Overall weight loss may not always be the best solution for patients trying to get healthier; often, goals should encompass whole body composition, which includes gaining lean muscle mass while losing fat.
As the new year begins, many people endeavor to begin their journeys to a healthier weight. New Year resolutions are made, diets are re-evaluated and patients start hitting the gym to achieve their desired results. Practitioners can play a significant role in helping their patients to identify what they should be consuming and doing to meet their goals.
According to the Centers for Disease Control and Prevention (CDC), nearly half of the U.S. population is trying to lose weight. This is likely due to the fact that, according to the National Center for Health Statistics, “over two-thirds (71.6 [percent]) of Americans are overweight or obese, and more than one-third (36.5 [percent]) of Americans experience obesity,” which can lead to hypertension, diabetes and cardiovascular disease.
Weight loss, however, is not always the only answer. Addressing overall body composition and recognizing the difference between fat and lean muscle mass is becoming increasingly important in this category.
Body Composition vs. Weight Management
Recently, some companies have shifted from using terms such as “weight maintenance” and “weight management” to “body composition” when marketing their supplements. “We believe the shift in terminology is helpful in measuring results,” said Ellen Hoil, in-house counsel, Nutritional Therapeutics (Islandia, NY). “It is not just losing weight that makes us healthy; it is the loss of fat and the benefit of a healthier lifestyle, including muscle and bone density that leads to better, healthier outcomes.” However, “management still plays a part. Without the ability to manage shifting your body’s composition and keeping it in a healthy state, the effort a person puts in is lost.”
Stephen V. Drehobl, senior marketing associate and Natarajan Ranganathan, founder/managing director, Kibow Biotech (Newtown Square, PA), concurred, adding that “One of the issues with weight management/weight loss as a concept is that it does not distinguish between fat and lean mass. Many approaches to weight loss prioritize losing weight at all costs, sometimes at the expense of lean muscle.” They continued, “Body composition as a paradigm instead looks more specifically at techniques to build healthy muscle while curtailing unhealthy levels of fat. Body composition also encourages individuals to tailor their approach to their own individual body type, helping them to determine what a healthy percentage of body fat might look like for them.”
Céline Torres-Moon, science writer Protocol for Life Balance, Bloomingdale, IL, further elaborated, stating that “Body composition is a broader term than weight management or weight maintenance. Some individuals may want, for example, to increase their muscle mass without necessarily affecting their overall body weight. In that case, they wish to alter their body composition regardless of their weight.” Additionally, “By using a broader terminology, companies marketing those products are most likely trying to attract a broader range of customers. Overall, these terminologies are pretty similar and most customers would use and understand them as being interchangeable.” Lastly, Torres-Moon mentioned, “from regulatory and legal standpoints, companies using ‘body composition’ terminology are probably trying a more conservative approach to weight management claims.”
Vanessa Pavey, ND, education specialist; Dayna Dye, education content writer; and Glenn MacEachern, vice president, product development, Life Extension (Fort Lauderdale, FL), offered another perspective. “The body composition market may be described as ‘Sports Nutrition,’ taking into account supporting lean muscle mass … People are looking to get fit after the 2020 lockdowns and gym closures, and supplementation is playing a part in these weight management and fitness regimens.” Further, “Increased consumer recognition of the benefits of supplementation have broadened supplementation utilization outside of the fitness enthusiast. Hydration supplements and protein powders lead the growth of the sports nutrition category, but consumers are also looking to adopt new supplements that benefit total-body health.”
Causes of Weight Gain/Obesity
“[Weight gain] is a complex and multifactorial issue involving behavior, biological and societal factors,” said Torres-Moon. “A better understanding of the underlying causes of weight gain and how to influence body composition are an important part of scientific research.”
Drehobl and Raganathan added that “The most common causes [of weight gain] are poor diet and lack of exercise; however, there are many factors that affect body composition. Most notably, genetics, metabolism and environmental factors all contribute to body composition issues.”
Hoil concurred. “While there is no one major cause, there are factors which have caused our waistlines to increase in size,” she explained. “We, as Americans, eat out more, and exercise less. We have increased our sugar intake and super-sized our food portions, all leading to an increase in our weight above a healthy level.” However, she noted, “other issues, such as gender, race and hormones also play a part.”
Nicole Avena, PhD (Princeton, NJ), explained that weight maintenance issues, which are common in America, “come alongside inactivity, imbalanced diet, stress and many more attributions. The most common issues include low muscle mass and increasing fat tissue. This process of the body replacing lost muscle with fat stores is an innate survival response! We humans store energy for later use, and when muscles are not being used regularly, they waste and can lead to slower metabolism and more fat tissue.”
