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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

For a more in-depth discussion of the study, please check out my @medscape article from this week: buff.ly/1IoKP94

F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

Grip strength won't solve all our body composition problems. But it's a start. We need to treat fat and muscle as two separate, opposing, interrelated tissues. And until we have good, cheap, reliable measures of both, we won't have a real grip on downstream disease risk.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

The real limitation here: the study only included people with elevated BMI. But a 2023 study found that 50% of US adults with NORMAL BMIs actually had obesity by body fat percentage. BMI's real problem isn't overcalling obesity, it's undercalling it.
buff.ly/qYhI7I7

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

Don't go squeezing stress balls thinking it'll save your life. Grip strength isn't protective in itself. It's a marker of overall functional and metabolic health. But I bet if you change other lifestyle factors grip strength will naturally follow.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

What's special about grip strength? It's a good body comp metric. Unlike biceps or quads, most people don't specifically train their grip (baseball players aside). It's a purer measure of your underlying muscle function and metabolic health, not just what you target at the gym.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

In a subset with actual MRI data, the relationship held: more muscle mass meant lower risk of complications and death. And grip strength correlated strongly with that muscle mass. This suggests that grip strength is probably a proxy for muscle mass as opposed to some other thing.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

People in the highest grip strength tertile (>44 kg for men, >26 kg for women) were 20% less likely to develop obesity complications. They were also 13% less likely to die overall, even after accounting for age, education, activity level, and baseline health markers.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

Over that time, 53% developed at least one obesity-related disease. Half of those went on to develop a second. Overall, about 10% died. But notice that those with stronger grips fared much better.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

New study in Clinical Endocrinology and Metabolism followed over 90,000 people with "preclinical" obesity (elevated BMI but no complications like diabetes or sleep apnea) for 13 years. They measured grip strength at baseline and watched what happened.
buff.ly/QS2bIH5

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

When you shake someone's hand, you might be performing one of the most prognostic physical exam maneuvers available. Grip strength turns out to be a consistent indicator of muscle mass and, beyond that, risk of death.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

Sure, we have DXA scans and MRIs to measure body composition accurately. But they're expensive and time-consuming. We need something simple, reproducible, reliable, and cheap. The answer might literally be in the palm of your hand...
(Sorry I can't help myself).

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

BMI is weight divided by height (squared). It can't tell muscle from fat. And that matters enormously. A pound of muscle burns 10 calories/day and revs up your metabolism. A pound of fat burns 2-3 calories/day, promotes inflammation, and increases diabetes risk.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 2h

There's a problem with BMI, and I can illustrate it like this: Seth Rogen (comedic legend, dad bod) has about the same BMI as Jalen Hurts (elite NFL QB, built like a tank). Both would be classified as "overweight" or nearly "obese." Clearly, something is wrong here. (🧵)

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

For now, I suspect we'll continue to see dollars drip drip dripping into these spas, unfiltered and largely unchecked.
But maybe this study will be a wake-up call.
Full piece here: buff.ly/3fU3lDG

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Adults can make their own decisions about their bodies and money. But those decisions should be informed by transparent facts.
If a spa makes a health claim, they should back it up with data. And patients need to understand both benefits AND risks.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

There's something very 2025 about this whole industry. This idea that going outside the standard of care means you're getting better care. That you can just optimize your way to health with the right cocktail of vitamins.
That assumption is likely false.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Look, I'm a nephrologist. Fluids are sort of my bag. ;)
The thing is, dripping fluids directly into your bloodstream has real risks. You need someone who knows your medical history, understands contraindications, and can handle complications.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

And when asked about risks, most just mentioned bruising. Only 6 of 87 clinics mentioned infection, despite documented cases of infections and at least one death linked to these treatments.
Oh, and zero clinics accepted health insurance.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

But here's where it gets really wild: the secret shopper calls.
When researchers called posing as sick customers:

86% got specific therapy recommendations from whoever answered the phone
Only 8% got connected to an actual doctor
Only 24% heard about ANY risks

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Then there's what these spas are actually claiming.
100% of the websites made health claims about their products.
Only 0.8%—that's 2 out of 255 sites—provided ANY references to back up those claims.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

First, the regulation picture. NO state has specific legislation for IV hydration spas.
Only 6 states have rules about who runs these places.
Only 12 regulate who can prescribe.
Only 4 states—FOUR—address all aspects of oversight.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Researchers (full disclosure: Yalies but I was not involved) examined state laws, reviewed 255 spa websites, and then called 87 spas posing as customers with headache and cold symptoms.
What they found was eye opening to say the least.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

Turns out there is a catch. A big one.
IV hydration spas are a $1.5 billion industry in the US, growing rapidly. And they're operating in a regulatory wild west with almost no oversight.
A new study in JAMA just exposed how bad it really is.
buff.ly/4iskboS

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

The ad promised to cure migraines, chronic fatigue, fibromyalgia, depression, anxiety—you name it. All I had to do was call a number and someone would come to my hotel room with a bag of "hydration fluid" and "electrolytes."
Surely there'd be no catch.

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F. Perry Wilson, MD @fperrywilson.bsky.social · 8d

I woke up in Las Vegas last week with some mysterious symptoms: pounding headache, nausea, feeling like I hadn't slept at all. Who knows what could cause such a thing? As I searched for coffee, I saw a sign promising salvation: IV fluids. On demand. For $248. 🧵

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