Obesity Medicine, Weight Management, Medical Weight Loss
Kelly Washburn is a Nurse Practitioner that specializes in Obesity Medicine and Weight Management through alternative interventions.
First of all, to maintain a healthy weight is more than cosmetic. Also having too much body fat leads to health conditions. Most noteworthy, heart disease, diabetes and high blood pressure, as reported by the Mayo Clinic. Therefore, even modest weight loss and regular exercise can provide healthier results.
What To Do And How to Access Obesity Medicine?
- While weighing often, have yearly exams with your doctor and ask about obesity medicine.
- Also adults with higher fat in their blood have other known risk factors. So for cardiovascular and diet-related chronic disease we give ongoing diet and nutrition counseling. Also, Obesity Medicine combats these risks.
- So at MHW, we offer a Medically Supervised Weight Loss program and Obesity Medicine. Learn more here.
Concerned about obesity? Schedule time to discuss the prevention and treatment of obesity with any MHW provider today.
First of all, Obesity Medicine is the field of medicine dedicated to the comprehensive care of patients with obesity. Also, Obesity medicine clinicians use a science based approach. As a result, it is comprised of nutrition, activity, behavior therapy, and meds to help patients achieve better health.
Weight Management & Obesity Medicine
Same as obesity, obesity medicine, weight problems, overeating, emotional eating, nutrition.
Most of all, find a new approach to weight management. In addition, it includes personal nutrition counseling, medically prescribed diets and an focused weight management program.
Also, choose our personal trainer who can help with a variety of movements. Including, high to low impact movement, step, resistance training, and circuit training. Also, aerobic, ball exercise and gentle paced exercises that are individually tailored.
Portland Weight Loss Clinic & Obesity Medicine
Welcome to Merritt Health and Wellness. MHW is an independent wellness clinic. MHW specializes in medical weight management, obesity medicine, disease reversal, functional medicine and primary care. We are located in Portland, Oregon and we opened our doors in 2012. Finally, we have two locations, one in Northeast Portland and the other in Southeast Portland.
MHW is owned by Seth Merritt, who is a licensed and certified Family Nurse Practitioner. Also certified with a few sub specialties including obesity medicine.
All the medical providers at MHW have the chance to study the advanced treatment of obesity medicine. As a result this includes weight management, diabetes and functional medicine.
Merritt Health and Wellness & Obesity Medicine
Merritt Health and Wellness offers a safe, effective and affordable weight loss program. First of all, designed to help you lose weight and keep it off permanently. What makes MHW different from other weight loss programs is our focus. In conclusion, on health and on the individual needs of our patients. Our weight loss program is grounded in a science based, holistic approach to health and wellness. Because we do not believe in the “quick fix” or “one size fits all” approach to weight loss. Therefore, you will not find fake meals, liquid diets, supplement sales or starvation menus at MHW. Instead, you will find a welcoming home vibe. Most of all, a weight loss program that is tailored to your needs, and a sound, science based program for your health and well being.
Lose Weight With Obesity Medicine
If you are reading this, then you want to feel and look better by losing weight. You are not alone. Weight management is a common struggle
Merritt Health and Wellness recognizes your individual needs.
You have a unique situation with unique conditions. Also you may have a medical issue; you may want to lose a lot or just a little. People struggling with obesity share something in common with the many people we’ve helped.
But you aren’t them. And we won’t treat you like you are.
Our programs are flexible and designed to be adapted to the needs of each INDIVIDUAL that passes through our doors. All of our services are one-on-one. We help one person, with unique needs and goals, at a time, in a medically supervised environment.
Personalized Nutrition Plan.
We address your needs on an individual, case-by-case basis.
We recognize that long-term weight loss requires a multi-faceted approach that includes attention to individual medical issues and conditions. Our programs help you reduce weight through a combination of nutrition counseling, medication therapy, behavior modification, fun motivational tools, education and exercise.
Our caring and professional providers are available to offer support and guidance throughout your weight loss process.
Throughout your progress, you will meet one-on-one with a medical specialist who will guide you to success. We understand what you are going through and what you need from both personal experience and medical knowledge.
Your individualized program can include a technologically sophisticated weigh-in and full body composition analysis, which accurately calculates metabolic activity, body fat and other vital measurements. This information can often help to form the basis of your customized weight loss plan and daily caloric and nutritional intake requirements.