Weight management and body composition issues are clearly prevalent in the U.S., with many factors causing them that may differ from person to person. As a result, the market for this category is growing.
State of the Body Composition/Weight Management Market
As a result of the stark statistics for overweight and obesity in the U.S., “consumers are seeking out health aids to support their weight loss goals,” said Pavey, Dye and MacEachern. “This is evidenced by the weight management category supplement growth in 2021, which has experienced the best market growth in years. According to Nutrition Business Journal (NBJ), the weight management category grew 9.9 percent in 2021, adding $596 million to the category.”
Furthermore, “Supplements have been the fastest growing sector for weight management compared to food and beverage, at 31 percent in the U.S., according to Innova reports.” Nutritional supplementation, the trio added, “can help to add an additional supportive layer to a healthy diet and exercise program.” However, traditional medical intervention may be needed, especially if weight issues are causing additional health problems.
“COVID-19 has impacted every industry and weight management has not been immune,” said Hoil. “The need for isolation affected weight loss centers, practitioners’ offices and clinics had to shut their doors. Overall, it has driven the behavior of consumers to change.” She explained, “As isolation wore on, the demand to find new and unique tools increased. That has driven up the market of people looking for safe and effective ways to achieve their goals.”
Drehobl and Ranganthan noted that “The market is flooded right now with many different weight maintenance products utilizing a diverse variety of approaches to the problem of healthy body composition. However, there is also a diversity of need, as a product that works well for one patient may not work as well for another.” As a result, “while it may be difficult to break into this crowded market, products that serve an unmet need are frequently rewarded with good word-of-mouth, allowing them to survive and even thrive.”
As far as trends, Hoil stated that “Phone-based diet applications have helped to improve body composition goals. The addition of online support allows more support and interaction between people.” However, she noted, online diet applications have also hurt body composition goals. “Some social media apps have worsened the self-image some people have of their body image and goals.”
Pavey, Dye and MacEachern specified a couple of diets that have been trending. “A ketogenic diet continues to be popular and successful for weight loss; however, there are drawbacks of a diet containing a high amount of fat that is often saturated.1 These include an increased risk of metabolic syndrome and cardiovascular disease. A way to get the benefits of the keto diet is by consuming supplements containing the bioactive ketone beta-hydroxybutyrate. Additionally, mangiferin, found in mangos and other plants, supports increased plasma ketone levels.2”
Another popular diet trend is intermittent fasting, which has been endorsed by celebrities such as Elon Musk, Jennifer Aniston, Kourtney Kardashian and many others, according to the trio. “A 2020 systematic review of 27 trials of intermittent fasting found weight loss of 0.8 percent to 13.0 percent of weight measured at the beginning of the study and no serious adverse events. The researchers concluded that intermittent fasting shows promise for the treatment of obesity.”3
Dr. Avena noted that “the wellness industry in general is looking at building a ‘curvy’ body through body composition, rather than just losing weight. The body positive movement and health at every size industry strives to be inclusive to everyone, even if the scale is higher than the portrayed ‘normal’ standard of the U.S. health system. This is positive for all, especially those who fixate on what the scale says.” She
further elaborated that “Driving forces like social media and news outlets reinforcing that putting on muscle is healthy, rather than being thin, makes health goals seem much more attainable for those who want to alter their composition. There is less focus on being thin and more focus on being healthy, no matter what stage of life you are in … and that should always be trendy.” Natural Approaches to Weight Management
“Diet and exercise are always the preferred approach,” said Hoil. “Eating nutrient-rich food as a starting point is best. Cutting out as much sugar as you can, while increasing ‘good’ fats and proteins is the basis of a good, well-rounded diet. Then, incorporating some form of exercise, even in short bursts, will get [patients] on the right path.” When assistance is needed keeping on track, Hoil noted, dietary supplements can be used.
