Body Composition Analysis with Nina Crowley, PhD, RD

Nina Crowley, PhD, RD, is a nationally recognized expert in body composition and obesity care. She holds a PhD in Health Psychology and blends clinical expertise with a deep understanding of behavior change and patient-centered care. Before her current role, she led the Metabolic and Bariatric Surgery Program at the Medical University of South Carolina (MUSC), where she focused on advancing patient outcomes through multidisciplinary care. As Director of Clinical Education and Partnerships at Seca, Nina leads strategic collaborations to expand education and access in obesity and metabolic health. She also serves on the Board of Directors for the Obesity Action Coalition and hosts the podcast "In the Know with Nina," where she explores body composition, obesity care, and health innovation.

Connect with Nina Crowley, PhD, RD:
LinkedIn: ninacrowley
Twitter/X: @PsychoDietitian
Instagram: @ninamcrowley
Facebook: @ninacrowley
Podcast: In the Know with Nina
Episode with Dr. Lindsay Ogle

We talk with dietitian and health psychologist Nina Crowley about why body composition beats weight alone for understanding health, risk, and progress. We break down where BMI falls short, how modern bioimpedance works, and how to use the data without getting trapped by daily fluctuations. 
• why weight and BMI miss muscle loss and hidden adiposity 
• how body composition supports obesity treatment decisions and dosing pace 
• why plateaus can still mean fat loss and muscle gain 
• better goal setting that focuses on behaviors and fitness markers 
• overview of body composition tests and what has improved over 20 years 
• office-grade bioimpedance versus home scales and common accuracy pitfalls 
• how often to measure so the numbers stay useful 
• why a care team helps turn data into sustainable behavior change 
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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

Why Body Composition Matters

Dr. Lindsay Ogle, MD 0:44

Today's topic is body composition analysis and what is it and why is it so important? And today I have a very exciting guest, Nina Crowley. She is a registered dietitian and she has her PhD in health psychology. She has both clinical and educational experience that I can't wait to hear about. And we're going to talk all about body composition today. So, Nina, thank you for being here. And if you could just introduce and share some more about your experience and why this topic is so important to you.

Speaker 1 1:21

Absolutely. Thanks for having me. I love our have loved our conversations already. So I think this will just build on that. Yeah, my background is in nutrition. I became a registered dietitian and started working early on in a bariatric surgery program and immediately felt like I needed a little bit more psychology to do that job really well. So I started in a program to be a health psychologist. And so I um I graduated with that while I was working, so that I kind of started using all of that stuff in practice and really have loved the behavior change space and kind of integrating nutrition and psychology together. When I finished that, I decided actually that my program that I loved so much needed some leadership. So I ended up being the director of our bariatric program for six years. And then after about 18 years at the Medical University of South Carolina, I'm here in Charleston, I moved over to industry. So I now work for SECA, which is a company that does weighing and measuring equipment. So if you've got kids, your baby was probably weighed on a SECA scale. They've been around 185 years and they've been in the body composition space for about 15. So I lead the education department here, and we um we work to educate our healthcare providers about um about body composition and why they should be using it. Um it's been a really nice time to be in this space as everybody's kind of finally on the on the train of saying, like, yeah, we should not be just telling people, don't worry about you know weight, but then only measuring weight. So it's been a really fun time to see people moving away from just weight as the only outcome for both diagnosis, but even more for treatment, um, you know, and getting people to look at their inside and look at muscle mass, look at, you know, fat mass, look at what's changing in response to treatment. And so I love this space. I've been in it for a little bit over three years. Um, and it's really been um if I'm talking to, you know, obesity medicine providers like you about how you can start doing this in practice, and patients love not having just weight and BMI. They really respond well to the other stuff.

Dr. Lindsay Ogle, MD 3:29

Yeah, I I see that in my practice. I mean, there are so many patients who really love the data and then tracking that over time. And if we're just looking at the number on the scale, we're missing so much important information. Um, so let's start there.