Weight Loss Covered by Medical Insurance
As with all of our primary care and health services we bill insurance for our care. As long as we are in network with your insurance then it is covered under your plan details.
MHW only charges for office visits you actually receive…there are no other fees or hidden costs and absolutely no contracts.
Prescription Appetite Suppressants are NOT the only thing our providers offer but in some cases these tools can help.
For those who are seriously struggling with weight loss, we also offer clinical strength appetite suppressants and dietary supplements by prescription.
These and other weight loss tools can be instrumental for those who struggle with losing weight.
MEDICAL WEIGHT LOSS
At MHW we offer a comprehensive medically-supervised weight loss program for patients looking to lose a significant amount of body weight. Unlike programs that focus primarily on hypnosis or meetings with non-medical personnel, our weight loss program is designed and administered by an in-house providers and a personal trainer who focus on long-term results through a variety of tailored dietary programs:
INTERMITTENT FASTING (IF)
The IF Program includes:
- 5 or more nutritionally balanced meal replacements a day
- Weekly medical supervision during the first month and once a month thereafter
- Weekly medical check-in
- Monthly lab work
- Monthly body composition analysis
HEALTHY SOLUTIONS (HS)
The HS program includes:
- 2 or more nutritionally balanced meal replacements, 2 entrees, 5 servings of fruits and vegetables a day
- Weekly or Bi-monthly medical supervision during the first month and once a month thereafter
- Quarterly lab work
- Monthly body composition analysis
LOW CARB HIGH PROTEIN
AUTOIMMUNE PROTOCOL (AIP) DIET
Regardless of the program selected, all patient-participants are put through rigorous laboratory testing to assess heart, liver, and kidney function as well as cholesterol and blood sugar levels. We evaluate thyroid and other hormones, percent of body fat, lean muscle mass, hydration, and metabolic rate. Again, the focus here is on providing a medically-supervised program that will provide long-term results through a combination of education and behavioral changes that encourage personal responsibility and healthier lifestyle choices.
Have you tried to lose weight without success? Have you lost weight with an expensive diet only to regain weight over the next year? Most patients who come to us for weight loss have spent money, time and effort on multiple diets.
They have spent money, time and effort on multiple diets. Perhaps they have tried Weight Watchers or Medifast, only to find that the weight loss doesn’t last. As weight is gained or regained, often they feel tired, bloated, and guilty that it didn’t work and their medical issues are getting worse again.
If your weight gain or regain has caused worsening joint pain, diabetes, blood pressure or cholesterol, we get it. Wondering how to lose weight when your knee pain prevents you from exercise, we get it. If you don’t know what to do about night-time snacking, we get it. Contact us.
We Can Help
As medical providers, we understand how your diet will affect your medical issues, mood, and relationships. We know how to adjust your medications to feel your best as you lose weight. Most importantly, we understand that your history with weight and your needs for a weight loss program are different.
Success in Losing Weight is as Individual as You Are
At MHW, we believe in promoting individual health. We actively assist in weight loss and maintaining a healthy weight through the four pillars of healthy weight:
Our Personal Trainer services may be eligible for insurance reimbursement. Schedule an appointment with Thad Merritt by emailing Thad@merritthw.com.
In other words, you get a program managed by your medical provider with your unique medical needs in mind. An expert in obesity medicine and weight loss who can prescribe supportive medications while understanding exactly how it impacts your unique health situation.
It’s medically supervised. Weight loss designed for you, with you, and by your doctor.
- Initial exam and body fat
- A 12-week custom program specific for your unique health needs
- MHW medical providers may recommend meal replacement products and supplements depending on your unique need.
- You must be a patient of MHW. If you are not, we are currently accepting patients. We also accept most insurances. Come in and get to know us to learn more.
- As an MHW patient, simply ask your provider about the program. All visits will be billed to insurance. Contact us to learn more.