“The best natural approaches start with maintaining a healthy diet and exercise routine. Dietary supplements can help along the way to ensure that all vitamins and essential nutrients are included in the diet,” said Torres-Moon. For instance, “For some individuals who wish to follow specific diets as part of their weight maintenance programs, dietary supplements are often necessary to limit potential deficiencies (i.e., vitamins B12 and D, as well as bioavailable zinc for vegans) or to kick start or help maintain a specific dietary lifestyle (i.e., MCT oil for keto diet).” Furthermore, “other supplements such as dietary fibers, prebiotics and probiotics, while not necessarily directly impacting weight maintenance, are important, since modifying diet to attain healthy body weight will impact gut flora and may trigger temporary GI (gastrointestinal) disturbance.”*
Pavey, Dye and MacEachern added, “All weight management starts with burning more calories than are consumed. To create a calorie deficit, it is important for the consumer to talk with their practitioner about an appropriate diet and exercise program.” Furthermore, “Traditional and integrative approaches to weight management both start with reducing calorie intake and increasing appropriate physical activity.” However, in cases of a high BMI (body mass index) or health problems related to obesity, pharmaceutical intervention may be needed, particularly if goals are not being met through diet and lifestyle changes.
Dr. Avena suggested that focusing less on cardio and more on weightlifting or resistance training while simultaneously increasing dietary protein can aid in altering overall body composition.
Natural Products for Weight Management/Body Composition
Nutritional Therapeutics offers Healthy Curb to practitioners, according to Hoil. The product contains two ingredients, “NTFactor and white kidney bean extract. White kidney bean extract is an FDA (U.S. Food and Drug Administration) approved amylase inhibitor. We use the branded ingredient Phase 2 in our product. We do not call it by that name as they require doses of 1,000 mg per dose and we use 500 mg.” She explained, “the white kidney bean extract limits the amount of complex carbohydrates that the body breaks down into simple ones. By doing so, one prevents the absorption of the carbohydrate, and if a complex carbohydrate makes it intact into the large intestine, the body considers it to be a fiber.”
The NTFactor base material for the supplement makes the product “a unique food and food extract design,” according to Hoil. “By working to restore damage caused to the cell and mitochondrial membranes, NTFactor helps balance out the production of the hunger hormone, leptin.” The product is made using NSF and cGMP (current good manufacturing practice) standards and the ingredients have more than 20 years of research behind them, Hoil added.
Protocol for Life Balance currently has five products for body composition: one targeting healthy hormonal function, one targeting healthy fat distribution and three pure MCT (medium-chain triglyceride) oil products, according to Torres-Moon. “MCTs are fats that are metabolized differently than long-chain triglycerides.* MCTs require little or no enzymatic breakdown and are easily absorbed by the GI tract and delivered straight to the liver where they can be used directly for energy production (instead of being stored as fat).”* In essence, she elaborated, “they act similar to carbohydrates, but without the requirement of insulin and with no effect on blood sugar.”* Torres-Moon added that they have no effect on glucose metabolism* and studies have demonstrated that MCT oil consumption along with a healthy diet can help to maintain healthy body weight, while sparing lean tissue.*
“Relora, a proprietary herbal combination that has been clinically demonstrated to support healthy cortisol levels, temporarily relieves perceived daily stress, and helps manage nervous appetite,”* said Torres-Moon. The company offers Adrenal Cortisol Support with Relora, which “has been formulated to support healthy adrenal response and appetite management.* Everyday life stress can impact adrenal production of cortisol and trigger stress-related eating. Adrenal Cortisol Support is a botanical and nutritional formulation that naturally supports a normal adrenal response and helps to promote healthy blood sugar management.”*
NOW’s 7-Keto-DHEA is a “natural metabolite of dehydroepiandrosterone (DHEA) that peaks in early adulthood and declines with age.* 7-KETO has been clinically shown to support healthy fat distribution and assist in the maintenance of a healthy weight when used alongside a healthy diet and exercise regimen.”* Likewise, the company’s 7-KETO LeanGels have been formulated to support weight management.* They combine 7-KETO with green tea extract, acetyl-L-carnitine and rhodiola extract to support cellular fat transport.*
“As required by law,” Torres-Moon added, “our products are manufactured following FDA GMP guidelines. Furthermore, both our manufacturing facilities and laboratories are third-party certified. Our MCT oil products are Non-GMO (genetically modified organism) Project verified and sustainably sourced.”
The newest ingredients added to Life Extension’s weight maintenance category include a lemon verbena and hibiscus flower extracts combination, Moro blood orange extract and a Sphaeranthus indicus flower and Garcinia mangostana fruit rind combination, according to Pavey, Dye and MacEachern.