BMI Blind Spots And Hidden Risk

Dr. Lindsay Ogle, MD 3:48

Why do we want to know or need to know somebody's body composition when we have, you know, our tried and true BMI? What are some of the, I guess, downfalls of BMI and what can we um gain by using body composition?

Speaker 1 4:05

Yeah, well, I think the the thing people first resonate with is kind of thinking about, you know, that old idea of just looking at your weight on the scale doesn't really account for people who are at really high levels of muscle or really low levels of muscle. So we always hear like the bodybuilders and the athletes saying, oh yeah, by these standards, I'm considered um, you know, as having obesity. And but look at me, I'm very fit, and of course I don't, right? So you sort of think of that on one end. And then on the other hand, you have kind of our aging population who by weight standards might be considered, you know, normal weight, um, underweight, even. But when you look at their body composition and see they may have very low muscle mass and even very high fat mass, but sort of those things, you know, balancing out puts their weight at a normal level. So you're really not seeing the impact of, you know, hey, maybe we really needed to be working on even bone health or muscle health rather than just looking at weight alone and maybe working to reduce their adiposity in someone who, you know, by all standards had normal BMI. So like I kind of always think about those two ends of the spectrum. But then there's a whole lot more, you know, in the in the middle, sort of in the middle of that range where you're thinking about people who might be thinking about um surgical or medical treatment for obesity and which ones should they consider. And, you know, if you're on a medication, how fast do you escalate dosage? How often do you have them seeing, you know, dietitians or exercise professionals? There's, you know, maybe limited resources and not everybody needs everything at the same dose or timeline. So I really have found body composition helpful for people in those treatment, you know, areas to sort of decide who needs a little bit more and who might not. You know, someone who's got um, you know, excess adiposity and a good amount of fat-free mass, that's everything else, but they're but their adipose or fat tissue, um, they might be okay to lose a little bit of that on a medication and we're not worried. But someone at, you know, also a high weight who has very high um adiposity, but maybe very low muscle mass, we might be a lot more careful about seeing them more frequently, looking at, you know, how how fast they're losing weight and and what of that might be some of that precious muscle that they don't have as much of. So I think it's really been helpful and apparent, especially in the obesity medication realm these days, but it's kind of always been important for you know anyone losing a significant amount of weight. But also in the non-obesity care space, there's, you know, aging populations. You hear a lot about sarcopenia, loss of muscle mass and function. Um, and how do we look at that? Again, people use their eyes and we know about bias and all of that. You look at someone and you're like, oh, you're fine. Why would I even, you know, think about something other than just telling you you're good, keep doing what you're doing. Um, so I think in the primary care space, we're seeing a lot more need for looking a little bit deeper and making treatment decisions or clinical decisions, or even for the patient, just understanding where they're at a little bit better.

Dr. Lindsay Ogle, MD 7:15

Wow. So there is so much that we can do with body composition. It really seems endless the possibilities. And I really like how you brought up it's not just in obesity care. It really is helpful for all of us to um periodically check in on our body composition. Um, and I would say even more important as we are getting older to make sure that we're maintaining our muscle mass. So that is super helpful.

Plateaus, Goals, And Motivation

Dr. Lindsay Ogle, MD 7:43

I'll add another um instance that is probably um really beneficial, especially from the um psychological side of things and just um not knowing what's actually happening in the body. Um, I had Dr. Matea Rintia on a couple of weeks ago, and we were talking about um weight loss stalls or plateaus or weight maintenance. And for you know, someone who is on a weight loss or health journey and they see that the number on the scale is not moving, but they're doing all of you know the healthy things for their body, they're giving themselves adequate nutrition and exercising. If they're not checking their body composition, they may miss the fact that they are actually building muscle and losing fat mass. And so if you're just looking at that number, you may think that things aren't improving. But if you're looking at your body composition, you're gonna see that actually you're making great progress. So I'm curious what your thoughts are about that.

