Fitness Nutrition Coach. Part IV - Assessing Nutritional Needs

Transcription

1 Part IV - Assessing Nutritional Needs 62

2 For the FNC, a nutrition assessment provides information on your client s diet quality and awareness about nutrient information. Clients should be encouraged to complete food logs on a regular basis ( or as determined by individual needs). After providing a day's worth of dietary information, you can see enough to provide an overall evaluation of where the client stands by comparing the amounts of food they have consumed to current nutritional guidelines you have strategized for them. This can be a labor intensive process to the coach, as analyzing food logs can become tedious. To give you a better understanding of your clients diet over time, encourage the client to establish a profile on the USDA Food Guide Pyramid website, where their food intake can be tracked for up to one year. In this way, some of the work load is shifted toward the client, who then, in turn, learns a great deal more about their nutritional intake norms. But that is only on the nutrition side of the equation. Yes, analyzing your client s eating patterns for assessment purposes is extremely useful and in most cases will be required - but it is the biometric assessments that provide so much more for you and the client. Furthermore, you will most likely be doing some form of assessments by way of monitoring the client s activity, using activity logs. When you begin to work with a client, you will want to establish a reference point. In this way, all of the work you set out to complete with the client is tethered to what once was, and work can then commence on what will be - or the end goal, for the client. A few pointers to keep in mind: Your client may not always know what is optimal for their health in the same way that you understand these principles. In other words, sometimes it is likely for the FNC to know more about how best to intervene with the client. Many times clients will come to you with a specific, numeric goal, such as I want to lose 15 pounds by the end of the month. This is a good, clearly defined goal (although may not be realistic!). But as the FNC, you know that reaching that goal implies much more, including: the client may not have realistic expectations for losing weight the client may not understand that they are not eating enough! the goal of losing fat mass will also have to have an exercise or PA component what it will require to bring the client to within healthy range of all biometrics Regardless of what the client brings to the equation, you are the scientist and in charge of navigating where the coach/client relationship goes. Begin this process by performing some assessments! Body Composition A lot of your clients will be seeking change in their metrics. Depending on location, a lot more of the general public is becoming aware of how to improve life quality by maintaining PA levels and verifying good health with metrics - such as Body Composition. Body Composition values tell us a lot about the client. You probably know that we can determine fat pounds and lean body mass, once we know an individual s percent body fat. For your review, this information is included later in the program. While the regular home scale of yesterday used to 63

3 measure body fat in raw pounds, many consumers have turned to more deluxe models; these scales measure pounds, percent body fat and even hydration in some cases. Accuracy aside, this is still an indicator that the casual health enthusiast is beginning to seek more information about maintaining or improving some of their biometrics. Of course that they know little of what to do with that information doesn t matter as much as how it is useful for you as their coach. obesity but regardless, if one was to plot BMI values on a graph while representing mortality as the variable, there would be a strong correlation seen among the two. This is because in general, BMI guidelines predominantly apply; only in cases of an individual maintaining a lifelong habit of strength training, should BMI be discounted or overlooked. Metabolic Syndrome BMI BMI is another easy way to establish a baseline for the client. This measurement ranks people according to levels of obesity. The significant drawback and caveat with BMI is that it does not then decipher how much of a given weight used in the calculation comes from fat versus lean body mass. Still, we are encouraged to keep our BMI under 24.9 to optimize health and to prevent the onset of chronic diseases brought on by obesity. android obesity gynoid obesity People who show more of an apple-shape are at greater risk of developing cardiovascular disease, than those of the same weight who are pear shape" There are exceptions to BMI. A well developed and large framed male could be very lean while having a BMI value in the higher 20 s, over the recommended ceiling. In this way, BMI is not as useful as a predictor for chronic disease due to Research also verifies the link between obesity and certain diseases. In situations where body fat patterns are studied, there are differences seen in body fat stored around the waist versus what is stored on the hip region. In subjects with more abdominal fat, a specific increase in risk for cardiovascular disease is seen. The waist-to-hip (WHR) ratio is a quick, easy method to estimate body composition and describe body proportions. It is a common measure that reflects the degree of abdominal obesity a person exhibits. If you are familiar with the calculations used, you may want to include this measurement in your client s profile. A WHR of 0.7 for women and 0.9 for men have been shown to correlate strongly with general health.in terms of waist circumference, values have emerged as guidelines to be aware of: Men Women > 40 inches > 35 inches These numbers have gained significance as predictors for diabetes. In some cases, a subject with a measurement greater than what is indicated above, may be at risk for metabolic syndrome. Metabolic syndrome is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. It affects one in five people, and prevalence increases with age. Some studies estimate the prevalence in the USA to be up to 25% of the population. This is also referred to as pre-diabetic. 64

