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.
Bibliography
Bottomley A, Mckeown J. (2008) Promoting nutrition for people with mental health problems. Nursing Standard. , 22(49), pp. 48-55. Byles J, Alemeida O. (2010). Body Mass Index and Survival in Men and Women Aged 70 to 75. Journal of the American Geriatrics Society, 58(2), pp. 234-241.
Campillo B, Paillaud E, Uzan I, Merlier I, Abedellaoui M, Perennec J. (2004) Value of body mass index in the detection of severe malnutrition: influence of the pathology and changes in anthropometric parameters. Clinical Nutrition, 23, pp. 551-559. Casey G. (1998) The importance of nutrition in wound healing. Nursing Standard. , 13(3), pp. 51-56. Coxall K. (2007) Applying the key principles of nutrition to nursing practice, Nursing Standard. , 22(36), pp. 44-48. Dudek S. G. (2010) Nutrition essentials for nursing practice.
6th edn. Philadelphia: Lippincott Williams & Wilkins Health. Frisancho A. R. (1990) Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor: University of Michigan Press. Greenberg J. (2001) Biases in the mortality risk versus body mass index relationship in the NHANES-1 Epidemiologic Follow-up Study. International Journal of Obesity, 25(7), pp. 1071-1078. Hamwi G. (1967) Diabetes Mellitus: Diagnosis and Treatment. vol. II ed. California: ADA. Harvey K. S.