“The combination of 500 mg of lemon verbena and hibiscus flower extracts has been clinically studied to encourage satiety by modulating hunger and satiety signals,4” they stated. “Moro blood oranges are cultivated in the Sicilian region of Italy and are a variety of red oranges, the most pigmented of the blood oranges. Clinically studied Moro orange extract at 400 mg per day for six months found a significant reduction in body weight and visceral fat, while preserving muscle mass when compared to the placebo group.5” Lastly, they explained, “the combination of Sphaeranthus indicus flower and Garcinia mangostana fruit rind at the clinically studied dose of 400 mg twice per day helps support a reduction in waist circumference.”6 All three studies combined the ingredients with a healthy diet and exercise to achieve realistic results.
Some of Life Extension’s best-in-class and popular supplement formulations include Body Trim and Appetite Control; Waistline Control; Gummy Science Mediterranean Weight Management; and Wellness Code Muscle Strength and Restore Formula.
Body Trim and Appetite Control is made up of the “combination of lemon verbena and hibiscus flower extracts, [which] were shown in a clinical study to modulate the appetite hormones, ghrelin and glucagon-like peptide-1 and was given in a pill form.”7 Gummy Science Mediterranean Weight Management contains “400 mg of Moro blood orange extract in the two-gummy serving size,” the clinically studied dose that provides benefits.8 “While many gummies on the market contain added sugar and low potency nutrients, the Gummy Science line was specifically created to contain no added sugar and to provide the same potencies of the active ingredients that provided benefits in the research studies,” said Pavey, Dye and MacEachern.
For Waistline Control, “In cell cultures, the Sphaeranthus indicus and Garcinia mangostana combination inhibited the expression of proteins that trigger adipogenesis (fat cell growth) and helped to encourage multiple pathways that promote fat breakdown.”9 Lastly, Life Extension’s Wellness Code Muscle Strength & Restore Formula “helps preserve healthy muscle function at any age,” according to Pavey, Dye and MacEachern. “HMB (beta-hydroxy-beta-methylbutyrate) is the bioactive metabolite of leucine that helps promote muscle growth when combined with resistance training.10 Vitamin D has also been shown to help promote healthy muscle function and metabolism.11 Together, 3 grams of HMB plus 1,000 IU of vitamin D3 can help preserve muscle health.” The unflavored powder easily mixes with any beverage, including cold water, a drink mix or protein shake mix, they added.
Life Extension uses “advanced analytical chemistry (high-performance liquid chromatography and gas chromatography, microscopy, etc.) to ensure our raw materials are exactly what we say they are. Then we test the finished products to ensure that what’s on the label is what’s in the product,” Pavey, Dye and MacEachern explained. The company also offers a Certificate of Analysis to verify testing upon request, and it has GMP registration from NSF International.
Kibow Biotech focuses on fiber, according to Drehobl and Ranganathan. Although the company’s multifiber supplement, called Kibow Fortis, was not intended specifically as a body composition supplement, “as its multifiber blend has multiple different applications, including immune and digestive health, body composition and satiety are only two of its benefits. We created this product because we wanted to promote microbiome/gut health for a population that is critically fiber deficient, and … maintaining a healthy microbiome can help a lot with weight management/body composition.”
Kibow Fortis contains “4-8 g of fiber. While this is a far cry from the 25-35 g the body needs each day, Fortis is a functional fiber, meaning its components have specific applications within the microbiome,” explained Drehobl and Ranganathan. Kibow Fortis contains “seven functional fibers, which each fill different niches within the microbiome. Inulin is especially effective regarding body composition,” because it is “undigestible by the human body, but the microbes in your gut break it down into short-chain fatty acids, which have many benefits within your body,” they explained. “Short-chain fatty acids provide nutrition to your colonic cells and can help reduce the risk of obesity, heart disease, type 2 diabetes and inflammatory diseases, among others.”
Other functional fibers in Kibow Fortis include “Two different types of beta-glucans … Oat beta-glucan is well-known for reducing cholesterol. Mushroom/yeast beta-glucan can help to boost the immune system and reduce inflammation. Like inulin, beta-glucans are also able to be metabolized into short-chain fatty acids.” Another is xylo-oligosaccharide (XOS), which is “a soluble fiber found in many plants known to increase the population of microbes of genus Bifidobacterium within the gut, which promotes a healthy balance of gut microbes. Arabinogalactan is another soluble fiber common in plants like carrots, wheat, radishes and peas. In addition to promoting beneficial microbes, it can also boost immune health. Finally, whole yeast fermentate has been shown to have immune-boosting and inflammation-reducing properties,” said Drehobl and Ranganathan. “These seven functional fibers work together to confer a variety of health benefits, including satiety and weight management.”
