Lohman (1991) argues that waist measurement is a better measurement for monitoring nutrition than BMI. In his studies he found that the risk of death for women over the age of fifty was highest for those with normal BMI, but waistlines over the 35cm. Lohman (1991) believes that large waist measurement is an indication of potential mortality in older persons but overweight/obese BMI measurements are not necessarily a risk to the patient. He proposes this theory based on the fact that waist measurements reflect the fat that accumulates around ‘the vital organs at an older age, this in turn can lead to cardiac arrest. Lohman (1991), however, does not further break down the classification of geriatric age groups, as Kozier (1998) argues ideal weight for old people varies between 51+, 70+ and 95+. The US Department of Health and Human Services states that waist parameters should be carried out in conjunction with BMI (The US Department of Health and Human Services, 2008). My experience of working in an eating disorder unit is that both measurements are taken, however in GP surgeries I have only witnessed the use of BMI. Therefore I have not witnessed evidence of a consistent approach across the NHS on anthropometric measurement.
Frisancho (1990) believes that anthropometric measurement should not only be composed according to age, but according to ethnicity. He explores the difference in anthropometric measurement of those living in the United States from Caucasian ethnicity, African ethnicity and South East Asian ethnicity in order to generate specific measurements. Kozier (1998) suggests that anthropometric data for cultural groups should be correlated according to universal mortality rates as opposed to weight norms within that culture because certain cultures diets are healthier than others.
The nurse should try to understand reasons for fluctuations in weight. These changes may be caused by medical, social and psychological factors. Medical factors that could affect appetite are a change in medication altering the ability to taste (Bottomley, 2008). This will need to be highlighted to the doctor to advise on a potential change of medication. The patient may be experiencing physical pain and thus pain killers administered prior to meal times may aid the patient to eat (Casey, 1998). Additionally, it may be necessary for the speech and language therapist to carry out an assessment to diagnose swallowing problems, in order to determine whether dietary aids such as thickeners and feeding spoons could be beneficial (Norton, 2008). A physiotherapist may also be needed to aid with any postural problems affecting eating (Paquette, 2005).
Psychological factors that could be contributing to a lack of eating may be clinical depression or a fear of eating due to past trauma or body image issues, or a general restlessness (Bottomley, 2008). Psychological issues will need to be treated by the nurse through gentle persuasion and behaviour modification techniques (Whitman, 1975) as well as potential referral for counselling. Using empathy and social skills is preferable to the alternative of parenteral feeding (Rosdahl, 2003).
Further social factors that may be affecting the patient’s eating habits are a partiality for certain portion sizes and preferences on presentation of food (Harvey, 2002). Not enjoying eating in front of others, unclean continence aids, not having a clean bed table and a generally dirty environment can further affect the desire to eat (Harvey, 2002).
In conclusion, accurate nutritional anthropometric measurement is a contested domain. The Hamwi method, Body Mass Index and waist measurement have advantages and disadvantages and there is debate surrounding the evidence behind the utilisation of these methods. Furthermore, it is a contested subject as to whether specific guidelines should be sought to accommodate age ranges and ethnicity as well as the extent to which these guidelines should be sensitive to age, sex and cultural background. Finally, nurses should not rely solely on anthropometric measurements as a guide to patient nutrition. It is the nurse’s duty to observe if a patient is not eating meals and to make every effort to address their concerns.
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