Speaker 1 8:42

Yeah, well, you know, I've always in the behavioral realm, I always think about how we talk about goals and goal setting. And so for so long, um, you know, in my experience in a bariatric surgery program, there was always like our our surgeons would talk to patients about like, you need to lose this much weight, and here's your ideal weight. And, you know, obviously the more I learned about psychology, the more I was pushing them away from making those types of goals and telling people what their goal or whatever should be. Um, part of that is just when you set a weight goal and you're saying, I want to get to this weight, it's a very, it's it's not a very active thing that you're working on. It's like passively, this is what's happening when you're doing all of those things, like you said, the nutrition, the movement, the sleep, the stress, the all of the daily behavioral things that we have to do that might impact a number on the scale, which is sort of a final or an outcome. Um, there's not a lot of control. We we all know this, right? There's not a lot of control you have over that number. It's just sometimes people, when they're on a medication or treatment, that they're seeing success and they're defining that by weight loss, um, that they start to be like, oh yeah, well, I like the scale now, I like the numbers now because they're moving in the direction to support the things that I'm doing in my daily behaviors. But I would still say it's not a great outcome measure at that point either, because once you get to sort of a weight plateau, stable maintenance, whatever you want to call it, I mean, you can't lose weight endlessly. That uh there's a stability that you have to reach, right? Staying the same is a really weird and not so exciting goal to achieve, right? So, like the status quo of anything, it's not really motivating uh to do the things, right? So, like you have to do all these things every day to just stay the same in any realm, right? So, in weight that's no different. And so having that as the goal, I think is problematic for a lot of reasons, but that's a big one. Whereas we're talking about fitness and athletes and people who every day have new personal best kind of goals that they can set, there's always fitness goals that you can achieve. And so I think that's a good example of why, you know, setting goals for things like, you know, maybe reducing adiposity is a big goal in the beginning. But once you've reduced that to a level that's, you know, in in a good realm for you, maybe then building up muscle mass, keeping muscle mass as you age is a is actually a big goal. And that's not status quo, because otherwise it would be going down. Um, so sort of thinking about it like uh what could you continually work on to improve your health and fitness and endurance and all these other things? And I think, you know, body composition is one tool that we can use to put in that um realm of things that can can be moved on and the needle can continue to be moving and not just staying up status quo. So I think it's great for someone who feels like, I mean, even just the idea of weight plateau. I don't love the term either, right? Because it's sort of again, focusing all of our energy on that. So there's a lot, I know you and I could talk about this probably for a while about language and terminology, um, but there's a lot of that. You know, we've just used the word weight for so long. And so that's what people understand this to be, but it really is health and health goals, we can always improve. You can improve your biomarkers, you can improve your lab work, you can improve your um endurance and all these other things that are so much more exciting than just let me get to that number and

Body Composition Testing Options Today

Speaker 1 12:09

stay there.

Dr. Lindsay Ogle, MD 12:09

I agree with you so much there. Thank you for going over that. And I think we've really established the importance and the application of body composition. How do we actually find out our body composition? What are the tests that are available to us and maybe what are some of the benefits of certain types of testing?

