A patient using a Calorimeter (on the left) and taking a body composition test.

Advancing medical science now offers a new and precise technology for metabolic diagnosis and weight management. The significance of this technological innovation is that it eliminates the guessing and estimating of serious weight problems and presents one's physical facts in hard data measurements. A multi-color printout shows key indicators: body mass index, body-fat ratio, and more.

The first phase of the metabolic diagnosis and weight management system (MD/WM) consists of three tests to determine multiple parameters of energy metabolism:

1. A segmental body composition test measures lean body mass, total body water, and percent of body fat.
2. The calorimeter determines the body's basal metabolic rate or resting energy expenditure and locates a weight management zone.
3. The patient wears a multi-sensor arm band 5-10 days at home to measure four key energy parameters: skin temperature, galvanic skin response, heat flux, and motion.

The result of this 3-step test is a reading of total energy expenditure per day/per week, of calories burned, plus physical activity levels (METs), and amount of sleep and steps taken.

The Science of Bariatrics
Bariatrics is the medical specialty dealing with treatment of obesity. The goal of obesity treatment is to establish a negative energy balance to achieve weight loss. Negative energy balance means that a person expends (burns) more calories than he/she consumes. Metabolism is the bodily process of burning calories to produce energy, and the metabolic rate is the rate at which this process takes place. Measurement of metabolic rate is vital to the success of obesity treatment.

The metabolic process may be viewed in three states: resting, activity, and exercise. When we are not moving around or engaging in physical exercise, our metabolic rate is at its resting state—most of the time. That is one‘s base or basal metabolic rate of energy expenditure: REE.

To establish a benchmark REE of a patient using the calorimeter is the first step of the therapy. It may indicate that the cause of the obesity is a slow ERR or hypometabolism. From this point, the bariatric specialist—aided by data showing body mass and average daily energy output—can make a calculation on the exact caloric intake the patient requires to maintain consistently a negative energy balance.

What is new and revolutionary about this system of treating obesity is the availability of a portable and relatively inexpensive device for obtaining an REE reading. The essential science of the process has been around for many years, but applied in a much larger machine that requires a hospital setting, and with a more complex method for gathering and more complex formula for interpreting energy output.

In the portable calorimeter, the patient breathes into a disposable tube for 5-10 minutes. The device automatically calibrates the oxygen measurements, and after the test is completed, results are presented on the display screen and/or sent directly to a color printer. The printout report will even recommend a diet and exercise plan customized to the patient's age, sex, height and weight.

Does this sound so easy and simple that you could do it yourself? Not quite. Obesity and overweight problems are persistent and serious to the extent that they required the attention of a specialist. While this amazing technology may accelerate some of the steps in the weight loss management process, it will always require the interpretation and experience of an expert standing by. A weight loss plan may get a science-based start, but it will then require the usual discipline and determination. The advantage of the technology is that you can be certain you are headed in the right direction and that your effort will lead to success.

Weight v. Circumference
Ever think you were getting fatter but not gaining weight? That could be. Public health researchers (in Scotland) measured the height, weight, and waist circumference of 1044 middle-aged subjects in three stages over a nine-year period. They found that, among a significant number, their overall weight did not change, but their waist circumference did. The implication of these findings is that your body is gaining fat and losing muscle—but not weight—as you age. One remedy is a regular exercise program that includes three sessions of brisk walking every week plus some resistance exercise using weights. Weight training is a targeted and effective way to build muscle. Pay attention to your BMI number (body mass index), and also your waist measure: over 40 inches for men and over 35 inches for women is obesity, generally.

My Personal Comments
This new metabolic Diagnoses and Weight Management system is something long-awaited here at the Heart, Diabetes & Weight Loss Centers. It moves us up to another level of high-tech health care. This system will allow me to prescribe precisely the appropriate weight loss program for each individual patient. It complements and is used in conjunction with other endocrine functional status markers. That is, it tells me how the hormones—thyroid, endocrine, sex hormone, and insulin levels—are affecting a patient's metabolism and causing obesity. From that point we can apply a sure-fire effective therapy and weight control solution.

About Dr. Vagnini
Dr. Vagnini is ELDR's chief medical advisor. He is the coauthor, along with ELDR Editor-in-Chief Dave Bunnell, of the book Count Down Your Age (McGraw-Hill). To learn more about Dr. Vagnini, visit his website »

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posted at 04:58:04 PM