Best Practices: Biopsychosocial Implications of Metabolism Testing

Bariatric science, is an emerging science that has progressed and developed diagnostic tools that can accurately determine an individual’s energy (calorie) needs as well as quantify their metabolic efficiency. The Resting Metabolic Rate test (RMR), and our ability to interpret the results, allows weight management to be an empirical science. This noninvasive 10 min. breathing test, accurately measures an individual’s energy needs and their specific rate of metabolism referred to as metabolic factor (MF).

These are physical metrics that bariatric health specialists can use to determine individual weight-loss and weight stabilization dietary plans. It provides an opportunity to predict an individual’s energy needs at the weight they choose as their goal; which may or may not realistic based on their MF. It also offers an opportunity to explain variability in losses and gains and surgeons can use these metrics when choosing an appropriate surgical procedure.

When a patient that has continually been plagued with “the slings and arrows” of lifelong obesity, discovers that they have a very low metabolic factor (hypo-metabolic) and likely the primary cause of their obesity….this test can begin to relieve a good deal of the shame and self-blame that has riddled their lives. Metabolic science can be shared with patients and even used as part of cognitive behavioral programs.

Seemingly a “numbers game” and only a physiological metric. Hopefully by watching the video tutorial (below) you will recognize the plethora of biopsychosocial implications. For bariatric professionals, not using RMR/MF testing would be like treating hypertension without measuring blood pressure or diabetes without measuring glucose.

 Tutorial: Interpreting Metabolism (RMR/MF)

AABC Research Fellows Identify “The Missing Link”. A New And Important Metric, In Understanding Why Some People Are Thin And Others Thick Despite Similar Caloric Intake.

The American Association of Bariatric Counselors is pleased to announce that two of their research fellows have completed an important bariatric science research project that identifies a primary cause of a most prevalent category of obesity.   The researchers, Dr. Brandon Davis from Grinnell Iowa and Dr. Joseph Indelicato from Queens, NY have recently been informed that their manuscript entitled "Stability of Metabolic Factor Before and After Bariatric Surgery" will be published in Obesity Surgery, the official journal of the International Federation for the Surgery of Obesity and Metabolic Disorders and is currently available online at:  
Dr. Brandon Davis Metabolic Factor

Dr. Brandon Davis

Lead researcher, Dr. Davis, a psychologist and Board Certified Bariatric Counselor commented, “Our research has identified a new metric that we call the Metabolic Factor, which can be thought of as the missing link in understanding why some folks are thin and others thick despite similar caloric intake. It can also explain why many dieters and bariatric surgery patients relapse and regain weight lost. Obese individuals with a low metabolic factor (hypo-metabolic) lend support to a genetic predisposition to a very prevalent category of obesity. The tools and the methodology we developed to diagnose and quantify an individual’s Metabolic Factor are currently available. This study's findings indicate that Metabolic Factor seems to be a stable characteristic within a person despite significant weight loss. We expect this discovery to be a game changer in the understanding of obesities and helping patients and bariatric health professionals make informed choices regarding care and treatment.”  
Dr. Joseph Indelicato

Dr. Joseph Indelicato

Dr. Indelicato, a professor at Touro College/University System and AABC Research Director noted, “For Bariatric Surgeons treating based on an individual’s Metabolic Factor, it is an essential metric for selecting an appropriate surgical procedure for each patient and thereby improving long-term, post-surgical weight loss and surgical procedure efficacy.”   Both researchers agree that perhaps a most important contribution of this discovery is the potential to reduce societal stigma and shame associated with obesities. Board Certified Bariatric Professionals are already licensed/certified health and education professionals. They include medical doctors, educators, psychologists, nurses, nutritionists and other disciplines that engage in research, diagnosis, treatment and prevention of obesities and related disorders. Click to view video
Female research partners; one a biochemist who weighed 250lbs (Lifelong obesity) and the other an endocrinologist who has always weighed 135lbs (since her teens). We performed their RMR tests; The endocrinologist’s RMR was 1485 Kcal per day. The biochemist RMR was 1500 Kcal per day. Both expend almost identical Kcal per day (1485/1500) and if they replace their expended calories with food they would remain at the same weight.   Despite one being thin and the other thick, they consume the same amount of calories. However, if you divide their individual RMRs by their weights: Endocrinologist: 1485/135lbs = 11 (MF) Biochemist: 1500/250lbs = 6 (MF)   The endocrinologist has a MF of 11 (which is in typical range) and likely predisposed her to be thin (135lbs). The biochemist has a MF of 6 which is very low (hypometabolic) and likely predisposed her to obesity (250lbs).You could say one has 6 cylinders and the other 11 cylinders. Needless to say, you use more gasoline (energy) if you have 11 cylinders.   We reviewed the test results with these friends and colleagues. The thin endocrinologist’s guilt fully addressed her friend; "I always privately believed you did not care about yourself, you were lazy and responsible for your own girth." She then told her how terribly sorry she was for her unfounded beliefs. You might say that this test helped both overcome irrational belief systems.   This is a shining example of how a numeric physiological test had profound psychosocial implications. It is up to us to use “best practices” in bariatric science (mind and body) and not get caught up in the science of public consensus.  

American Association of Bariatric Counselors

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