Speaker 1 12:29

Sure. So it's what I've really learned. I just got back from two meetings back to back where, you know, working with healthcare providers at various levels, I think it's reminding me so much that many of us did our training 20 or more years ago. And back then, the the options for body composition assessment were pretty limited. It was kind of like research setting, you know, underwater weighing or MRI. You could, you know, see these things being done and study, DEXA, even for a lot of people. Um, these are things that were done in a in a full-day-long lab testing scenario, right? And so that sort of established what body composition assessment was and bioimpedance, which I can talk a little bit about, but back then it was um it wasn't so great. It was just sort of coming into its own. And so I have just found, again, most recently, that a lot of our colleagues have made their decisions about body composition assessment based on what we learned from 20 years ago. So the good news is um methods have come a long way, validations have come a long way. We're thinking beyond just uh, you know, a Caucasian male who's healthy, and we're looking at, you know, doing validations in various ethnic groups, various gender, um, in in bigger ranges of weight, so that we can say like what would be the normal range for someone of your particular um demographic characteristics. So that's come a long way. Um, and and in my realm, the the company that I work for makes bioimpedance devices. And what that is, is it looks like a scale, actually. You stand on it, you have your shoes off because there's a little electrical current that goes through a looks like a little metal plate buried under the glass through your feet and out through your hands. So you're holding um, you know, a stable handrail and the electrodes, you've got two on each hand and two on each feet that you're just holding. Um, and those electrodes conduct a low dose electrical current that goes through your feet, out through your hands, and that current goes through your body's tissues different differently. So different speeds. It goes faster through water and water-containing tissue, which muscle is 75 or 80 percent water, it goes slower through your fat tissue, which is much less water. Um, so then the speed at which that goes through and comes out the hands goes into a formula, and these formulas are are validated against the reference methods of you know, imaging like MRI or DEXA. Um, and they've found them to be, you know, quite valid at predicting the thing that you could image. So, like set, you know, for us muscle mass is 70 or not 70, sorry, muscle mass is 97% compared to MRI. So whole body MRI, which most people wouldn't do to look at their muscle mass ever or very often, um, we can get really close, 97%. And for fat mass, you we use the four compartment model, which is what I meant by that all day. You know, uh you're testing the four different compartments. So you've got air displacement, you've got the weight on the scale, you've got uh um the water by deuterium water dilution, which is an all-day affair, and then bone density, looking at that with DEXA. So those four compartments is what's called the four compartment model. That's the best way to look at someone's fat mass. Our bioimpedance devices are validated to that four compartment model with 98% agreement. So we can feel pretty confident in a clinical space that if you put someone on a scale that is validated to those imaging techniques, that we're pretty close to what those would be actually if we measured it. And so that's really what um what our our company in our you know world is based on in bioimpedance to assess body composition. There's you know a few different companies out there that do it. Um, I feel like really lucky that I landed in one that's um, you know, a very precise German company that is very focused on precision. So um, so yeah, so it's been it's really it's really neat. I know, you know, where I worked before, um, we were not able to get that in. But now that I've I've been talking, still in touch with them, they're right in town here. And so they have they have one of our devices now because they've you know seen what it can do. And I'm kicking myself for not pushing through the red tape of an academic medical center even harder back then, because I think it really would have been helpful for the patients I worked with for all those years.

Dr. Lindsay Ogle, MD 16:58

That's amazing, and what wonderful technology and how fascinating that, you know, just how it works and we can get so much information so quickly because you just you step on a scale like a normal scale, but it's giving you so much more.

Office Devices Versus Home Scales

Dr. Lindsay Ogle, MD 17:13

Um, I'm curious, um, kind of two questions here, because I know that there's the scales that are in an office, and then there are home scales. Um, I'd love to hear a little bit about the differences of those. And then also how often should somebody be monitoring their body composition?

Speaker 1 17:33

I knew you were gonna ask me that. Um, so yeah, one of the things that's funny is like you see it, it looks like a scale. So we assume like they would be equivalent, right? Um, one of the big things is that you know, for people for healthcare providers who or clinicians who've been in this space, they probably remember those old, like it looked almost like a steering wheel you grabbed on. Those were like uh two handles and maybe four points of contact that sent the electrical current around the upper part of the body and used formulas to extrapolate or estimate the bottom half of the body. So our scales that we step on with our two feet now will do that same thing. It'll send the electrical current from one foot out through the other, and that's estimating your bottom half of your body and using formulas to extrapolate to the upper half. So the one of the big differences that the the scale or the bioimpedance device that you'd step on in a um in an office would be whole body bioimpedance. It's also back in the day used to be single frequency, meaning one current they'd send through. And that's not strong enough to get through both your um inside your cell and outside your cell. Part of what the technology is for bioimpedance is it's going through the cells and estimating your water through that method. Um, so now we have multi-frequency. So they're, you know, a bunch of different frequencies, some that go through, some that go around a cell, and that helps with the estimation. Um, so with that all said, the home scales are generally foot-to-foot, and and that is not as accurate as the whole body. Some have like a pull-up handrail that they do. Um, you know, there's also some, you know, this is kind of in the weeds, but there's also some um validation to having that handrail in the same spot every time. So the scales in the office that have a stable fixed handrail you're holding, and you know that your hands are like out like this, the same every time versus the ones that are kind of movable. Like your bioimpedance numbers will be different if you're holding your arms up like this or down like this. And at home, you don't know exactly what that positioning is. So that can make it a little bit different too. Um, another kind of weird thing is at home your scale's probably got a pretty small um footprint, right? You know, I don't know, 12 inches by 12 inches, maybe. And so bioimpedance, again, if you're home on your scale, you're probably naked, your legs are probably touching. Um, and so the bioimpedance current will kind of want to go through that way and assume almost like you have one leg. And so the numbers will be a little bit funny that way. So if you do have that, you want to make sure you're you know wearing pants that um they can touch that way. You just don't want that skin-to-skin contact. And then for people whose um by spreading their legs on the scale are not that tiny, um, it's harder to achieve that um when you have a really small foot plate at home. And if you made it much bigger and more complex, you'd basically be creating an office grade scale that we already have and in many offices around the country. So I think there's some of that. It's like if we could make the technology as good as in the office, then we'd replace it with that. But right now we don't, they're not as they're not as accurate. Um, there's also, you know, a big, I'm glad you asked about um how often, because a big thing that I think of is most people who have a scale at home are getting on it every day.

