Mary Schmucker, known from the popular reality show Return to Amish, has captured the attention of her fans due to her inspiring weight loss journey. While primarily known for her role in the TV show, her recent focus has shifted to her health and wellness. Her transformation has not only improved her physical health but has also inspired countless others to embark on their own weight loss journeys.
Mary Schmucker: From Amish Life to Health Advocate
Mary Schmucker was introduced to viewers as a strong-willed woman who lived by Amish traditions. She captured hearts with her down-to-earth personality, balancing her Amish heritage with modern-day challenges. Over the years, she gained fame for her honest and relatable personality, sharing her life as a member of the Amish community.
As she aged, Mary faced some health challenges, which may have motivated her to make lifestyle changes. Mary Schmucker has been open about her health challenges, which may have contributed to her weight loss journey.
Key Strategies in Mary's Weight Loss Plan
Mary’s weight loss journey wasn’t about quick fixes or fad diets; it was about making sustainable lifestyle changes. Mary Schmucker’s weight loss journey is a testament to the power of perseverance and making smart, sustainable lifestyle changes.
1. Balanced Diet
Diet plays a key role in any weight loss plan. Mary likely adopted a healthier, balanced diet, focusing on nutrient-rich foods. Cutting back on processed foods, sugary snacks, and empty calories could have been a big part of her success.
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2. Regular Physical Activity
Physical activity is another essential element of weight loss. Although Mary Schmucker’s life likely involved a lot of movement, adding structured exercise routines could have made a difference. Walking, light cardio, and strength training are great ways to boost metabolism and burn calories.
3. Portion Control
Portion control is a strategy that helps people lose weight without feeling deprived. By reducing portion sizes, Mary could enjoy the foods she loves while keeping her calorie intake in check.
4. Mental Discipline and Motivation
One of the most important aspects of any weight loss journey is mental discipline and motivation. Mary likely set clear goals and stayed focused on her reasons for losing weight.
Addressing Unintentional Weight Loss in Older Adults: A Comprehensive Approach
Unintentional weight loss is a common geriatric syndrome that requires a comprehensive evaluation and management plan. It's defined as >5% weight loss (unintentionally) in 6-12 months (in normal aging people might lose 0.2-0.4 lbs per year). This condition can be caused by a variety of factors, including underlying medical conditions, psychological issues, functional impairments, and social circumstances. To effectively address unintentional weight loss, healthcare professionals can use the Geriatric 5Ms framework: Multicomplexity, Mind, Mobility, Medications, and What Matters Most.
The Geriatric 5Ms Framework
The Geriatric 5Ms are a great way to approach any condition in older adults (Health in Aging Tip Sheet, Holliday et al 2022)! (Note: don’t get confused, some sources like the IHI/John A. Hartford Foundation call this the “4Ms” which doesn’t include multicomplexity).
Read also: Beef jerky: A high-protein option for shedding pounds?
Multicomplexity
Consider comorbidities and organic causes of weight loss. For example, do they have advancing or severe COPD or heart failure? Do they have an undiagnosed new disease like cancer or a malabsorptive condition? Make sure to review neglected symptoms that can affect eating such as visual deficits, smell or taste impairment, and dental issues. Multimorbidity/Multicomplexity Consider comorbidities and organic causes of weight loss.
Mind
Focus on mood symptoms/depression and cognitive impairment/dementia. Depression may reduce interest in eating. Dementia can cause dysphagia, behavioral issues with eating like food pocketing, wandering (increasing energy expenditure), and impaired ability to purchase or prepare food. Mild/moderate cognitive impairment can also contribute to weight loss, particularly if they have a neuropsychiatric symptom like apathy or paranoia (eg the person worries the food is poisoned). Mind/mentation Focus on mood symptoms/depression and cognitive impairment/dementia.
Mobility
Consider activities of daily living (ADLs) and instrumental activities of daily living (IADLs). ADLs: are they able to feed themselves? IADLs: are they able to shop and/or prepare food (or arrange for shopping and food preparation independently)? If there are deficits, do they have adequate caregiving or social support? What is their physical function and activity level- are they more sedentary and losing muscle mass?
