Frequently Asked Questions

01 Do you accept insurance?

In Vermont, we are in-network with Medicaid, Blue Cross Blue Shield of Vermont, MVP, and Cigna.

We do not accept insurance at our other locations.

02 Are Metabolic Testing and Body Composition painful tests?

No! Both metabolic testing and body composition analysis are non-invasive tests, so you don’t have to worry about being poked by any needles at our office. During the metabolic testing procedure, the patient sits in a reclining chair under a lightweight canopy hood and basically relaxes for about 20 minutes. For the body composition analysis, the patient must lie down and have electrodes attached to the wrist and foot to pass a small and painless electrical current through the body.

03 How long will it take for my metabolism to improve if I am malnourished?

Your metabolism begins to improve as soon as you start to adjust your caloric intake. The length of time depends on how severely hypometabolic you are, how much repair the body requires, and if you are able to follow the treatment recommendations. With total compliance, we have seen metabolic rates corrected in six to eight weeks.

04 But Doesn't exercise improve my metabolism?

Exercise may actually slow your metabolism if your body is not getting enough nourishment. The reason this result occurs is because your body is trying to conserve energy stores in the body. Exercising when the body is trying to repair itself uses vital energy.

If I eat more calories than my body is burning, won't I gain a lot of fat weight?

When the body is repairing, it is using the extra calories to restore cellular integrity. The body will gradually weight restore both lean and fat weight. There may be an initial weight gain, but as the metabolic rate improves, it stabilizes.

05 What is the difference between Body Composition Analysis (BCA) and Body Mass Index (BMI)?

BMI is based on height and weight but does not take into account the body composition. BCA measures body fat, lean dry mass (muscle), total body water, intracellular water, and phase angle (the measurement based on the total body resistance and reactance). During annual physicals, the focus is typically on a healthy BMI, but this number is too narrow and often misleading.

06 How can I be malnourished if my body weight is normal?

This is also an issue of how BMI is a poor indication of total health. Attaining a normal weight is not an indication that your body is burning a normal amount of calories and not breaking down its own protein stores. It is possible to eat enough to gain weight but not improve your metabolic rate. Our tests can properly assess your body's total health and whether or not you are nourishing your body properly.

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08 What are the goals by which you measure success?

Our goal is for you to reach your optimal health. Because we can measure your health from the inside with metabolic testing and body composition analysis, we want your numbers (i.e. metabolism, muscle mass, fat-free mass, fat mass, intra cellular water, and phase angle) to be within normal ranges. Another goal is for you not to obsess about food, body, and weight and to focus instead on your energy, activity levels, and future goals.

09 How long does treatment take?

There is no one-size-fits-all when it comes to treatment. If you follow our plan and your metabolism isn’t too far off the normal range, it takes six to eight weeks for your metabolism to recover. However, individuals with more serious problems often take longer to heal. We recommend that you come in once a week. This schedule allows us to learn how your body is responding to the food plan and suitably adjust course as you are making progress.

10 What does a typical eating plan from the Kahm clinic look like?

There is no typical eating plan. Each one depends on what the machines tell us about your body, and each body is different. Every time you come in for an appointment, we adjust your diet depending on what has happened to your body in the previous week.

We don’t recommend particular foods or recipes. We will, however, tell you how many calories per day your body needs. We will translate that into food groups, allowing you to enjoy an endless variety of combinations. We will also guide you in balancing your customized food plan throughout the day.

11 Don’t other nutritionists have these machines too?

Yes, some nutritionists have the capabilities to complete metabolic testing and body composition analysis. Usually, though, their metabolic machines give far less information than ours. Our metabolic machine is typically used in large hospitals by cardiologists to see whether patients have cardiac or pulmonary problems. Unlike others, ours show if your body is breaking down muscle and organ tissues (protein substrate utilization) and can see whether you are hypometabolic or not. It also reveals how you are metabolizing carbohydrates and fat, which is crucial information for diagnosing an eating disorder.

Beyond its incredible usefulness for treating eating disorders and disordered eating, the carbohydrate substrate utilization, for instance, can guide us to screen pre-diabetes at an early stage (one of the risk factors of metabolic syndrome). Using metabolic testing and body composition analysis in tandem and making sense of the data is very difficult and requires extensive training. As of now, there are only four other places in the country that know how to use these machines as we do.

For most nutritionists, using the metabolic test or the body composition analysis is an optional add-on to their treatment. For us, it is unequivocally crucial to what we do, and we cannot imagine working without them. To read more about the tests, go here.

12 Are the numbers triggering for some people, especially for those with eating disorders?

We are very careful not to share exact numbers with our clients. The information provided from our machines are a clinical tool to give our dietitians better knowledge of the degree of malnutrition. This information, in turn, allows them to create an individualized plan for recovery. Just as we hide the numbers on the scale from patients, we also hide the numbers from these machines. When we discuss the body composition analysis results, we only share general trends (i.e. gained significant muscle mass). We have found that, for many clients, talking about the body composition analysis trends is less triggering than just discussing weight alone.

We do, however, share numbers with patients about their metabolic rates, which we check every few months. This information provides us and the patient with a starting point for their meal plans. It helps the patient better understand possible damage that has been caused by the eating disorder or disordered eating patterns.

13 I am concerned about fasting prior to my first visit. Is this mandatory for all clients?

Yes, fasting is required for a minimum of four to five hours prior to sitting for the metabolic test. Our machine is determining an individual's resting metabolic rate (RMR), and fasting is needed to get an accurate result. We understand that asking an individual to fast can be challenging, especially for those who have been struggling with restrictive eating. If this is the case, we encourage you to fast for the minimum amount of time (four hours) and bring food with you to eat right after we complete the metabolic test. We spend the last portion of our visit discussing results and a meal plan, allowing for plenty of time to eat while we talk. Early appointments are preferable because you wake up fasted, get tested at the appointment, and then have a slightly later breakfast immediately afterwards.

As a reminder, we will only require you to fast for the initial visit. You will not have to fast for any follow-up visits.