Weight Loss Program
CLINICAL WEIGHT LOSS APPROACHES
If you focus on attaining vibrant, whole-body health, then excess pounds just melt away with no particular effort. But if your body is burdened with imbalances (hormonal or digestive or neurotransmitter), or if your stress load, toxic burden or overall inflammation is too high, then your body may protect itself by holding onto excess fat. Certainly the SAD (Standard American Diet) has gone astray… Read More >>
DISRUPTIVE INFLUENCES ON WEIGHT MANAGEMENT
Many hormones must be properly balanced in order for the body to maintain its own ideal weight. Here are a few imbalances that MHW commonly restores in clinic, in the course of weight loss treatment… Read More >>
Clinical Weight Loss Approaches
If you focus on attaining vibrant, whole-body health, then excess pounds just melt away with no particular effort. But if your body is burdened with imbalances (hormonal or digestive or neurotransmitter), or if your stress load, toxic burden or overall inflammation are too high, then the body may protect itself by holding onto excess fat. Certainly the SAD (Standard American Diet) has gone astray.
All too often people are doing their best to “eat healthy,” following the official Food Pyramid or the low-fat, high-carb policy of the past few decades, and yet their weight is creeping upward. Lacking true nourishment, their bodies go into famine mode, efficiently holding onto every single calorie, growing fatter year by year. How frustrating it is to not understand why the body does this, how crazy-making it is to be often overwhelmed by cravings for sweets or salties or caffeine or bakery items. With good cheer and step-by-step coaching, MHW guides people out of the swamp of “over-fed but under-nourished” every day.
Questions to Ask
If you are shopping for a weight-loss plan, here are some considerations: Medical weight loss must be truly nourishing, with no synthetic food-like substances. Medical weight loss must be flexible, adapting to each individual’s needs. It must treat and prevent diabetes, treat and prevent Metabolic Syndrome (high blood pressure, high cholesterol, spare tire around the middle), and it must treat and prevent allergies and inflammation (this cannot be done using artificial colors, artificial flavors, or synthetic preservatives, because they are toxic to the body).
Most importantly of all, medical weight loss must teach people how to eat real food (not synthetic food-like substances) while honoring our genetic, evolutionary heritage (how did our hunter-gatherer ancestors eat?) Medical weight loss must reduce the killer load of stress that many people carry. And of course, clinical weight loss plans must offer dramatic weight loss while preserving muscle mass and melting fat — does your clinician measure your body fat percentage at every visit to ensure this? MHW certainly does, and finds that people are often encouraged to see fat melting away even during a plateau phase when the scale is not moving.
Long-term success with weight management requires self-awareness, excellent nutrition, good metabolism, and refusal to revert to the unhealthy ways that led to overweight in the first place. For many people, this means a thoughtful re-examination of beliefs, habits, misinformation (there is a lot of that!), and hunger for things other than food — such as love, acceptance, conflict resolution, hormonal imbalances, intestinal dysbiosis, even brain chemistry imbalances. As an exceptionally compassionate, well-informed listener and coach, MHW providers love to assist in navigating these often confusing pathways.
Hormone Injections and Creams
There is an extremely popular pregnancy hormone being utilized for weight-loss purposes these days. The Federal Trade Commission has made it illegal to advertise this hormone’s use for weight-loss. So please contact your provider the clinic if you have any questions about HCG weight loss. We have other options that we recommend over the HCG diet. The HCG can create many unwanted side effects.
DISRUPTIVE INFLUENCES ON WEIGHT MANAGEMENT
Many chemical messengers* must be properly balanced in order for the body to maintain its own ideal weight. (*Chemical messengers include hormones, neurotransmitters, and cytokines.) Here are a few imbalances that MHW providers commonly restores in clinic, in the course of weight loss treatment.
Excess insulin instructs the body to lay down adipose (fat) tissue — and then insulin also prevents this lumpy stored fat from being burned for metabolic fuel (how unfair is that?) The SAD (Standard American Diet) is much too high in dietary sugars and starches, causing habitually high releases of insulin from the pancreas, which re-shapes bodies into the current alarming state of affairs: about two-thirds of Americans are currently overweight or obese. Excess insulin is well-known to reduce life span in all animals, and it induces insulin resistance or hypoglycemia or metabolic syndrome or pre-diabetes, if permitted to continue running its course uninterrupted. MHW providers are on a personal, life-long, heartfelt mission to prevent and cure this tragic series, because she has witnessed its health-robbing pain in our own immediate family.