How Often To Measure Body Comp

Speaker 1 20:51

Maybe once, maybe more. Um, and behaviorally, I've got a whole lot to to say about that. Um, but for many people, for many people, that is a part of their daily practice and that keeps them in a you know, kind of a feeling like they're on track. But for others, um, they get obsessed, they get on it too much, they make decisions on daily food intake based on a number on the scale, which fluctuates. Our weight fluctuates with, you know, water, with intake, with when we go to the bathroom, with, you know, medication, with all sorts of things. So if you were to track your weight, no matter what, it's going zigzag down or up or whatever, um, your body composition is gonna try to estimate the amount of your weight in the compartment of fat mass and everything else and divide it down, right? So if your weight is up five pounds, the numbers are gonna shift and they're gonna estimate it that way to tally up to that number. So I just think sometimes people's um brains can't comprehend that level of uh daily individual change, and it can make you obsess or think too much and perseverate a little bit on that topic. Um, when really the goal of this. Is let's look at your numbers and then pivot, make some changes to what you're doing, do those things day in and day out for a month or two, and then come back and see the effect of that. So that's where I behaviorally think that the daily weighing and the daily body comp assessment might not be for everyone. So, and it's hard to know if you make it a consumer product like that, who has the skill set to handle that data and that data influx frequently.

Dr. Lindsay Ogle, MD 22:28

I absolutely agree. Um, some of the guidance that I've heard of um for you know obesity medicine providers, if you are watching body composition, would be at most once a month to do body composition.

Speaker 1 22:41

Four to six weeks is usually what I hear. And then a lot of people in practice are, you know, getting people in person if they, you know, some people have virtual programs, but in person maybe every three months or so. Yeah. You know, or if you see a dramatic change in if they're monitoring weight um and you're seeing a dramatic change in weight and you're wanting to sort of dive into, you know, where is that coming from more frequently? Or if you're in a particular program and maybe you're monitoring escalation dosage to a medication, you might do that more frequently versus when you're getting out to maintenance phase. Again, handling fluctuations. I mean, I have people every day, I've two probably that just came in my email while we're talking, um, of people saying, like, these numbers are a little bit different. Like, what do I do? They're like, they got on the device five minutes apart and are wanting to know why there's a tiny little fluctuation. Um, and it's that, you know, our body is constantly shifting and moving water in and out of compartments too. And so, you know, the technology that we have is is good at estimating uh your body's composition at that time point, but it's not, it's not responding, like you're not building two pounds of muscle overnight, right? But if you're if your numbers are fluctuating, it might think it's that based on you know the way that the formulas work. So, you know, it's not it's not something that is, it's not imaging and it's not um, you know, an autopsy, which would be the definitive way to look at your body composition.