Kibow Biotech utilizes cGMP manufacturing procedures in all of their products on the market, and “in addition to the many independent studies investigating the efficacy of the component fibers of Kibow Fortis, we conducted a SHIME study (Simulation of Human Intestinal Microbial Ecosystem) to investigate the product’s efficacy as a prebiotic and what effect it could have on the human microbiome.”
Advice/Assistance for Practitioners
“We have technical staff available to answer any questions practitioners may have, as well as access to researchers,” said Hoil. “Our belief is that the more we can educate the practitioners directly, the better they can understand how it can help their patients and feel confident that it will be safe and effective.”
“Healthy body composition/weight maintenance require a very personalized approach, and practitioners should really tailor their recommendations to the specific needs and circumstances of their patients,” explained Torres-Moon. “Supplement recommendations will vary greatly depending on which type of weight management program to which the patient adheres. For example, practitioners cannot recommend the same supplementation protocol to an individual following a low-fat plant-based lifestyle as to one following a keto lifestyle. That is why it is very important for practitioners to be knowledgeable about the many weight management solutions that currently exist, how they affect metabolic functions, and how dietary supplements can enhance and complement these programs,”* she said.
Furthermore, Torres-Moon continued, “Practitioners can better serve their patients by staying on top of current knowledge regarding weight management/body composition as it is a field that is constantly changing, and where the general public is bombarded with a lot of information that is not always of the best quality. In addition, there are a lot of unproven products on the market. It is important for practitioners to only promote methods and products that are safe, well-established and thoroughly clinically evaluated.” She concluded, “Having honest discussions about patients’ expectations, their lifestyle and what supplements can and cannot achieve is extremely important when it comes to weight management, as the practitioner’s credibility is at stake.”
Life Extension provides trifolds, sales flyers, staff training and webinars to assist practitioners, according to Pavey, Dye and MacEachern. “To help support their patients’ weight management efforts, practitioners can offer high-quality, science-based formulas verified with a certificate of analysis,” they advised. Concurring with Torres-Moon, they added that “Maintaining a healthy weight and body composition is complex, and practitioners can help their clients by tailoring to their individual needs. In addition to developing a healthy diet and exercise program, adding specific, research-backed ingredients that can help balance appetite, promote abdominal fat loss, support muscle-building and/or enhance resting metabolic rates may help their patients reach their goals more efficiently.” They added that practitioners can also suggest small but effective lifestyle changes, such as drinking eight glasses of water a day, avoiding empty calories by incorporating more fruits and vegetables, stress reduction techniques and getting seven to eight hours of sleep every night.
“Our health care system continues to have a bias toward weight and overall health,” said Dr. Avena. “Practitioners can become more inclusive by asking questions regarding lifestyle and diet during regular visits. When it comes to body composition in particular, it can be hard to gauge willingness to change from patients, and that’s okay! It’s more about finding ways to work with patients to reach their own personal goals by establishing their current lifestyle and how new habits will fit into their schedule. No one is going to change their entire daily routine to achieve their goal weight or composition, so making small, manageable steps that your patient can achieve is encouraging.” Lastly, Dr. Avena added a reminder that “the scale is not the end all; health is multi-faceted and looks different for everyone. Give yourself grace, and you can achieve your goals if you start small!”
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
1 Gardner CD, et al. JAMA. 2007; 297(9): 969-77.
2 Na L, et al. Sci Rep. 2015; 5:10344.
3 Welton S, et al. Can Fam Physician. 2020; 66(2):117-125.
4 Lee YS, et al. Nutrients. 2018 Sep 1;10(9):1204.
5 Briskey D, et al. Nutrients. 2022; 14(3):427.
6 Stern JS, et al. Obesity (Sliver Spring). 2013; 21(5):921-927.
7 Biox-Castejón M, et al. Food Funct. 2018; 9(6):3173-3184.
8 Briskey D, et al. Nutrients. 2022;14(3):427.
9 Stern JS, et al. Obesity (Sliver Spring). 2013; 21(5):921-927.
10 Panton LB, et al. Nutrition. 2000;16(9):734-9.
11 Girgis CM, et al. Endocr Rev. 2013;34(1):33-83.
Healthy Take Aways
• According to the Centers for Disease Control and Prevention (CDC), nearly half of the U.S. population is trying to lose weight.
• According to the National Center for Health Statistics, over two-thirds (71.6 [percent]) of Americans are overweight or obese, and more than one-third (36.5 [percent]) of Americans experience obesity.
• Supplements have been the fastest growing sector for weight management compared to food and beverage, at 31 percent in the U.S., according to Innova reports.