Excess cortisol generates a spare tire around the midsection and in prolonged cases it creates a fatty pad at the back of the neck as well. The popular press has made this connection well-known in recent years, thank goodness; however, many people still struggle with elevated stress levels, multiple daily stress reactions, and the ensuing cortisol body type that in extreme cases can resemble the Alice in Wonderland characters Tweedledee and Tweedledum with large bellies and skinny limbs. All this can be caused by ordinary, garden-variety stress, which is why stress management, blood sugar control, and adrenal restoration are essential to health, well-being, and weight management.
Poor leptin-ghrelin balance leads to lack of satiety, that is, never receiving the bodily cue that it’s time to stop eating. The brain gets de-regulated and cannot sense fullness if it has been over-exposed to fructose, which comprises 50% of table sugar, 50% of maple syrup or honey, 55% of HFCS (high-fructose corn syrup), up to 90% of agave syrup, and a very large fraction of both soft drinks and fruit juices. You read that right: fruit juices, which most people view as healthy, actually contain so much naturally-occurring fructose that they are classified as both appetite de-regulators and inducers of fatty liver disease which can include high blood pressure. (Thank you, Dr. Robert Lustig, for making this so clear in your popular YouTube lecture.)
Testosterone has roughly opposite effects in males and females (no surprise there!) — including the prevention or induction of abdominal obesity. In men, adequate testosterone is essential to maintain lean body mass, mental drive, ambition, libido, and healthy blood cholesterol levels. However, in women, excess testosterone is associated with abdominal obesity, hirsutism (unwanted facial hair), irregular periods, and insulin resistance or pre-diabetes.
Adipose (fat) tissue is extremely hormonally active. Anyone who is 10 or more pounds medically overweight should view their fat deposits as another endocrine organ, a hormone-producing machine that tries to self-perpetuate. Adipose tissue continuously sends out cytokines (cellular messenger molecules) that cause inflammation throughout the body and brain. Inflammation refers to arthritis, brain fog, allergies, cancer, hardening of the arteries, and many other discomforts. In males, the enzyme aromatase can become overly abundant in adipose tissue; aromatase then turns good masculine testosterone into feminizing estradiol (a type of estrogen) which robs men of vigor, lean body mass, and well-being; in severe cases, actual breast tissue (gynecomastia) can induce by the enzymatic activity from adipose tissue. How’s that for an unfair reaction to carrying extra pounds?
Neurotransmitters are another form of messenger molecules, sometimes overlapping with hormones; together with cytokines, these three types of messengers carry information and instructions from one body tissue to another. Imbalances can range from imperceptible to lethal and everything in between. Imbalanced brain chemistry is epidemic these days; psychotropic (brain-altering) prescriptions represent billions of dollars in commerce — and millions of people with sub-optimal health. Depression and anxiety plague us all to some degree or another, in some cases completely ruining quality of life. And the abilities to regulate appetite, weight, and body composition all profoundly affected. MHW prefers to utilize nutrition with real foods, plus nutritional supplements when needed, and stress-management techniques, before resorting to extreme measures such as brain-busting prescription medications. The prescription painkillers in the opiate family (codeine, oxycodone, hydrocodone) all have profound, unwanted effects upon digestion, elimination, and even suppression of most hormones.
Many, many people are self-medicating their imbalanced and impulsive moods by over-eating or otherwise harming their health. Seeking wise counsel and good-humored coaching can be a life-saving turning point. Please do not allow prescription medications or an eating disorder to ruin your appetite control, your weight, your metabolism, your libido, or your ability to be fully yourself. Seek help sooner rather than later.
Our social environment with respect to food often aims us in the wrong direction. We are so flooded with advertising and factory-farmed commercial products that we’ve lost sight of Mother Nature. As a nation, we are both over-fed and under-nourished. Eating real food, in healthy portions, which is something we ought to be able to take for granted, has become an arduous project — think of it as swimming upstream, instead of comfortably floating down the river. Although simple, it’s not easy!
Our digestive tract is an ecosystem with an ever-changing balance of friendly bacteria and other micro-organisms who do much of our digesting for us. When unfriendly bacteria, or even fungi (yeast, candida) grow out of balance, there are profound effects on biochemistry throughout the body. The immune system and the brain may be especially hard-hit, with inexplicably strong urges to consume starchy or sweet foods, or with indigestion and frequent illnesses that just don’t make sense. Correcting the balance of the intestinal ecosystem can clear up bloating, cravings, and many other problems.
