”.

InBody has been a helpful tool to show patients that they aren’t necessarily stuck on a path that will end in medication. Patients can see the work they put in to improve their body composition translates to real health benefits.

“We’re taught in medical school and in post-doctoral education that diabetes is pretty much a one-way street. You’re a diabetic. It’s a life sentence and you’re gonna be on medication for life.  That just not the case.”

Through program design and careful monitoring, Dr. Misra has even been able to successfully liberate patients from their insulin medication. InBody plays a critical role in that process, acting as a patient’s GPS as they follow Dr. Misra’s roadmap for a healthier life.    

Building Trust and Improving Patient Care

Technology can help enhance patient care, but trust in a patient-doctor relationship remains one of the most important factors for an effective treatment plan. One study found that nearly two-thirds of patients with high levels of trust follow their doctor’s treatment plan.

The tools a doctor uses must be fundamentally reliable because trust itself is a non-negotiable entity. Dr. Misra trusts the InBody to monitor his own health, so he confidently recommends it to his patients. I say, “Look, I check this about once a month to keep track of my personal goals and fitness things that I have in mind, and I encourage you to do it too.”  

At the end of the day, it is up to the patient to take control and be accountable for their health. However, because of knowledge gaps, a patient may be too scared to bother the doctor with follow-up questions. Dr. Misra has found that starting a conversation around body composition – losing body fat and gaining muscle- is something that is relatable, helps build that conversation, and makes a patient a partner in being responsible for their lifestyle choices. When a patient is motivated to take responsibility and make changes, the rewards are endless.  

“It saves the patient from morbidity. It saves them money. It saves them time. It reduces their cost to their insurance plan. It reduces the cost to their employer. I mean it’s a universal win where the most important stakeholder – the patient – is the one who benefits the most.”

Disclaimer: InBody devices should be used as an adjunct for clinical decision making and are not intended to diagnose or treat any diseases.

Cincinnati Children’s Hospital Medical Center is ranked third in the 2016 U.S. News and World Report survey of best children’s hospitals. The 598-bed facility is also home to the Center for Better Health and Nutrition, one of the largest pediatric weight management programs in the country. They focus on addressing the health concerns of obese and overweight youth through comprehensive, family-based treatment. Patients receive tailored exercise and dietary regimens specific to their individual needs. Cincinnati Children’s is also involved in research to help advance the science of obesity prevention and treatment in youth.

Christopher Kist is an exercise physiologist at The Center for Better Health and Nutrition. He specializes in counseling children on exercise, healthy eating and making better lifestyle choices. Kist is also an expert in nutritional biochemistry, diabetology, and nutrition and dietetics.

Cincinnati Children’s and Christopher Kist are real InBody customers and were not paid to do a testimonial.

The Childhood Obesity Challenge

According to a 2016 study, nearly one in three children ages 10 to 17 are overweight or obese. To fight this epidemic, Cincinnati Children’s deploys teams of employees throughout the Tri-State area. Their goal is simple: Get obese kids to enroll at the Center, improve their eating habits, and motivate them to exercise more.

Once a child is enrolled in the program, Kist and his team track each patient’s progress by taking circumference measurements every few months. But they soon found themselves running into two problems:

1. The circumference measurements were all over the place. There was no consistency in the data, making it hard for Kist and his team to accurately see each child’s progress and trust that the numbers were correct.

2. Many of the patients were growing taller, exercising more, and eating better; however their weights on the scale remained the same – or worse, their weights increased. There was no way of showing his patients or their parents that there were actually positive internal changes happening in their bodies that led to weight gain, such as increases in muscle mass.

Something needed to change in the way they were measuring these children’s health, especially if they wanted to battle against an increasing population of overweight and obese youth.

Weighing the Options

Cincinnati Children’s quickly recognized that they needed to base their patients’ success off something other than weight and circumference measurements. These numbers were just simply not enough. Kist and his team needed a device that would reveal what was happening inside each patient’s body, a tool that could measure the changes in fat and muscle.

So, Cincinnati Children’s purchased an RJL body composition analyzer in hopes of getting more helpful data to better assist their patients. The RJL could measure muscle and fat mass, but the children found all the wires on the device intimidating. Soon, it became hard to motivate the children to continuously measure their body composition. The hospital considered purchasing DEXA scanners and BodPods but decided against them after considering the cost and the amount of space the devices would occupy.

“Our hospital is so big; we can’t just send people to different places to get different tests done,” said Kist.

“We needed something that we could put in our clinic so our patients wouldn’t have to go all over town for different measurements we wanted.”

