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What Resources Are Available to Assist in Assessing Body Weight in the Elderly Population?
from the association
QUESTION OF THE MONTH
What Resources Are Available to Assist in Assessing Body Weight in the Elderly Population?
T
he National Institutes of Health Guidelines for the Identification, Evaluation, and Treatment of Obesity recommend the use of body mass index (BMI; calculated as kg/m2) as a more practical approach of assessing body weight in the clinical setting vs methods such as total body water, total body potassium, bioelectrical impedance, or dual-energy x-ray absorptiometry (1). Epidemiological and observational studies have shown that BMI provides an acceptable approximation of total body fat for the majority of patients. However, studies of those aged 65 years and older were not well represented in the evidence used to evaluate the prognostic utility of BMI. A review of federal guideline standards found that most studies showed a negative or no association between BMI and all-cause mortality and that higher BMI values were associated with lower relative risks among adults aged 75 years and older. Consequently, the researchers recommended future guidelines should consider the evidence for specific age groups when establishing standards for healthful weight (2). Considering the potential for BMI to inaccurately reflect body composition, an article published in the May 2005 Journal suggested that, in addition to BMI, registered dietitians should consider the presence of comorbid conditions, and pose questions about their clients’ daily functioning to assist in the determining the appropriateness of intentional weight loss in elderly people (3). The questions in the assessment may include:
● ● ● ● ● ●
Do you have difficulty getting in and out of chairs or bed? Do you have difficulty bathing or showering? Do you have difficulty getting dressed? Do you have difficulty doing housework such as laundry or vacuuming? Do you lose your balance while walking? Do you have difficulty taking stairs?
The ADA publication, Nutrition Care of the Older Adult: A Handbook for Dietetics Professionals Working Throughout the Continuum of Care, states that usual body weight is the preferred standard for older adults with the most important issue being achieving a stable weight for a period of 6 months or more (4). The National Resource Center on Nutrition, Physical Activity, and Aging’s Long Term Care Institute has an online resource, Obtaining and Trending Accurate Body Weights (5), which outlines simple methods to obtain and trend accurate body weight measures with a focus on the five elements listed below: This article was written by Eleese Cunningham, RD, of ADA’s Knowledge Center Team in Chicago, IL. Contact [email protected]. doi: 10.1016/j.jada.2007.08.031
1846
Journal of the AMERICAN DIETETIC ASSOCIATION
● ● ● ● ●
Simple method to assure accuracy of scales. Assignment of responsibility for body weights to a few welltrained staff who perform these measures on a daily basis. Simple step-by-step approach to obtaining accurate weights. Weight trending form (12-month) for the medical record. Pre-programmed Excel (Microsoft, Redmond, WA) spreadsheet for ongoing calculation of significant weight changes.
The dual trends of the aging of the US population and the obesity epidemic make it essential to stay current on developments in body weight assessment of elderly people. References 1. National Heart, Lung, and Blood Institute (NHLBI) and National Institute for Diabetes and Digestive and Kidney Diseases (NIDDKD). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adult: The Evidence Report. Available at: www.nhlbi.nih. gov/guidelines/obesity/ob_gdlns.htm. Accessed August 7, 2007. 2. Heiat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med. 2001;161:1194-1203. 3. Kushner RF, Jackson DJ. Risk Assessment of the overweight and obese patient. J Am Diet Assoc. 2005;105:53-62. Available at: http://www. adajournal.org/article/PIIS0002822305001604/fulltext. Accessed August 9, 2007. 4. Neider K, Dorner B, Consultant Dietitians in Health Care Facilities Dietetic Practice Group. Nutrition Care of the Older Adult: A Handbook for Dietetics Professionals Working Throughout the Continuum of Care. Chicago, IL: American Dietetic Association; 2005. 5. National Policy and Resource Center on Nutrition and Aging, Long Term Care Institute. Obtaining and Trending Accurate Body Weights. Available at: http://nutritionandaging.fiu.edu/. Accessed August 9, 2007.
On the Next Page. . . NEWS TO USE This month’s Nutrition Fact Sheets are brought to you by: ● Wrigley Science ● The Egg Board
Institute
Fact Sheet Review Board standing members are: Sharon Denny, MS, RD, Director, Knowledge Center Harold Holler, RD, Director, Governance Esther Myers, PhD, RD, FADA, Director, Scientific Affairs and Research Jennifer Herendeen, Editorial Director, Journal. Two member reviewers are selected for expertise in subject matter of each topic.