WEIGHT LOSS AND DETOXIFICATION SPECIALISTS
A common reason people come to the clinic is they want assistance in losing weight and detoxifying their body. Our providers work with clients to develop a program that is safe, effective, and comprehensive to help reach and maintain ideal body weight. Despite what advertising may tell you, there are no quick permanent fixes for weight loss. Rapid weight loss programs are almost always followed by weight gain.
HOW IT WORKS:
- You will receive a medical evaluation to assess for physiological obstacles that may have contributed to your weight gain and inability to lose weight.
- If deemed helpful, labs to assess your thyroid and adrenal functioning. Proper functioning of these glands is crucial for successful weight management.
- Potential obstacles to weight loss addressed such as insulin resistance, functional hypothyroidism and elevated cortisol levels.
- An individualized, health-promoting, low-allergenic whole foods diet prescribed for you that will help you to lose weight and detoxify.
- Targeted supplements often utilized to help in liver metabolism of fat, detoxification, and improved gastrointestinal function.
- A sensible exercise program tailored recommended for you.
- Bioimpedance evaluation via a scale available as applicable.
BENEFITS OF THIS PROGRAM:
- A weight loss program medically supervised and safe
- Through this program you will learn to transform your diet into one that is enjoyable, gives you energy, and fosters a lifetime of helping prevent chronic disease.
- Many health conditions often improved and even eliminated through dietary change and care.
- Food sensitivities often identified if present.
- Lipid levels improved, blood pressure often normalized, and blood sugar lowered if elevated.
- Evaluation and improvement of physiological obstacles preventing you from having weight loss success.
Bio Identical Hormone Replacement Therapy (HRT)
Well researched hormone replacement options.
Find relief from signs of aging and symptoms of hormonal imbalance.
In our clinical experience, we have seen exceptional results in restoring and maintaining hormone balance in our patients both safely and effectively with the use of bio-identical hormones.
Bio-identical hormone optimization has emerged as the preferred hormone therapy option for patients seeking relief from signs of aging and symptoms of hormonal imbalance including perimenopause, menopause, adrenal fatigue, andropause and thyroid disorders.
Merritt Health and Wellness Medical Home
Among several, integrated health resources available here at your Medical Home, Merritt Health and Wellness offers comprehensive health services. Including diabetes management and medical weight loss management.
Medically supervised weight loss aids your weight-loss results via a multi-faceted program. This program is individualized to each patient’s health profile and goals. We have available both individualized counseling and group behavior support. All from experienced medical providers. Passionate and specially trained in helping you reclaim your health and vitality through medical weight loss.
Comprehensive Approach to Weight Loss
Our comprehensive approach to lifestyle change not only enhances the impressive weight loss results we see. But ensures that patients remain at their healthful and empowering lower body weight over that long term. We are frequently able to reduce and then fully discontinue prescription medications. Including meds for diabetics or pre-diabetes, high blood pressure, high cholesterol, stomach issues, asthma, insomnia, anxiety, and depression. Also aches and pains such as low back, hip and knee pain chronic fatigue, fibromyalgia. Others include, sleep apnea, menstrual irregularities, infertility, and headaches improve with medical weight loss. Many patients not aware of the risk for multiple concerns can become dramatically decreased.
We are fully committed to true, primary preventative care at Merritt Health and Wellness. We feel that our empowering and supportive weight loss resource reflects the partnership we’re here to share. Check out our website for more details, watch short informational videos Also review multiple actual patient reviews and stories at Merritt Health and Wellness.
Weight loss program
Obesity has been shown to be associated with higher risk of breast and colon cancer, as well as many other diseases. Hence, Obesity medicine is a specific tool to help combat weight management issues.
Learn how to achieve a healthy weight for the long term and feel your best every day. Whether you need to lose a little or a lot, we can connect resources to help you achieve results.
If you feel like you need to lose weight, try our medically supervised program.
Finally, our providers have modified a weight loss plan that is safe, effective, and medically researched. This fulfills our commitment to higher health.
Weight Loss Program at Merritt Health and Wellness
Weight Loss program at Merritt Health and Wellness in Portland, Oregon – based on research and clinical experience. At our medical office, we see consistent, positive change in most of our patients. Change that keeps us deeply inspired and has the potential to change lives for the better!
The Obesity Medical Weight Management Program has been the main focus of our medical practice since 2012. The weight loss experienced by our patients comes from fat stores. Very little to none will come from lean body mass.
