Bioelectrical Impedance Analysis

Case Studies

 

 

Case Study #1: Weight Loss Goal/Marvin

Marvin, your favorite client, comes in to have his body composition evaluated.  You have a few measurements on him to start (each about six weeks apart) and want to monitor his progress on your recommendations.  Here are his readings, let’s discuss…

Table 11.  Marvin’s BIA Test Results*

Compartment Reference** Reading 1 Reading 2 Reading 3
Weight 148 (IBW) 200

AOW = 161

 190

AOW = 158.5

 190

AOW = 158.5
Body cell mass 57.7-66.6 Actual (goal)

72.5 (62.8-72.5)

 Actual (goal)

66.5 (61.8-71.3)

 Actual (goal)

71 (61.8-71.3)
Extracellular mass 59-66.6 Actual (goal)

80 (78-90)

 Actual (goal)

80 (74.1-85.5)

 Actual (goal)

80 (74.1-85.5)
Fat 14.8-32.6 Actual (goal)

47.5 (20-40)

 Actual (goal)

43.5 (19-41.8)

 Actual (goal)

39 (19-41.8)

* in pounds; **values based on Marvin’s sex, height (67 inches), and weight

IBW = ideal body weight; AOW = adjusted obese weight [link to AOW section in text]  

Marvin may be overweight, but he is a pretty muscular guy. His BCM weighs in at 45% of his adjusted obese weight (AOW), at the top end of the expected range.  Marvin decides he wants to lose a little weight to look the buff guy he is under the extra fat tissue.  In Marvin’s case, you recommended reasonable calorie levels and continued exercise. 
Your hope is that his weight loss will be mostly fat.  In exercise-induced weight loss, typically much slower than diet-induced weight loss because of maintenance and improvement of muscle tissue, you expect an 80-20 split between fat and lean tissues.  Calorie deprivation may change that ratio a bit, so you minimize the emphasis on that aspect of weight loss.  In checking up on him you find that he has, in fact, lost about 10 pounds, 6 of which are from the fat compartment.  You might suspect that the weight was lost primarily due to calorie changes.  He still has a good buffer of lean tissues, so you remind him of his exercise goals to improve the type of weight loss. 
About six weeks later, Marvin is complaining that he has not lost more weight!!  After your evaluation, you discover that he has, indeed lost fat and his pants are even looser than the last time you saw him.  Exercise appears to be doing its job to maintain his muscle tissue, so he may be able to support some calorie deprivation. 
It looks like he will do pretty well, so you might recommend that he get regular check-ups, maybe once every 3 months or so to keep him on his toes and once he gets close to his goals, set the man free!!

 

 

Case Study #2: Achieving Pre-Disease Weight/Jean

 

Jean was always pretty healthy and quite athletic prior to being diagnosed with breast cancer.  She is trying to gain weight back after a bout of chemotherapy as a follow-up to mastectomy.  The first time you saw Jean was after surgery and she was pretty weak.  Exercise was pretty much out of the question.  Jean insists, “Things have to get better!”  So, you are set to help her to become very aggressive about regaining weight.  Table 12 shows Jean’s readings.

 

Table 12.  Jean’s BIA Test Results

Compartment Reference** Reading 1 Reading 2 Reading 3
Weight 130 (IBW) 115 110 120
Body cell mass 39.0-46.8 36 34 40
Extracellular mass 48.1-57.2 60 58 56
Fat 26-41.6 19 18 24