4 Classification BMI Risk of Co-morbidities (kg/m 2 ) Underweight <18.5 Low (but risk of other clinical problems increased) Normal range 18.5 to 24.9 Average Overweight 25.0 to 29.9 Increased Obese Class I 30.0 to 34.9 Moderate Obese Class II 35.0 to 39.9 Severe Obese Class III 40.0 Very severe Body Composition ACSM standards of body composition gender ideal obese female 16-19% BF (Body fat) >32% BF male 11-13% BF BF >25% Numbers may differ slightly between studies and varying sources. For those individuals whose body composition lies outside of the the ideal range, it has been found that these individuals have more health risks tied to obesity. Being above the ideal category shows that when compared to the ideal standard, an overweight individual has a greater risk of coronary artery disease, specifically. We know that athletic performance dictates that body composition be as lean as possible. But with your client s needs in mind, the fitness professional must recognize that athletic performance and general health do not always go hand in hand. Methods of determining body composition Hydrostatic Weighing This method uses the Archimedes principle, which states that when a body is submerged in water, there is a buoyant counter force equal to the weight of the water which is displaced. Because bone and muscle are denser than water, a person with a larger percentage of fat free mass will weigh more in water and have a lower percent body fat. Conversely, fat floats. Therefore, a large amount of fat mass will make the body lighter in water and have a higher percent body fat. If each test is performed correctly according to the recommended guidelines, there is a +/- 1.5% error. Test accuracy depends on the client s ability to blow all the air out of their lungs both during a pre-test screening with a spirometer (to measure vital lung capacity), and during the test itself. Since air makes the body float, an inability to perform either of these requirements will result in overestimation of the subjects percent body fat. 65

5 Body Mass Index Weight in Pounds 58in in in in in in in in in in in in in in in in in in BMI Healthy Weight Overweight Obese 66

6 hydrostatic weighing 1. This method is currently considered the gold standard in percent body fat measurement 2. Repeat measures usually prove consistent, and can be used to chart progress 1.This method usually requires a lot of equipment and space Advantages of NIR Non-invasive Within 2% of hydrostatic testing Fast Reproducible and precise results This method of determining body composition is quick, convenient and non-invasive, but access to this type of test is not typical in fitness operating environments. 67 advantages disadvantages 2. Testing is time consuming and involved 3. Requires in-depth knowledge to administer the tests and compute the calculations 3. Being submerged under water may be difficult and produce anxiety 4. Results can be altered by hydration status or bone density 5. Cost: Usually hydrostatic weighing will cost anywhere from $10-$75 due to the involved nature of the test. Near-Infrared Reflectance (NIR) This method of assessing body fat is based on the principles of light absorption, reflectance, and near infrared spectroscopy. To estimate body composition, a computerized spectrophotometer with a scan and probe are used. The probe is placed onto a selected body site such as the biceps and emits an infrared light which passes through both fat and muscle and is reflected back to the probe. Subject data such as height, weight, sex, age, frame size and activity level are taken into consideration. Density measurements are obtained and incorporated into the prediction equations. A digital read out, including percentage body fat and lean tissue, are displayed. Futrex 5500 is an example of NIR. This method of determining body composition is quick, convenient and non-invasive. Calipers This method is the most widely used body composition testing method for assessing percent body fat (BF). Equipment used for this assessment includes skinfold (SF) calipers designed specifically for the simple and accurate measurement of sub-cutaneous tissue. In the personal training operating environment, either a 3 or 7 skinfold site method is typically used, although it is important to note that other skinfold tests protocols exist. How accurate is it? If SF tests are performed correctly, according to the recommended guidelines, there is a +/- 3% error. Validity (compared to underwater weighing): 7 site skinfold (r =.90), 3 site skinfold (r =.89).* Commonly used calipers: Lange Skinfold Calipers: This device is widely used in schools, colleges, and fitness centers. It is very popular among physical educators, coaches, and health and fitness professionals. The price range is $ $ The Harpenden Skinfold Caliper is the standard caliper used in research. The majority of data involving body composition assessments in use today are based on studies using these calipers. Its accuracy is within 0.2 mm and can be read to the nearest 0.1 mm. Harpenden Skinfold Calipers are popular among Exercise Scientists and or Health Science Researchers. The price range is $ $

