Assessing body fat can be done using the following methodologies: Hydrostatic weighing, skinfold assessment and bio-electrical impedance. Of these methods, one that is both accurate and practical is skinfold measurement.

The measurements are taken with calipers, which gauge the skinfold thickness in millimeters of areas where fat typically accumulates i. Once the measurements are recorded, the numbers are inserted into an equation that calculates a body fat percentage and alternatively body lean mass.

Skinfold is a preferred method of body fat measurement for non-clinical settings because it is easy to administer with proven accuracy and is not obtrusive with regards to the patient.

It also provides much more data than just the final composition measurement - it also yields the thickness of many sites, which can be used as bases of comparison with future results. For example, an abdominal skinfold improvement from 35mm to 24mm would show a significant improvement in that site even if the overall body fat percentage may have only reduced minimally.

BMI is often mistaken as measurable guide to body fat. However, BMI is simply a weight to height ratio. It is a tool for indicating weight status in adults and general health in large populations. BMI correlates mildly with body fat but when used in conjunction with a body fat measurement gives a very accurate presentation of your current weight status.

With that being said, an elevated BMI above 30 significantly increases your risk of developing long-term and disabling conditions such as hypertension, diabetes mellitus, gallstones, stroke, osteoarthritis, and some forms of cancer. For adults over 20 years old, BMI typically falls into one of the above categories see table above.

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For older adults who may be taking weight loss medications, increasing protein intake, resistance exercises and other measures may help mitigate the loss of lean muscle, Batsis says. Home Page. Health · weight-loss and diet control industry. BY Madison Muller and Bloomberg. Jorgensen, chief executive officer Novo Nordisk.

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Sign up for free today. There was no study-specific assessment of the compliance with these general guidelines. Screening included a physical examination consisting of Tanner stage assessment; vital signs and physical measurements weight, height, waist and hip circumference ; and clinical laboratory tests hematology, blood chemistry, vitamin levels, glucose and insulin responses to a 2-hour oral glucose challenge.

Following the placebo lead-in period, vital signs were taken and weight and height were measured every 2 weeks for the first 4 months, and then every month until the end of the study 18 visits in total.

Waist and hip circumferences were measured every month for the first 4 months and then every 2 months until study end. Tanner stage was graded 1 to 5 after 6 and 12 months and based on breast development in girls and genital development in boys.

Clinical laboratory tests were repeated on day 1 and after 3, 6, 9, and 12 months. Sex hormone measurements estradiol, free testosterone, and sex hormone-binding globulin were taken on day 1 and after 6 and 12 months. Blood samples were drawn in the morning following an overnight fast and all samples were analyzed by a central laboratory.

Twelve-lead electrocardiographic examinations, gallbladder and renal ultrasound examinations, and bone mineral content and body composition measurements determined by whole body dual-energy x-ray absorptiometry for patients at centers that had such equipment were performed at baseline among a subset of participants and at week All radiology technicians followed specific guidelines to ensure that standard operating procedures were adhered to across all centers.

The study was conducted in accordance with good clinical practice, the Declaration of Helsinki, and the laws and regulations of the countries in which the research was conducted, whichever afforded greater protection to the individual.

The study was approved by the institutional review board at each participating center. Written informed consent was received from the parents or guardians and written assent was received from each patient. Participants were maintained on a nutritionally balanced, hypocaloric diet designed to produce an initial weight loss of 0.

At each study visit, the dietician spoke with the patient about compliance with diet. Participants in both treatment groups received a commercially available daily multivitamin supplement Centrum Kids Extra Calcium; Wyeth Consumer Healthcare, Madison, NJ throughout the active period of the study.

All study centers had behavioral modification programs in place, but used a study-specific manual as a guideline. Staff at the study centers were to support and reinforce behavioral modification techniques regularly. Guidelines were provided to encourage regular physical activity and reduce sedentary behavior.

Strength, flexibility, and aerobic activities were included as part of the exercise plan wherever possible. A behavioral psychologist spoke with patients about compliance with the exercise program at each study visit. The primary efficacy parameter was the change in BMI from baseline to study end or study exit.

Secondary efficacy parameters included change in body weight, levels of total, high-density lipoprotein, and low-density lipoprotein cholesterol, ratio of low-density lipoprotein to high-density lipoprotein cholesterol, triglyceride levels, systolic and diastolic blood pressure, waist and hip circumference, glucose and insulin responses to an oral glucose challenge, and changes in body composition.

At each visit, the participant was systematically questioned by the investigator on the presence of gastrointestinal tract adverse effects, using a specially designed dictionary of standard terms for defecation patterns for reproducibility and consistency of reporting. Nongastrointestinal tract adverse events were noted by investigators at each clinic visit following general questioning.

Any adverse event was discussed at each subsequent visit until resolution. For adverse events extending beyond the end of the study, the participant was contacted 4 weeks after the last visit to assess the outcome. All adverse events were considered resolved at the time of the last contact with the participant.

Other safety parameters that were directly measured included physical and sexual maturation, vitamin levels, sex hormone levels, gallbladder and renal structure, cardiac function, and bone mineral content. The allocation process was triple-blind; the allotted treatment group was obtained through an automated telephone system.