* in pounds; **values based on Jean’s sex, height (66 inches), and weight

IBW = ideal body weight  

  You can see that in the first reading Jean’s BCM may have already been compromised.  If we want to make the change even more glaring , you could calculate that she was down 8% of BCM from the lower end of optimal. The fact that she lost some fat suggested a calorie balance issue. Fluid in ECM was higher, suggesting a stress response.
Appropriate guidelines would suggest strategies to specifically address the problems at hand, support the chemotherapy cycles, and prevent any nutrition-related problems that may further compromise Jean’s health.  If we surmise that starvation (calorie imbalance) is one issue and the stress response from chemotherapy assaults is another, then we can work on the nutritional management reverse starvation and to reduce the detrimental effects of stress responses related to chemotherapy.    
Jean started on an aggressive plan to improve nutrient intake and minimize symptoms.  Jean’s well-matched plan of action should yield some specific outcomes: improved BCM and fat volume, and appropriately reduced ECM. At her next appointment, you noted that she looked better and she noted that she felt better. 
While Jean worked hard to make up for lost ground, you continued to monitor her progress.  Her last reading showed that her weight gain was an especially good one, with normalization of BCM (up) and ECM (down).  Her fat compartment improved, but didn’t overshadow her gain in muscle tissues.  Jean said she is “psyched” and will continue to be proactive about maintenance of her health.

 

Case Study #3: The Long-Term Survivor/Jeffrey

Jeffrey is a long-term HIV disease survivor who you have seen through many ups and downs (including multiple episodes of wasting) over his 12-year diagnosis.  He has always been a slim man, but has gained quite a bit of weight.  He told you, “It is getting out of control!”  He was dismayed that he used to be able to eat anything and was feeling like he needed a very restrictive diet to return to his usual svelte form.  Because you have followed him for a long time, you had BIA readings at an asymptomatic baseline, prior to his multiple episodes of wasting. 

Table 13. Jeffrey’s BIA Test Results

Compartment*

Reading 1

Reading 2

Reading 3

Reading 4
Weight

140

120

160

150
Body cell mass

Actual (goal)**

60 (54.6-63)

50

72

68
Extracellular mass

Actual (goal)

60 (54.6-63)

Actual (goal)

70 (46.8-54)

Actual (goal)

65 (62.4-72)

Actual (goal)

62 (60.5-69.8)
Fat

Actual (goal)

20 (14-30.8)

Actual (goal)

10 (12-26.4)

Actual (goal)

23 (16.35.2)

Actual (goal)

20 (15-33)

* in pounds; **values based on Jeffrey’s sex, height (68 inches), and weight

IBW = ideal body weight

Jeffrey’s first reading reflected his baseline and what he felt were pretty good levels for him.  His second reading reflects one of his wasting episodes during infection with reduced BCM and fat while ECM was elevated.  If 5% total weight loss is associated with increased morbidity and mortality in HIV disease, then you can imagine how detrimental it is to lose even 5% of the body’s important BCM stores.
Jeffrey’s wasting was in the severe category for BCM (more than 8% down!).  Fluids shifted up, as is normal in infection or injury.  He lost his appetite and was not taking in enough calories to sustain his fat level, either.  He was weak and having repeated episodes of infection.  To shore him up, the health care team agreed that an appetite stimulant and an anabolic medication would help.  You instructed Jeffrey about the importance of nutrient intake to enhance the medications and send him down the hall to the physical therapist to obtain an evaluation and exercise prescription with his weakness and physical limitations in mind. 
You monitored Jeffrey carefully over the next three months and he improved to the levels you see in Reading 3.  Jeffrey took all of your advice to heart and wanted to have and maintain a buffer of weight, preferably as BCM. As his weight returned to usual levels the appetite stimulant was discontinued.  Once his weight was at 20 pounds above usual, you noted that 12 of those pounds were in additional BCM.
Jeffrey then cycled off of the anabolic medication.  With exercise and continued work on his diet, he held pretty steady at 150 pounds and an enhanced level of BCM.  You decided it was worthwhile to maintain a regularly scheduled visit with Jeffrey every few months to keep him motivated.

 

Reimbursement Issues  Which code(s) to use in order to obtain payment for services. 

Appendices  Contains downloadable spreadsheets (MS Excel) and reports (MS Word)

Resources and References  Where to find additional information

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