Medications
Go through the medications (including over the counter meds) with a fine-toothed comb! Medications can cause impairments in taste, appetite, dry mouth, nausea, etc- all of which can contribute to weight loss (Gaddey and Holder 2021). Examples of meds to look out for include antibiotics, propranolol and allopurinol (which can cause altered taste or smell), anticholinergics and antihistamines (which can cause dry mouth), and metformin, anticonvulsants, and SSRIs (which can cause anorexia). Also explore substance use that could affect appetite (eg alcohol or tobacco).
What Matters Most
Learn about the patient’s day to day life- what brings them joy and value in their life? Are they socially isolated? Are there financial or physical barriers to purchasing food? Unintentional Work Loss Work-up Guide your work-up by the 5Ms, history, and physical exam. Learn about the patient’s day to day life- what brings them joy and value in their life? Are they socially isolated? Are there financial or physical barriers to purchasing food?
Read also: Inspiring Health Transformation
Diagnostic Work-Up for Unintentional Weight Loss
The diagnostic work-up for unintentional weight loss should be guided by the 5Ms, history, and physical exam.
Labs
Start with the basics: CBC (looking for anemia that might signal an occult GI malignancy or bone marrow issue), complete metabolic panel (with particular attention to liver and renal function as well as glucose), TSH (to assess thyroid function) and vitamin B12. If they haven’t been screened for HIV or HCV this should be done. Consider if A1c, ferritin, or ESR/CRP would help you, but do not order in every situation. Beware of the hail mary prostate specific antigen PSA- this is not very useful in this context.
Imaging
Some sources suggest starting with a chest x-ray or abdominal ultrasound depending on symptoms (Gaddey and Holder 2021). Dr. Szymanski suggests doing a chart review to see if they have had recent imaging that helps to rule out conditions/need for additional imaging, but she typically pursues cross-sectional imaging (eg CT chest and/or abd/pelvis) if she decides imaging is needed (expert opinion). Whole body CT scanning for unintentional weight loss has been shown to have a diagnostic yield of 33.5% for organic etiologies (Goh et al. 2018).
Cancer Evaluation
Making sure a patient is “up to date” with cancer screenings isn’t totally appropriate in an unintentional weight loss work-up, because at this point the tests are diagnostic, not for screening (since the patient is symptomatic). Carefully chart review historic data which may uncover colonic polyps or lung nodules that were never followed up on and could guide next steps.
Ageism can impact the health of older adults, and is compounded by structural racism (Sun et al 2023). This can contribute to disease underdiagnosis (eg being dismissive because someone is a certain age) AND overdiagnosis (eg being overly aggressive in diagnostics in a person who is frail and chronically ill, and does not wish for aggressive interventions). Age is just a number- it is important to assess physiologic age and fitness and use that information in concert with a patient’s goals and values to drive evaluation and treatment.
Treating Unintentional Weight Loss
Treating unintentional weight loss involves a multi-faceted approach that addresses the underlying causes and supports the patient's nutritional needs.
Counseling the Patient and Caregiver
When unintentional weight loss is present, patients and caregivers are often worried about malignancy. They can be reassured that a negative initial workup is usually reassuring against malignancy (and non-malignant organic causes). Watchful waiting is appropriate in this situation (with an agile response/change in management if things get worse) (Bosch et al. 2017). Explain the multifactorial nature of unintentional weight loss, the intended evaluation (guided by “What Matters”) and what the future might hold. Patient/caregiver resources are so valuable- the Alzheimer’s Association has advice for people with cognitive impairment/dementia as does the Family Caregiver Alliance.
Medications
Treat underlying causes such as depression, with appropriate medications. Mirtazipine can help stimulate appetite and cause weight gain in those who have depression, but there is little evidence that it should be prescribed outside of depression management.
What about appetite stimulants (eg megestrol acetate and dronabinol)? It is an American Geriatrics Society Choosing Wisely recommendation to avoid using these in older adults, because of rampant side effects (Choosing Wisely, Health in Aging resource, Garcia et al 2013).