© 2007 by the American Dietetic Association
QUESTION OF THE MONTH
What Resources Are Available to Assist in Assessing Body Weight in the Elderly Population?
T
he National Institutes of Health Guidelines for the Identification, Evaluation, and Treatment of Obesity recommend the use of body mass index (BMI; calculated as kg/m2) as a more practical approach of assessing body weight in the clinical setting vs methods such as total body water, total body potassium, bioelectrical impedance, or dual-energy x-ray absorptiometry (1). Epidemiological and observational studies have shown that BMI provides an acceptable approximation of total body fat for the majority of patients. However, studies of those aged 65 years and older were not well represented in the evidence used to evaluate the prognostic utility of BMI. A review of federal guideline standards found that most studies showed a negative or no association between BMI and all-cause mortality and that higher BMI values were associated with lower relative risks among adults aged 75 years and older. Consequently, the researchers recommended future guidelines should consider the evidence for specific age groups when establishing standards for healthful weight (2). Considering the potential for BMI to inaccurately reflect body composition, an article published in the May 2005 Journal suggested that, in addition to BMI, registered dietitians should consider the presence of comorbid conditions, and pose questions about their clients’ daily functioning to assist in the determining the appropriateness of intentional weight loss in elderly people (3). The questions in the assessment may include:
● ● ● ● ● ●
Do you have difficulty getting in and out of chairs or bed? Do you have difficulty bathing or showering? Do you have difficulty getting dressed? Do you have difficulty doing housework such as laundry or vacuuming? Do you lose your balance while walking? Do you have difficulty taking stairs?
The ADA publication, Nutrition Care of the Older Adult: A Handbook for Dietetics Professionals Working Throughout the Continuum of Care, states that usual body weight is the preferred standard for older adults with the most important issue being achieving a stable weight for a period of 6 months or more (4). The National Resource Center on Nutrition, Physical Activity, and Aging’s Long Term Care Institute has an online resource, Obtaining and Trending Accurate Body Weights (5), which outlines simple methods to obtain and trend accurate body weight measures with a focus on the five elements listed below: This article was written by Eleese Cunningham, RD, of ADA’s Knowledge Center Team in Chicago, IL. Contact [email protected]. doi: 10.1016/j.jada.2007.08.031
1846
Journal of the AMERICAN DIETETIC ASSOCIATION
● ● ● ● ●
Simple method to assure accuracy of scales. Assignment of responsibility for body weights to a few welltrained staff who perform these measures on a daily basis. Simple step-by-step approach to obtaining accurate weights. Weight trending form (12-month) for the medical record. Pre-programmed Excel (Microsoft, Redmond, WA) spreadsheet for ongoing calculation of significant weight changes.
The dual trends of the aging of the US population and the obesity epidemic make it essential to stay current on developments in body weight assessment of elderly people. References 1. National Heart, Lung, and Blood Institute (NHLBI) and National Institute for Diabetes and Digestive and Kidney Diseases (NIDDKD). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adult: The Evidence Report. Available at: www.nhlbi.nih. gov/guidelines/obesity/ob_gdlns.htm. Accessed August 7, 2007. 2. Heiat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med. 2001;161:1194-1203. 3. Kushner RF, Jackson DJ. Risk Assessment of the overweight and obese patient. J Am Diet Assoc. 2005;105:53-62. Available at: http://www. adajournal.org/article/PIIS0002822305001604/fulltext. Accessed August 9, 2007. 4. Neider K, Dorner B, Consultant Dietitians in Health Care Facilities Dietetic Practice Group. Nutrition Care of the Older Adult: A Handbook for Dietetics Professionals Working Throughout the Continuum of Care. Chicago, IL: American Dietetic Association; 2005. 5. National Policy and Resource Center on Nutrition and Aging, Long Term Care Institute. Obtaining and Trending Accurate Body Weights. Available at: http://nutritionandaging.fiu.edu/. Accessed August 9, 2007.
On the Next Page. . . NEWS TO USE This month’s Nutrition Fact Sheets are brought to you by: ● Wrigley Science ● The Egg Board
Institute
Fact Sheet Review Board standing members are: Sharon Denny, MS, RD, Director, Knowledge Center Harold Holler, RD, Director, Governance Esther Myers, PhD, RD, FADA, Director, Scientific Affairs and Research Jennifer Herendeen, Editorial Director, Journal. Two member reviewers are selected for expertise in subject matter of each topic.
© 2007 by the American Dietetic Association