Turning Data Into Behavior Change

Dr. Lindsay Ogle, MD 24:06

And this also highlights the importance of you know surrounding yourself with a team that is going to support you along with this information. Um, because if you are, you know, doing it yourself and trying to review those numbers and implement changes based on that, it can be really overwhelming. And so working with an obesity medicine physician, a dietitian, um, a coach in this area, um, somebody who is really going to support you through it is going to be so helpful. And sometimes multiple people, you know, if you you really need that, need that team, um, which is great to have that support.

Speaker 1 24:43

Yeah, I'm a big, I'm a big fan of the comprehensive, you know, care. I think, you know, again, in this space right now, there's a lot of people, you know, just relying, maybe or or thinking they can just rely on a medication to to be the treatment. Um, and it's really, it is part of the treatment and and having that on your own. Um, you know, it's a lot, it's a lot of data to handle. And really, we're we're not so good at translating that into the next thing, which is the hard work of behavior change. That, you know, there's a there's very few workarounds for that. And so um, you know, I see that a lot with some of the wearables and technology. You know, there's a lot more even in the sleep realm where people are getting all this high-level data about, you know, we we know steps and movement. We have people, you know, monitoring slicker ways even of monitoring your your intake um and your sleep. And it's just, I think there's a point at which um there may be too much data and not enough time to process, analyze, and code that into your actual behavior change. And so um, that is, of course, where I don't think we can be replaced by technology. If it were that easy, you know, to just do take a medication and you know, see the results, like, you know, that's that's not what this is all about. Medication has been an amazing biological uh, you know, tool to help people with the weight loss, but keeping it off, keeping, you know, all the other parts, you know, optimized with the nutrition and protein and with the movement and the exercise and the you know behavior stuff, all of that is still, it's so hard. It's so hard to do that. I I love that we have agents that um can take the the food noise, the biology, the appetite, all of that down to a level where now most people feel like they do have it within their skill set to be able to work on those other things. But it definitely takes a village to help optimize.

Dr. Lindsay Ogle, MD 26:37

It does, it does. That reminds me of the four pillars of obesity medicine, nutrition, physical activity, behavior change, and medical interventions. And so we really need all four of those to ensure, you know, a healthy outcome, which is our goal. Absolutely. So I think we've covered everything.

Ask Your Clinic For Better Metrics

Dr. Lindsay Ogle, MD 26:56

Is there anything else that you would like to mention or um, you know, share with our audience on how they can get in touch with you if they want to learn more?

Speaker 1 27:06

Sure, yeah. I mean, so Sika is the company I work for. We have you know social media, Seeka North America. Um, myself, I'm you know, on LinkedIn is probably the best place to connect with me, Nina Crowley on LinkedIn. Um I do, I do still have my ex account with Psychodietician was my name on there. Um used to be active on there. Um and then on Instagram, I do sort of personal and professional as well. Um, but you know, just I think for for your viewers, learning more about, you know, what body composition is all about now, the advances that we've had over the past 20 years, um, and I'm sure there's more more to come and we'll make it even easier moving forward. Um, if you've got patients listening, I think having um having that conversation with your doctor or your healthcare team about, you know, this is something that you want and you want to see in the practice. You know, I talked to a patient group the other day, and it really sort of hit home that they're hearing from their team, it's not all about the weight. They're hearing that message finally. You know, we heard hadn't heard that message for so long, they're hearing it's not all about the weight, but then they go into the office and they're getting on um a scale and just getting a weight. So it's like that mismatch between what we're saying and what we're doing in practice is tricky and it's confusing to patients. So if you're a provider who understands the value and is telling your patients it's more than about just weight and BMI, um, you know, put your money where your mouth is and offer bioimpedance or body composition testing in your office or have a pathway, you know, where you can refer or you can get them to a you know clinic or a gym or a you know exercise facility that does have this so that you can look at that data together and kind of modify your treatment plan together.

Dr. Lindsay Ogle, MD 28:55

Well, thank you so much for taking the time and sharing your amazing knowledge. It was so helpful. I know I learned a lot. I'm sure everyone else did as well. Um, and we will continue to collaborate together, I'm sure.

Final Takeaways And Closing

Dr. Lindsay Ogle, MD 29:07

Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.