High-Calorie Supplements and Dietary Recommendations
The American Geriatrics Society also recommends against high-calorie supplements (Choosing Wisely, Health in Aging resource), but Dr. Szymanski suggests that these may have a role in select patients (expert opinion). They have been shown to help people to gain weight but it isn’t clear if this translates to real outcomes like mortality. It is important to stress to patients that eating “real food” is best, and if supplements are suppressing appetite at mealtime, that is counter productive. Use supplements in between meals. Supplements can also be very expensive- note Carnation Instant Breakfast is cheaper than Boost or Ensure (courtesy of Dr. Josh Uy’s dot phrase!) (Milne et al 2009). Liberalize the diet completely- add oil, butter, peanut butter, etc to add extra calories where they can. Undo the messages they have received their whole lives to “watch their diet”- she suggests telling them “if you feel like ice cream, eat the ice cream”. You can also encourage patients to play around with food texture, spice/taste, temperature and smell.
Social Recommendations
Social connection and social eating is an important recommendation. Explore if the patient needs help with feeding, affording food, physically obtaining groceries and/or making meals, and recommend appropriate social programs/caregiving resources.
Feeding Tube Considerations
Anxiety and worry over weight loss is often an emotionally charged discussion that includes uncertainty, grieving, etc. Enteral feeds in advanced-staged dementia is not recommended and can cause harms (eg hospitalizations, bed sores) and does not improve mortality. It is important to provide alternatives to a feeding tube instead of saying there is nothing we can do (eg we are going to do careful 1:1 hand-feeding) (Choosing Wisely, Health in Aging resource, Finucane et al 1999, Palecek et al 2010).
Dot Phrase for Patient Instructions (Courtesy of Dr. Josh Uy)
To stimulate your appetite try changing the variety in your food. Specifically change the:
- Taste-Salty, sweet, bitter, sour, spicy
- Temperature-Hot or cold
- Texture-Crunchy, soft, chewy, liquid
- Smell (for taste issues)
Make sure your mouth is clean to improve taste. Make sure your mouth is moist. Eat with others. Puree the foods to make chewing easier.
To increase calories:
- No restriction on diet: No limits on salt, sugar, fat, or carb restriction. Eat anything you want: Bacon, sausage, bread, ice cream, candy, cookies, cheese etc.
- Increase the calories in your food by adding: Heavy cream, cheese, sugar, oil, avocado, full fat yogurt
- Buy Carnation Instant Breakfast instead of Boost or Ensure because it is cheaper. Drink them between meals, not with meals.
Eating Frequency and Its Impact on Body Weight and Composition
The association between eating frequency and body weight has been a topic of interest in recent years. Studies that have attempted to determine the effects of eating frequency on weight have reached different conclusions. More recently, mainly in the 2000s, studies have shown mixed conclusions. Overall energy intake also has a relevant role in the causal pathway that links meal frequency and weight maintenance, although the results of studies evaluating the effect of eating frequency on energy intake were inconclusive.
Systematic Literature Review (SLR) Methodology
To assess the association of eating frequency with body composition or body weight, an SLR was conducted aiming to find original articles on the association between eating frequency and body composition or body weight. The research protocol was identified using the PICO (patient, intervention, comparison, outcome) strategy. PubMed, EMBASE and Scopus databases were searched. Articles published from 1960 to August 2016 were included. Terms relative to eating frequency and body weight were used. Additional papers were identified in the reference lists of selected articles that met the inclusion criteria. All records identified were uploaded or manually entered into EndNote X4. The searches were conducted by two independent investigators (R.C.). The articles that met all the established criteria were included. Two reviewers (R.C. and A.S.G.) independently read all titles and abstracts. At a second stage, the reviewers read in full all manuscripts that had consensus about their inclusion. If consensus between the two reviewers could not be reached, a third reviewer (M.T.A.O.) was called upon to make a final decision. In four instances the full text of the article was not available.
