I’ve been getting a regular body composition measurements by DEXA Scan since December 2018 with a goal of less than 15% body fat and optimal visceral fat. At my latest scan, February 12, 2022, Rafi the tech who has witnessed our entire journey, made the comment:
Welcome to the 1% club. You’re in rarified air my friend.
Rafi, Composition ID Arlington VA
It took me a bit to internalize this. Looking closely at my DEXA I realized it means, after a starting point at the 57th percentile for my age as compared to the USA NHANES Database, I’m now at the 1st percentile for my age! This is pretty shocking to me but represents years of work to improve my diet, add strength training, and really dial in a way of eating that got me to 15% body fat! (What is NHANES ?)
A key take away is that the DEXA Body Composition Scan can be a very powerful tool to identify problems in body composition. Critically, it also can provide the motivation needed to continue adjusting diet and lifestyle. If you are serious about your health, you must ignore weight and BMI, and instead focus on body composition. To illustrate DEXA I’ll share some key parts of the report for me.
Visceral Fat – The Most Important Measure?
What upset me the most at my first DEXA scan was how many pounds of body fat I was walking around with. I think it was the psychology of the the number — 50 lbs! It was really the wrong number to focus on but it stuck in my head and initially became my “why”.
However, it was really the number on the last page which should have been the focus. That number was 2.41 lbs of visceral fat. Why? Visceral fat is the fat buries way under the skin. It’s the fat that lives in and around your organs. It’s the fat that disrupts the function of your internal organs. In short, its the stuff that will cause painful chronic disease and ultimately kill you off early.
After I got over the “omg 50 lbs!” shock from my initial scan I realized that, more than anything, I needed to get my VAT down to less than 1 lb as quickly as I could. Less than 1 lb seems to be the key for minimizing risk of heart attacks and chronic disease.
Three years after my initial scan I’m well below 1 lb now. Rafi explained that while you can go lower, and some people are at 0 lbs, the ability to go that low may depend a lot on genetics. So getting to 0 may be the best but it also may not be practical or even possible.
Fat Distribution – Subcutaneous vs Visceral Fat
I’m not even sure I need to say much about this part of the DEXA Scan report. Look at the red coloration in my 2018 scan and you can clearly see the visceral fat where my organs live. Then see the 2022 scan where virtually all the remaining fat is clearly subcutaneous (under the skin) and far less important to metabolic health. You do need some amount of fat to live so this will never be zero.
Here is another graphic that’s been motivating to me. Using this chart I was able to easily understand which dietary changes I’ve made helped, and which didn’t. Early on (circa 2018-19) it was simply keto and low-carb but eventually I hit a plateau. Most recently (circa Fall 2022) I changed to carnivore’ish but with a focus on increased protein and decreased dietary fat. See the huge change October 2021 (20.6% body fat) to February 2022 (15.4% body fat).
Bone Mineral Density – Haven’t Found the Magic
The one area of my DEXA Body Composition report that continues to frustrate me is bone mineral density. I’m told I’m still in positive territory so that’s good. However, my BMD has steadily dropped over time. I had thought that the increase in protein would have reversed this trend. So far it has not. Supposedly strength training can help to reverse this. But I’ve been increasing the amount I can lift steadily to no avail. So this is still a work in progress as I look to identify what part of my diet may need a change.
If You Care About Health – Track Your Body Composition
There are several different options available for tracking body composition. Two of the better known are DEXA and Bod Pod. Regardless of what you choose be consistent and track your progress. Doing so once a quarter is a good starting point though you can go more often if you think there is value. Expect to pay out of pocket and if you think its expensive consider the future costs of monthly medication you will avoid if you get body composition in line.
Combine tracking of body composition along with select blood markers to understand and rapidly improve your health.