Now known to be an “endocrine organ”, fat secretes cytokines. Cytokines contribute to inflammation and disease in our body. Free your body from unhealthy fat stores. Let us teach you how to live and eat for your overall health and well-being! We love to help patients escalate their health, energy levels and over all well-being to new heights.
We have seen our DIET & WEIGHT LOSS PROTOCOL:
– Firstly, unlock the potential for dramatic weight loss that comes from fat stores and preserves lean muscle.
– As a result, give a jump start to boosting metabolism
– In conclusion, teach patients how to eat and cook “real” food to maintain weight loss and lower inflammation
– Most noteworthy, provide knowledge & guidance on the most ideal ways to live and eat. Also to maintain your new healthy weight.
– Offer patient support every step of the way. We care about our patients and patient success is our priority.
Most of all, our medically supervised Weight Management PROGRAM is successful for most patients. And we combine simple lifestyle & dietary changes.
Obesity Medicine Surgery Options
Weight Loss Surgeries From Other Providers As a Last Resort
First of all, the weight loss balloon is a form of weight loss treatment that does not require surgery. Most of all, Obesity medicine uses surgery as a last resort for treatment. A soft, durable balloon inserted through the mouth into the stomach in a simple, 30-minute procedure under sedation. Hence, this translates to no recovery time and no scarring, since there are no incisions. Therefore, balloon combined with a 12-month diet and exercise plan to ensure patients maintain their results. On average, patients with the balloon lose three times the weight they do with diet and exercise alone.
Yet, the weight loss balloon program utilizes a team approach after Obesity Medicine services have failed. Hence, your physician, dietician and exercise physiologist work together to guide you through the process of developing a customized diet & exercise program. Most of all, this supports you in making healthy lifestyle choices.
Weight Loss Balloon Info
First of all, the weight loss balloon program utilizes a team approach. So your physician, dietician and exercise physiologist work together to guide you through the process of developing a customized program. Therefore, it supports you in making healthy lifestyle choices.
- A soft, durable balloon inserted and filled through the mouth into the patient’s stomach. A 30-minute procedure under sedation.
- Mostly, patients go home a few hours after the procedure.
- The balloon takes up space in the stomach for six months, which helps patients eat smaller meals.
- After six months, one removes the balloon during a simple procedure.
- The balloon combined with a comprehensive, twelve-month diet and exercise plan.
No, the weight loss balloon does not currently receive coverage by insurance. Obesity Medicine services at MHW does receive covereage by most insurances.
First of all, a weight loss balloon is a non-surgical and short-term (temporary) weight loss device. A smooth, soft saline-filled balloon (size of an grapefruit) placed in your stomach. Allowing you to control your portion sizes filling space in your stomach. By following professional health and wellness advice, you can adopt good healthy eating habits and change your lifestyle. You can lose weight quickly and keep it off long term.
First of all, published clinical studies have shown that you will maintain weight loss through dieting post-removal. So, if you stick to your new, healthy lifestyle you will be on the way to maintaining weight loss.
First of all, weight loss balloons used in the management of obesity medicine for over 20 years. While over this time they have evolved in shape, size, and design. Therefore, this results in a modern, durable product, now well established as a safe weight loss procedure.
First of all, the weight loss balloon fills with saline to partially fill the stomach. As a result, patients may consume smaller portions of food. Mostly weight lost in the first three months. Because the balloon stays in for six months, you will learn the amount of food to eat to maintain.
First of all, it is likely the presence of the balloon in the stomach will cause nausea or vomiting after placement. In some patients, it may last one to two weeks. Therfore, your provider may prescribe medication to help minimize these potential effects. Also patients should contact their provider immediately if they experience any severe or unusual symptoms. Most of all, Obesity Medicine services have less side effects.
First of all, BMI – the most widely used measurement for obesity. So the BMI approximates body mass using a mathematical ratio of weight and height [(weight in kg ÷ height in meters) or (weight in pounds ÷ height in inches x 703)]. Seems like most agencies regard a BMI of >30 as the threshold for obesity and Obesity Medicine treatment. While a BMI of 40 or more generally qualifies as morbid obesity. However, note that BMI measurements in body-builders and athletes may not be accurate determinants of obesity. Because the BMI does not distinguish between muscle and fat.