Thursday, November 12, 2015


Carolyn Hodges Chaffee, Annika Kahm say testing
is simple and invaluable way to improve patient care.

Carolyn Hodges Chaffee and Annika Kahm are co-authors of a new book that explains the importance of using two simple measurement techniques that are invaluable tools in helping to assess and treat eating disorder patients.
Carolyn, MS, RDN, CEDRD, the owner and director of Upstate
Carolyn Hodges Chaffee
New York Eating Disorder Service in Elmira, and Annika, MS, an eating disorder therapist and nutritionist in private practice in Stamford, Conn., wrote “Measuring Health From The Inside: Nutrition, Metabolism and Body Composition” to help clinicians, patients and their families.
“Both Metabolic Testing and Body Composition Analysis are being used in research, but very few clinicians are using them to help treat those struggling with an eating disorder,” said Carolyn, a certified eating disorder specialist. “It is
our hope that by writing this book, clinicians will become more familiar with the testing and incorporate it as part of their standard of care.”  
Body Composition Analysis, done by electrical impedance, is a measurement of the body’s lean mass, fat mass, hydration status, and phase angle (which helps assess how healthy an individual is at the cellular level). The results also help determine the long-term impact malnutrition has had on the body.
Metabolic Testing, or indirect calorimetry, is an actual
Annika Kahm
measurement of the body’s resting energy expenditure. The results are used to accurately assess the current nutritional status of the patient. The test results show how the body adapts to being underfed. Metabolic Testing determines how many calories a body is burning at rest with no activity. It also shows if the body is breaking down excessive protein stores.
The book is receiving national attention.
“Carolyn and Annika bring decades
of expertise in the care of patients with anorexia, bulimia, binge eating disorder, and the many related atypical and subsyndromal variants,” said Dr. Diane Mickley, director of the Wilkins Center for Eating Disorders in Greenwich, Conn. “Their clinical wisdom, understanding of the experience of sufferers and those who love them, and understanding of these illnesses and the recovery process infuse these pages.”
Mary Ellen Clausen, the founder of Ophelia’s Place, an eating disorder prevention and advocacy center in Liverpool, N.Y., said “Measuring Health From The Inside” reveals the truth about our bodies’ needs and invites us to be part of the healing and recovery process.
“It is a profound book that will forever change how we see and treat this devastating disease,” Clausen said.
Dr. Mickley, writing in the Foreword, said “Measuring Health From The Inside” shines a light on a valuable addition to the treatment of eating disorders: Metabolic Testing and Body Composition Analysis.
“These are noninvasive assessments with immediate results. The results show patients numerically and graphically if they have slowed their metabolism and if they are burning off muscle for lack of fuel. The testing provides objective data on how many calories the patient needs, as well as what is an accurate ideal weight.”
Question: Are you and Annika writing the book for treatment professionals?
Carolyn: Yes, but it is also for patients and their family members. The use of these two tests encourages patients to become a partner in their recovery process. The more knowledge patients have about why their body responds the way it does, or why they physically feel the way they do, the easier it is to make changes in their intake or behaviors. There are educational sections about the different disorders and behaviors and how to effectively use and apply the testing in the treatment process. The book opens with chapters on malnutrition and the eating disorder “voice,” followed by an explanation of the Metabolic Testing and Body Composition Analysis.
We dedicated chapters to Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Compulsive Exercise, and Other Specified Feeding and Eating Disorders.
We also have chapters explaining healthy eating, treatment protocols, and how and when to access higher levels of care. We conclude with a look at why recovery is not a linear process and how patients can sustain long-term recovery.
Annika: It’s important to have other clinicians on a patient’s treatment team who are not familiar with Body Composition Analysis and Metabolic Testing understand why I push for higher weight based on the numbers. So frequently when I work with other clinicians, they settle for too low discharge weight and let the patient think that that is their goal weight. This becomes hard for the patient, so the book is needed for other clinicians on the team to respect, accept and support the patient to reach a healthy weight goal range.
Question:  Why is this book important in your practice?
Annika:  When I see a patient for the first time, I go over and explain all the numbers from the tests, and make sure they understand the concept. What frequently happens is that a couple of days later, they are back to their own (eating disorder) thinking and don’t trust the concept. With the book, they and their support team can be reassured that what we initially planned is the right treatment. In other words, with the book, they can trust the treatment sooner and it becomes a time-saver for the patient and me as well.
Question: Will patients and their families understand?
Carolyn: We wrote this for everyone affected by eating disorders. It is written in a way to make it accessible for all readers. We had many editors and readers help us find the right balance for professionals and non-professionals.
It is our hope that clinicians incorporate the testing as part of their practice, and patients seek clinicians who use these treatment methods. Patients and their families need to know there are resources available they may not be aware of. 
Question: Have your patients requested more information about testing?
Annika: Patients frequently struggle with the treatment based on the test results, especially when they need to eat more in order to, for example, lose weight.
The message may seem counterintuitive and not only they but their loved ones may question it as well. As an example: “You went to the nutritionist in order to lose 30 pounds, and she wants you to eat more?” With the book, they and their loved ones can read why they need to eat more initially in order to lose weight.
Question: Why did you write this book?
Carolyn:  Colleagues, patients, and family members are always saying:  Why don’t you write a book? Or they would ask me to suggest a book they can read that will provide more information about metabolism, malnutrition, and the testing. This book fills that gap. It helps everyone better understand the how and why the body works the way it does.

> Go to to learn more about the book and read excerpts.

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