7 Bioelectrical Impedance 7 site skinfold -chest -abdomen -triceps -axilla -subscapular -suprailiac -thigh 3 site skinfold (men) -chest -abdomen -thigh 3 site skinfold (women) -triceps -suprailiac -thigh BIA is a quick, easy and convenient method to assess BF. Using a calibrated device, the subject either grips the handles (when using a handheld model) or stands barefoot on metal foot plates, where a low voltage electric current is sent from one hand through the body to the other hand (or up one leg and down the other). Since fat is a very poor conductor of electricity, it will impede (slow its progress) the electric current more than lean tissue does. By measuring the resistance to the current, the machine estimates the percent body fat. In clinical reasearch environments for body composition testing, using this form of assessment requires that the individual lie down, with electrodes attached to the both hands and both feet. Most commercial testing equipment does not follow this protocol, which may create drastic variance in measurement accuracy and reliability. Protocol of original research must be followed in order to ensure high accuracy. calipers advantages disadvantages 1. Easy to use once skill has been mastered 2. Inexpensive way of estimating percent body fat 1. Technical sources of error due to inexperience of fitness professional and inconsistency in precise site locations between measurements 2. Mostly concerned with subcutaneous fat (under the skin) 3. May not be an ideal measurement for those who are obese and very lean due to theory of caliper testing that states body fat is 50% subcutaneous and 50% can be measured at the skin layer (accurate theory for year old males) 4. Potentially invasive for many individuals How accurate is BIA? When done correctly on properly maintained equipment, it is approximately +/- 3%. However, accuracy is dependent upon several client-based variables. It is recommended the following guidelines be followed: Abstain from eating and drinking within 4 hours of the test Avoid exercising within 12 hours of the test Void (urinate) completely prior to testing Do not drink alcohol within 48 hours of the test Avoid taking diuretics prior to testing unless instructed by your physician Caffeine intake - due to its diuretic effects, should be avoided in the hours before the test. For some competing athletes, the minimum level of BF for males is 3% and in the range of 12 to 15% for females. These numbers are very low and are known to vary in printed materials, but there is no real value in debating a percent or two, one way or the other. 68

8 bioelectrical impedance 1. Requires little or no technical knowledge of the operator or client Food Log Assessments You and the client will determine the interval and/ or need for food logs. advantages disadvantages cost 2. Testing itself takes under 1 minute 3. The unit can be easily transported from place to place 4. Requires only an electrical outlet and the machine itself 1. This method has a higher standard error range if protocol not specifically followed 2. Tends to consistently overestimate lean people and underestimate obese people 3. The accuracy BIA does have is very dependant on multiple variables which may be hard to control for some people 1. To be measured on a machine at a school or club, prices range from free to $30 per use 2. BIA machines can be purchased for home use for $100 to $400. In a general sense, consider analyzing food logs more in the beginning of your relationship with your client. This will tell you a lot about their current eating norms. If clients continue to need more intensive scrutiny of their food logs, for whatever the reason, you must provide that information back to the client. If you client begins to show compliance and results rather quickly, you may not feel as compelled to check food logs every week. Since food logs are tedious to keep and to analyze, make sure that your client is clear on what information needs to be included in their food logs. We have provided a template for you to use if you do not currently use one for clients already. Items included on food logs should be clarified if there are any questions from the coach. Many times people will put down food descriptors that require follow-up; investing the time in making the instructions clear, up front, can expedite the process. Descriptions for Food Logs: While no guidelines exist that correlate to peak performance in athletes, it is widely held that some athletes will most likely perform better with lower body-fat values. Others, like football lineman or powerlifters, for example, will more than likely have higher body fat values. Typical athletic males and females range from 6 to 10% body fat and 10 to 15%, respectively. A good range is considered 11 to 13% for males and 16 to 19% for females. ACSM tables also factor age and percentile ranks; in some groups, an individual may be considered overweight when values exceed 21 to 24% for males and 31 to 36% for females. These approximate values correlate when compared to the general population. Food item Portion size - approximate if needed Time of day Homemade, store-bought or restaurant? Any food labels attached? Any comments on emotional status Once your client has done several food logs, it is then appropriate to review actual intake totals with what was designed in their eating strategy. Discussion with the client should be included in normally sessions that you meet with them as their coach or trainer. It is also a good time to set goals for the next week and to make a commitment consistent with the intended outcome. Experiment with having your clients commit to one change in-between coaching sessions and in this way, you are positively reinforcing a good behavior. 69