The safety population consisted of all randomized participants who received at least 1 dose of study drug and had at least 1 follow-up assessment. Efficacy was assessed in a modified intent-to-treat population, comprising all randomized participants with a baseline assessment and at least 1 postbaseline efficacy measurement.

Efficacy analyses were performed using the last observation carried forward method for those who dropped out.

Primary and secondary efficacy analyses were performed using mixed-model analysis of variance. For the primary efficacy parameter, the analysis of variance model included change from baseline as the response variable, with treatment, center, treatment by center interaction and baseline stratification as terms.

Body weight and BMI were corrected for age and sex by z score the difference between the value and the mean, divided by the SD based on Centers for Disease Control and Prevention charts.

Change from baseline was analyzed using center, treatment, and treatment by center as covariates. All analyses were performed using SPSS statistical software A total of patients were randomized to orlistat and to placebo; Figure 1. The baseline characteristics of those who dropped out were similar to those participants who completed the study in each treatment group Table 1.

A total of participants did not complete the study. Reasons for noncompletion were similar for the 2 groups Figure 1. Two hundred fifteen participants in the orlistat group and in the placebo group underwent dual-energy x-ray absorptiometry.

Demographic and clinical characteristics of the safety population were similar for the orlistat and placebo groups Table 1. Overall, Most participants had an elevated waist circumference or high fasting insulin levels Table 2. During the first 12 weeks after randomization, both groups experienced a mean decrease in BMI.

Subsequently, the BMI tended to stabilize in the orlistat group, but increased to beyond baseline in the placebo group Figure 2. By the end of the study, the least-squares mean BMI of participants treated with orlistat had decreased from baseline by 0. Compared with baseline, both groups lost weight during the first 4 weeks of the study, although participants receiving orlistat lost more weight Figure 2.

Starting at week 4, participants treated with orlistat continued to lose weight steadily to a maximum weight loss at week Subsequently, both groups regained weight, but the effect attributable to the drug ie, the between-group difference in body weight after 6 months was sustained.

No significant differences were found between the 2 groups with respect to changes in lipid or glucose levels. By the end of the study, 2-hour insulin levels for orlistat recipients were lower than at baseline, but the decrease was not significantly different from that in the placebo group Table 4.

In contrast, participants treated with orlistat experienced significantly greater decreases from baseline to end point in both waist circumference and hip circumference than participants receiving placebo Table 4.

There was no statistically significant change in systolic blood pressure in either treatment group. Twelve orlistat and 3 placebo participants discontinued treatment because of adverse events Figure 1 ; the timing of participant withdrawals in the 2 groups was similar. The baseline characteristics of the participants who dropped out were similar to those of the participants who completed the study in each group Table 1.

The most common adverse events were gastrointestinal tract—related; these were more common in the orlistat group Table 5. The majority of participants reporting gastrointestinal tract adverse events reported 1 event.

The decrease in BMI was not affected by gastrointestinal tract adverse events in the orlistat group. The 5 serious adverse events in the placebo group were acute demyelinating encephalomyelitis, facial palsy, pneumonia, worsening of asthma, and pain in the right side Table 6.

Only the symptomatic cholelithiasis that led to cholecystectomy in a year-old girl treated with orlistat was considered possibly related to study medication by the investigators; the patient had lost Ultrasound revealed multiple tiny gallbladder calculi but no gallbladder thickening, pericholecystic fluid, or dilated biliary tree.

No patient developed acute cholecystitis during the study. One placebo and 10 orlistat recipients developed abnormalities during the study that were detected on electrocardiograms. None of these were believed to be related to the medication based on review by an independent cardiologist. In general, levels of vitamins A, D, E and beta carotene were within the normal range and increased in both groups during treatment Table 7.

The levels of estradiol among girls decreased from baseline in the orlistat group compared with a slight increase in the placebo group —7.

There was no significant difference in height gain between groups Table 3. Participants in both groups experienced normal sexual maturation, as shown by changes in Tanner stage over the 52 weeks of the study Table 8.

In the orlistat group, 14 participants had a baseline abnormality revealed by gallbladder ultrasound, including 8 participants with fatty liver infiltration or hepatomegaly and 3 participants with gallstones.

Of these, 2 patients still had gallstones at the end of the study; the third patient did not have a follow-up examination. At the end of the study, 6 participants in the orlistat group were found to have asymptomatic gallstones not seen at baseline; 5 of these patients had lost large amounts of weight 8.

Another patient had multiple gallstones on ultrasound at day after a In the placebo group, 8 participants had a baseline abnormality, including 4 who had a fatty liver, 1 who had previously had a cholecystectomy, and 2 with gallstones that were still evident at the final visit.

At the end of the study, 1 participant in the placebo group was found to have gallstones not seen at baseline. Ultrasound also identified 2 additional new renal abnormalities in the orlistat group mild left hydronephrosis and 6-mm echogenic focus without evidence of renal calculus.