Quality Assessment
In the present SLR, a validated checklist originally proposed by Downs and Black was used in order to assess the quality of the selected articles, especially regarding possible bias. This checklist, originally proposed to rate the quality of clinical trials, consists of twenty-seven items that evaluate the risk of bias in five domains: reporting, external validity, internal validity, confounding and power, and items 8, 13, 23 and 24 were eliminated for longitudinal studies, while items 8, 9, 13, 17, 23 and 24 were excluded for the assessment of cross-sectional studies. In the present SLR, items 14 and 15 were also eliminated for both designs because they evaluate the blinding process and most observational studies do not take blinding into consideration. The final scale ranged from 0 (poorest quality) to 21 points (best quality) for longitudinal studies and 19 points (best quality) for cross-sectional studies. All items received scores of 0 or 1 (1 if the item was contemplated in the study and 0 if the item was not contemplated or was not able to be determined), with the exception of item 5. Item 5 evaluates if a list of main confounders was provided, ranging from 0 to 2 (0=no; 1=partially; 2=yes). In the second stage of the quality assessment, in the same way, a general assessment of the quality of the articles was performed for each item of the evaluation instrument. The two reviewers (R.C. and A.S.G.) independently made use of the checklist to assess the quality of the retrieved articles.
SLR Results
The search strategies resulted in 6357 articles (2503 from PubMed; 2380 from EMBASE; 1474 from Scopus). After excluding duplications, 5789 titles and abstracts were examined; 209 full texts were selected for reading. One hundred and eighty-two articles were excluded for the following reasons: outcome and exposure measurements did not meet the inclusion criteria (n172); the study population was not adult (n1); and the article did not show the statistical results for the analysis of the relationship between exposure and outcome (n1). Twenty-seven articles met all of the inclusion criteria. The references of these articles were checked, resulting in four additional articles. As a result, a total of thirty-one articles were included in the present SLR. The studies had different sample characteristics, and the age of the participants was between 18 and 90 years old, and twenty-nine cross-sectional studies were retrieved.
Risk of Bias Assessment
In the reporting items, most articles were classified as having a ‘low risk of bias’. On the other hand, in the external validity domain, several of the articles were not clear about how their participants were selected (42 %) or/and did not rely on representative samples (70 %). As regards internal validity, 34·8 % of the studies did not use an accurate method (valid and reliable) to measure the outcomes, using self-reported measures. In the confounding domain, 54·8 % of the articles did not describe characteristics of participants lost between the initial selection process and the final sample, and 29·0 % of the studies did not perform any adjustment for confounding in the analysis. Finally, almost all studies (96·7 %) did not report a power calculation for their sample size and were classified as having a ‘risk of bias’ in the power domain.
Eating Frequency Assessment
In the majority of studies (n 5), eating frequency was assessed through multiple recalls or meal pattern questionnaires.
Conclusions on Eating Frequency and Body Weight
Our SLR focused on the association of eating frequency with body composition or body weight. We concluded that, to date, there is not sufficient evidence for establishing a clear association between eating frequency and body composition or body weight. The findings should be interpreted in light of the methodological characteristics of the articles included. First, the outcome and exposure measurement might not be accurate in some studies. Moreover, the outcome measurement varied among the studies, thereby limiting the comparability among them. For example, the role of eating frequency on body weight might be different from the one it has on central adiposity. With respect to exposure, different methods were used for data collection. Some studies used methods such as multiple recalls or food diaries and meal pattern questionnaires, and may be more accurate than others, such as simple questions, for eating frequency assessment, there is no information about the validity of most of the meal pattern questionnaires and simple questions used in these studies. Furthermore, different cut-offs were used to determine high or low eating frequency. Only six authors classified eating frequency according to the three major meals (breakfast, lunch and dinner) and compared intake of three meals with intake of a greater number of meals. Other studies assessed the exposure as a continuous variable or compared the extremes of eating frequency (e.g. two v.
