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Part II Nutrition Assessment, Consequences, and Implications Figure 6.2 Level I Screen

Level I Screen Body Weight

Measure height to the nearest inch and weight to the nearest pound. Record the values below and mark them on the Body Mass Index (BMI) scale to the right. Then use a straight edge (ruler) to connect the two points and circle the spot where this straight line crosses the center line (body mass index). Record the number below.

Healthy older adults should have a BMI between 24 and 27.

Height (in): Weight (lbs): Body Mass Index: (number from center column)

Check any boxes that are true for the individual:

❒ Has lost or gained 10 pounds (or more) in the past 6 months.

❒ Body mass index <24 ❒ Body mass index >27

For the remaining sections, please ask the individual which of the statements (if any) is true for him or her and place a check by each that applies.

NOMOGRAM FOR BODY MASS INDEX

WEIGHT KG LB

130 140 150

100 110 120

90 95

75 80 85

65 70

45 50 55 60

35 40

30 25

100 110 120 130 140 150 160 170 180 190 200 220 240 260 280 300 320 340

50 55 60 65 70 75 80 85 90 95

BODY MASS INDEX

[WT/(HT)2]

60 70

WOMEN OBESE OVERWEIGHT ACCEPTABLE

40 50

30

HEIGHT CM IN

MEN OBESE OVERWEIGHT 20 ACCEPTABLE 10

125 130 135 140 145 150 155 160 165 170 175 180 185 190 195 200 205 210

50

55

60

65

70

75

80

85

Eating Habits ❒ Does not have enough food to eat each day ❒ Usually eats alone ❒ Does not eat anything on one or more days each month ❒ Has poor appetite ❒ Is on a special diet ❒ Eats vegetables two or fewer times daily ❒ Eats milk or milk products once or not at all daily ❒ Eats fruit or drinks fruit juice once or not at all daily ❒

fewer times daily ❒ Has difficulty chewing or swallowing

❒ Has more than one alcoholic drink per day (if woman); more than two drinks per day (if man)

❒ Has pain in mouth, teeth, or gums

Living Environment ❒ Lives on an income of less than $6000 per year (per individual in the household)

❒ Lives alone ❒ Is housebound ❒ Is concerned about home security ❒ Lives in a home with inadequate heating or cooling ❒ Does not have a stove and/or refrigerator ❒ Is unable or prefers not to spend money on food (<$25–30 per person spent on food each week)

Functional Status Usually or always needs assistance with (check each that apply):

❒ Bathing ❒ Dressing ❒ Grooming ❒ Toileting ❒ Eating ❒ Walking or moving about

❒ Traveling (outside the home)

❒ Preparing food ❒ Shopping for food or other necessities

Source: Reprinted with permission by the Nutrition Screening Initiative, a project of the American Academy of Family Physicians and the American Dietetic Association, funded in part by a grant from Ross Products Division, Abbott Laboratories Inc.