This study evaluates the use of orlistat, a lipase inhibitor, in the treatment of obese adolescents. In conjunction with a reduced-calorie diet, exercise, and behavioral modification, treatment with mg of orlistat 3 times daily for 52 weeks statistically significantly decreased BMI, waist circumference, and body fat compared with placebo.

This effect is probably due to the decrease in the absorption of fat and its associated calories. In these adolescents studied over a 1-year period, no major safety issues were raised. Orlistat has been shown to cause meaningful and sustained weight loss in overweight or obese adults when given at a dose of mg 3 times daily and combined with a mildly reduced-calorie diet for up to 4 years.

In the current study, the same dosage of orlistat was associated with a statistically significant decrease in BMI over the course of 1 year in contrast to a BMI increase in the placebo group. This result must be interpreted considering the characteristics of an adolescent rather than an adult population.

In the absence of intervention, overweight and obese adolescents can continue to gain weight rapidly well into adulthood. Body mass index decreased with orlistat but increased with placebo. The relationship between the changes in BMI and body composition is explained through the dual-energy x-ray absorptiometry results obtained from a subset of our study population.

The increase in fat-free mass and bone mineral content was similar in both groups, reflecting normal growth.

In contrast, change in fat mass was markedly different between groups. Thus, the difference in absolute weight experienced by participants receiving orlistat was mostly due to a loss in fat mass, suggesting a favorable change in body composition.

Orlistat treatment resulted in decreases in weight of 2. This improvement in BMI was similar to that observed after 1 year in 5 major placebo-controlled studies in adults between-group BMI difference of —0.

These values are similar to those reported in studies of obese adults without severe comorbidities in which orlistat-treated participants were up to 2. We attempted to clarify the baseline characteristics of those patients achieving these decreases.

While the study was not powered to address this question, these descriptive data may enhance the design of future studies attempting to predict which participants will benefit most from pharmacotherapy. Thus, from this study, orlistat appears to have similar efficacy in males and females and there is no evidence of any influence of ethnic origin.

Baseline age and BMI were not predictive of a greater decrease in BMI over the duration of the study. Secondary efficacy parameters, including lipid and glucose levels and diastolic and systolic blood pressure, were mostly normal at baseline. This contrasts with an earlier, pilot study of weight loss with orlistat in 20 adolescent participants, in which obesity was extremely severe mean BMI, 44 , and obesity-related metabolic risk factors hypertension, sleep apnea, abnormalities in lipid levels, and glycemic control were more frequent.

In this 1-year trial, orlistat did not raise any safety issues, and the adverse event profiles—except for gastrointestinal tract adverse events—were similar between the orlistat and placebo groups.

However, the efficacy and tolerability of orlistat for more than 1 year of treatment has only been confirmed in adults. Gastrointestinal tract adverse events were reported by a higher proportion of orlistat-treated participants than placebo recipients, although the majority of the participants did experience a specific adverse event only once; these adverse events were generally mild to moderate in intensity and may relate to the mechanism of action of orlistat.

Gastrointestinal tract adverse events also occurred in a small percentage of placebo recipients, which has been previously reported in adult studies. This is consistent with the specific questioning for named gastrointestinal tract adverse events and also the known occurrence of gastrointestinal tract adverse events in obese patients not receiving any pharmacotherapy.

There were no clinically relevant differences in any of the laboratory tests between the 2 groups. Fat-soluble vitamins A, D, E, and beta-carotene increased in both groups at the end of the study as expected with daily multivitamin supplementation.

Levels of the sex hormones, estradiol, free testosterone, and sex hormone-binding globulin were also assessed.

The only notable difference between treatment groups was the greater decrease in estradiol levels in girls treated with orlistat rather than placebo. This is consistent with the known effect of weight loss on estradiol levels in adolescent girls.

It is well established that there is an increased incidence of gallstones in obese adults and adolescents. In our study, placebo recipients, who generally did not have significant weight reductions from baseline, did not develop gallstones.

In contrast, a greater proportion of orlistat-treated participants achieved significantly greater weight loss from baseline and would therefore be at higher risk of developing gallstones.

At study end, 6 of the orlistat-treated participants, all girls aged 13 to 15 years with a mean weight loss of Five of these participants developed gallstones during the study and 1 additional participant already had a cholecystectomy prior to study entry.

However, the absence of gallstone formation in orlistat-treated participants who had BMI decreases without large weight reductions suggests that gallstone development was related to weight loss and not to the intrinsic effect of orlistat. Indeed, previous studies have shown no increase in the lithogenic index of bile and no evidence of microcrystal formation in the gallbladder with orlistat treatment.

Certain limitations of this study should be considered. First, diet, exercise, and behavioral modification were not standardized. However, the absence of a significant center by treatment interaction suggests that the treatment effect across centers was similar.

Second, the study was performed in a predominantly white population and as is common in such studies, 39 most participants were female. The average participant was at the 98th percentile for BMI, a significant degree of obesity, so it is not known if less obese adolescents would achieve similar results.

The present study excluded participants with certain characteristics more likely to be associated with metabolic syndrome, although one quarter of the participants did have the metabolic syndrome at randomization. How these characteristics affect the generalizability of our results is not clear.