Preventative Medicine Needs a Paradigm Shift
An idea for capturing at risk patients before metabolic disease takes hold
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Medicine is stuck in the past. In this day and age, with our access to advanced diagnostics and treatments, it is a travesty that preventative medicine is as rudimentary as it is. Today, if a relatively young and healthy person goes to a doctor, they measure the height, weight, heart rate and other vital signs in order to assess whether or not the patient is at risk of developing a chronic condition, like high blood pressure or insulin resistance. If they deem you to be at a risk, they may vaguely counsel you on healthier lifestyle choices with some generic advice. Given that on average, the doctors themselves are not taking these steps, they will not be particularly motivating or compelling, and what will likely follow is medical therapy later in life.
This approach has clearly failed the American population and continues to fail our young adults. In particular, it misses patients that appear to be healthy on the outside, but are actually at very high risk on the inside. A patient just like myself.
I had a feeling I could be in better shape before Luca was born, and given my background in medicine I knew that body composition analysis via DEXA scanning would be a good way to get to the truth behind my current health risks. I pursued the scan independently and at my own expense since it was not widely available. The results shocked me and led me to pursue a completely different path in life. I was suffering from “sarcopenic obesity.” Sarcopenia, meaning low relative muscle mass, and obesity meaning high body fat percentage. The colloquial term for this is “skinny fat.” On my original DEXA scan, my overall body fat percentage was 25% and my abdominal fat percentage was 36%. This conferred me a very high likelihood of developing the metabolic cascade of diseases including but not limited to type 2 diabetes, high blood pressure, and coronary artery disease.
It was after getting this wake up call that I was hell bent on reducing my total body fat percentage to as low a level as I could sustain and tolerate, while maintaining or increasing my lean muscle mass. Through careful planning and execution, I was able to achieve just that. Over the course of 6 months I lost over 25 pounds of pure fat and dropped my overall body fat to 11.5% and my abdominal body fat to 15.5%. Plus, I did not lose a pound of muscle mass. Given my weight loss, my ratio of muscle mass to body weight increased. I looked better and I felt better. I am so thankful I took that step over a year ago, because even today I have managed to stay at roughly the same weight and body composition, and I am confident that I am doing my part to stave off the chronic metabolic diseases that are plaguing my peers.
What is unfortunate though is that this valuable tool is not being used as widely as it could be. While DEXA machines are widely available all over the country, the vast majority are solely being used to assess bone mineral density in older patients, and to stratify them for risks for orthopedic fractures. This exact paradigm could be enormously beneficial in identifying adolescents and young adults that are at high risk for obesity related illnesses, and in particular, in identifying those patients that are “skinny fat” like I was. These patients can then be educated on their risks and be referred to aggressive lifestyle management, just as I did.
If we can use insurance dollars to scan the older members of our population for preventative medicine, can we not use those insurance dollars much earlier in the pipeline, for possibly greater good?
My gut tells me that there is enough data to warrant body composition screening just like we do for breast and colon cancer, in order to help identify high risk patients, but I need to dig into the data more. In the mean time, if you’re curious where you stand and want to take the first step, look for DEXA scanning near you. If you need help, reach out to me. I can even help you interpret your results and help you develop a plan to get the results you want. I’ll keep doing whatever small part I can to advocate for positive lifestyle changes.
The more we can better ourselves, the better we can take care of those we love.