When it comes to weight loss it’s easy to succumb to the instant report card that are the bathroom weighing scales… Taking a glance to track our progress, justify our next cheat day, or even calling for an emergency session with our Personal Trainer can be hard to resist, however, according to our experts, relying on the scales alone can often do a lot more harm than good, as there is a lot more complexity to that number than we might think. So, what is in a number? To find out we spoke to our newest contributor and Family Medicine Consultant Dr. Nas Al-Jafari who advocates an all out ban on the scales in favour of more sophisticated measure called DEXA in order to really get a handle your weight loss progress.
Weight on the scales means nothing unless you can accurately assess whether the weight you’re trying to lose (or gain) is made up of muscle or fat.
Generally speaking, we all want to gain muscle and lose fat to varying degrees, depending on our goals. However if you don’t know how much muscle and fat you have to start with, then you’ll have no idea of what to aim for or how to get there. I most commonly encounter patients who have enrolled in a weight loss program based on calorie restriction and limited exercise (if any at all). In most circumstances they turn up metabolically broken ‘skinny-fat’ versions of their former self. Skinny-fat means that while they have achieved a normal weight or BMI, their fat percentages are the same or even higher than when they started. Similarly, I have had patients who have seen their weight increase but their body fat percentage go down. Both are example of how scales are limited by not offering us information on body composition.
For this very reason I recommend my patients not become obsessed with the scales. Standing on a set of scales tells you nothing more than your relationship with gravity. Similarly, the body mass index (BMI) doesn’t tell you anything about your body composition. It doesn’t measure percentage of body fat or lean muscle tissue and makes absolutely no distinction between the two. Despite this reality almost everybody, from doctors through to nutritionists, are still using this mostly useless tool which is meant to provide a proxy for human body fat based on an individual’s weight and height.
Unlike scales, a DEXA leaves nothing to tricks of bad calibration, human error or what you had for breakfast.
DEXA (Dual Emitting X-ray Absorptiometry) is a relatively inexpensive alternative method to weight measurement that can more accurately flag individuals who actually have excess body fat compared with those whose BMI is raised because of muscle or dense bone mass. The use of DEXA is well established amongst elite athletes, and can usually be performed at most diagnostic centers. In my own practice I ditched the scales and BMI chart a long time ago, favoring DEXA and waist measurements as more reliable tests. The bigger your waist measurement and the more fat you carry, even if you’re at normal weight according to the BMI chart, the greater your risk of heart disease, diabetes, and death from any cause.
I regularly see athletes get caught up in their body fat and are shocked at how other methods have under-estimated their percentage when I send them for a DEXA. A DEXA will accurately measure the amount of body fat, lean tissue and bone in each major part of your body – arms, legs and trunk. The scan will determine how much visceral fat you have – the tissue that surrounds your internal organs, and is linked to diabetes, heart disease and premature death. Another important number is your Lean Mass Index (LMI). This gives us a very good indication of how much muscle you are carrying.
I suggest a DEXA for any of my patients beginning a diet or fitness program, and then periodically as a progress check. Not only does a DEXA offer a baseline and accurate monitor of progress, it is a significant motivator in any program. Improvements in body composition can maintain motivation levels even when other measures may not tell the whole story. For females in particular, who naturally carry a higher proportion of fat, a DEXA scan can provide reassurance that any weight gain is proportional and not just of fat. Similarly, if you’re a bodybuilder, marathon runner, cross-fitter or professional athlete, you’ll be fixated on your performance and body composition. There is no need to compromise your hours of hard work with inaccurate and out-dated testing. A DEXA will provide the right information for measuring your fitness performance.
For more information on DEXA measurement or to book a consultant with Dr. Nas Al Jafari please contact Intercare Health Center in Abu Dhabi.