Cincinnati Children’s needed a device that would be more accurate than circumference measurements, be able to provide fast, detailed body composition analysis without scaring off the kids or breaking the bank, and be small enough so that it wouldn’t take up half of the room.  That’s when they found InBody.

Consistency is Key

Kist first saw the InBody body composition analyzer at an expo and decided to give InBody a test run at the hospital. Turns out, InBody was what the team was looking for all along.

“We got very consistent results from the InBody and we could see consistent changes in our patients as they got older and stronger,” said Kist. “We would see the decreases in weight and increases in lean body mass and we’ve been using it ever since.”

Cincinnati Children’s has been using InBody products since 2012. They currently own seven InBody 230s, one InBody 270 and one InBody 370. InBody devices have been integrated into Cincinnati Children’s standard procedure.

“We’ve stuck with InBody because they’re dependable,” said Kist. “It was well received by the kids. They thought it looked like a spaceship and it was definitely less intimidating, so they would hop right on it.”

When patients visit Kist and his team, they have their height, weight and InBody recorded on their charts. The new procedure has been well received by the staff because of the device’s simplicity.

“There’s no room for error, you enter the height, age and gender and you get the results. If we can get the height right, everything else is going to be consistent. We can have more staff use the InBody because it’s so easy.”

Since implementing InBody, Cincinnati Children’s has been able to track consistent, measurable changes in body composition as kids go through the program.  Kist and his team are able to see if the programs are benefitting the children and monitor the changes in weight from muscle gain and fat loss.

Shown above is the Muscle-Fat analysis graph that reveals how much of a user’s weight is Skeletal Muscle Mass and Body Fat Mass. The bar graphs extend to show pounds of each type of body composition as well as if the numbers are under, normal, or over the recommended amount for that user. 

“When we got the InBody, we were hoping to see consistent measurable changes in body composition and lean body mass,” said Kist.

“We’ve seen consistent numbers across the different models and have gotten clear results that are easy to interpret. We’re finally getting consistent changes that are measurable and now, we can say these are positive outcomes.”

Education and Results Interpretation is a Family Affair

All of Cincinnati Children’s patients come with their parents, and the ones who get their whole family on board with the program tend to be the most successful. Kist and his team educate parents on the changes they need to be making for the whole house since the kids typically aren’t buying and cooking the food. But this also means the parents are as disappointed as their children when they see no changes in weight.

“With InBody, we can tell a parent, ‘hey look, the number on a scale is exactly the same but your kid is getting stronger, they’ve lost body fat and they got taller as well. There can be improvements without seeing improvements on a regular scale.”

This helps keep parents and patients involved and motivated to keep exercising, eating better and making the lifestyle changes they need to make in order to become healthier individuals.

Parents and patients also love that InBody results sheets are printed on a piece of paper so they can learn what’s happening and see their changes over time.

“As kids grow, they gain weight so sometimes there’s no change in BMI but they’ve decreased their body fat percentage and increased their lean body mass,” said Kist. “These are changes we wouldn’t have known without an InBody.”

Measuring success and making changes for life

Kist and his team measure success in a number of different ways; it’s not just numbers on a scale. They look at everything, from self-esteem to cholesterol to family engagement. But the improvements in percent body fat and decreases in overall fat levels and improvements in lean body mass are the ones that reveal if a patient is actually making lifestyle changes, eating better and exercising more.

“It’s very important that we find something positive at every visit, especially if the patient is struggling,” said Kist. “We get to say ‘hey look, you’re struggling here and you’re struggling here, but your percent body fat is down and you’re getting stronger.”

Shown above is the Body Composition History chart that tracks the changes of a user’s body composition over time. Being able to track changes is an important part of any person’s health journey because it provides a holistic view of what they’ve been able to achieve.

“InBody gives us another way to measure success for these kids.”

Like any organization, Cincinnati Children’s has adjusted their procedures within their practice. They’ve swapped inaccurate circumference measurements for body composition and haven’t looked back– for good reason.

With InBody now integrated into their programs, Cincinnati Children’s is able to get consistent, accurate body composition data and provide that on a result sheet for patients to take home. No more random fluctuations in data. No more intimidating devices that deter patients from measuring their body composition.

Cincinnati Children’s is now able to monitor the changes in patients’ body composition as the children grow, teaching them that it’s not about weight or measurements around the body. Getting healthy is about monitoring the changes within the body and keep track of how better lifestyle choices can improve the body from the inside out.

“Some of our patients come back as adults and say, ‘I became a healthier adult from the tools and education you gave me,’” said Kist. “And they’ve carried this through their adulthood.”

Looking for healthcare data to improve decision making to promote better patient outcomes? We can help. Contact Us