Second, the results are based mostly on cross-sectional studies, with only two studies selected having a longitudinal design, which should be considered a limitation in the current available literature. Longitudinal studies are well known for being a better study design to investigate the temporal relationship between the exposure and change in outcome status. Finally, obesity is a multifactorial disorder arising from genetic, environmental, socio-economic and behavioural factors. In this sense, another methodological issue that is very important in this type of epidemiological investigation is the inclusion of main confounders and mediators in the analysis. The effect of dietary characteristics (energy intake and quality of diet) in the causal pathway linking eating frequency to body weight and body composition was adjusted for in the multiple analyses of most studies. However, in order to understand the role of a variable in a causal chain, sometimes it is more informative to stratify the analyses according to this variable, rather than adjusting for it in multiple analyses. eating frequency and carbohydrate energy percentage, as well as relative fibre intake, increased with higher eating frequency; while the energy percentage from fat, protein and alcohol decreased. found that sweet and fatty food groups were associated with snacking and contributed considerably to energy intake. showed that intakes of fruit and vegetables, whole grains, dietary fibre, dairy and added sugars also increased as eating frequency increased. In our SLR, fourteen studies reported an inverse association between eating frequency and body weight or body composition. have called attention to this apparent inverse relationship between eating frequency and adiposity measures, suggesting it is an artifact that in part can be attributed to the under-reporting of eating frequency concomitant with the under-reporting of energy intake by overweight or obese subjects. study showed the importance of evaluating energy intake misreporting when examining the association between eating frequency and overweight/obesity and central obesity. In their study, energy intake misreporting was evaluated based on ratio of energy intake to estimated energy requirement (EI:EER). In the multiple analyses, without taking into account energy intake or EI:EER, eating frequency showed an inverse or null association with the outcomes. However, after full adjustment including EI:EER, a completely different picture emerged: eating frequency was positively associated with overweight/obesity and central obesity.
Even though it was not the objective of our SLR to investigate differences between sexes, when analysing the results of the articles included, a potential protective effect of high eating frequency on the outcomes was observed among men. However, this difference could be due to the fact that men who have high eating frequency also have a healthier lifestyle, including practice of physical activity and healthier eating habits, which results in reduced body fat and waist circumference, a high fibre intake was the clearest diet-quality indicator associated with a high eating frequency among men. was physical activity measured by a direct method (pedometer), self-reported measurements were used, which can be inaccurate. showed that men compensated for extra eating occasions by reducing the mean energy per eating episode.
The Significance of Systematic Literature Reviews
The present review is the first SLR of observational studies that examines specifically the association of eating frequency with body weight and body composition in adults with a systematic approach, and these concluded that the evidence available to suggest the presence of an association between eating frequency and weight, BMI and body fatness is limited. Considering there is contradictory evidence about the association between eating frequency and body weight, it is important to assess the whole body of evidence about this topic and in particular to do so systematically. In this respect, at the same time as we encourage the conduct of more clinical trials to help to examine and potentially determine this causal relationship, future high-quality observational studies are needed to understand the role of eating frequency on loss and maintenance of weight and body composition and to guide clinical recommendations. However, evaluating eating behaviour is also a complex task and we demonstrated substantial heterogeneity in the methodological quality of studies. Thus, in Table 6, we call attention to some important methodological issues that should be considered in future observational studies. It is necessary to conduct studies with long-term longitudinal design and representative samples. Outcome and exposure should be measured with accurate methods and classified based on clinically relevant aspects.
Current Status and Health Information about Mary Schmucker
- Mary Schmucker, known from the popular reality show Return to Amish, has been open about her health challenges, which may have contributed to her weight loss journey. While she hasn’t shared specific details about a weight loss program, fans have noticed her transformation over the years.
- As of now, there has been no official obituary for Mary Schmucker. Though rumors sometimes circulate in the media or on social platforms about her health, Mary remains alive and continues to be a beloved figure from the Return to Amish series.
- Yes, Mary Schmucker is still alive. Despite facing some health concerns in recent years, including hospital visits, Mary continues to stay connected with her fans through social media and occasional updates.
- Mary Schmucker was born on July 6, 1950, which makes her 74 years old as of 2024. Despite her age, she remains active and involved with her family and community.
- In recent years, Mary Schmucker has faced some health issues, which led her to step away from the reality TV show Return to Amish. She has focused on her recovery and well-being.
- As of now, Mary Schmucker does not have an official Wikipedia page. However, she is widely known through her appearances on Return to Amish, where she gained popularity as the fun-loving and outspoken matriarch.
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