NUTRITIONI

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Gaining on Weight ControlBy PECGY KrOSTEI{ YI'i'i

SUGGESTED WEIGHTSFOR ADULTS

Source; Derived from National ResearchCouncil, 1989.

Printed in Nu/rition and Your Health: DietaIYGuidelines for Americans (Home and GardenBulletin No. 23211 3rdedition, U.S. DepartmentofAgriculture ana U.S. Department of Healthand Human Services, Nov. 1990.

1Without shoes.2Without clothes.3The higher weights in the rangesgenerally apply to men, who tend to havemore muscle and bone; the lower weightsmore often apply to women, who haveless muscle and bone.

5'0" 397-128 108-138

5'1" 101-132 111-143

5'2" 104-137 115-148

5'3" 107-141 119-152

5'4" 111-146 122-157

5'5" 114-150 126-162

5'6" 118-155 130-167

5'7" 121-160 134-172

5'8" 125-164 138-178

5'9" 129-169 142-183

5'10" 132-174 146-188

5'11" 136-179 151-194

6'0" 140-184 155-199

6'1" 144-189 159-205

6'2" 148-195 164-210

6'3" 152-200 168-216

6'4" 156-205 173-222

6'5" 160-211 177-228

6'6" 164-216 182-234

RIA mMJEWIR_

Keeping It Simple

new guidelines, need to lose weightbecause weight reduction can lowerblood pressure and blood sugar. Byadding this third criterion, the com­mittee proposes that healthy weightis not synonymous with normalweight. It is the weight necessary totreat or control a health problem.

In their search for a weight tablethat was simple and useful, theguidelines committee reviewed sev­eral standards. They rejectedMetropolitan Life's criteria, whichare based on an insured population,not a representative sample of allAmericans.

The committee also examined thedata from the Department of Healthand Human Services' Second Na­tional Health and Nutrition Exami­nation Survey but decided theconclusions-which did not relateweight to health and mortality-fellshort. Of greatest interest was thework of the National ResearchCouncil (NRC), which reviewed themost recent studies on weight andhealth. The NRC concluded thatolder adults can be somewhat heav­ier than previously thought withoutcompromising their health(2).

Ranges of 8MI found acceptablein the NRC report were simplifiedand sorted into two age groups forthe dietary guidelines table. BMIcorrelated with body fat. The usualcutoff point indicating obesity is aBMI of 27.8 for men and 27.3 forwomen. (The calculation of 8MI isweight [in kilograms] + height [inmeters] squared.) To be on the safeside, the new dietary guidelines use27 as the upper limit for BMI, eventhough the data indicated that 8Mlsup to 29 are well within healthyguidelines.

Weight in pounds2

19 to 34 3S yearsyears and over

Height!

PEGGY KLOSTER YEN, RD. MPH, is a nu­trition consultant, Chronic Disease NutritionServices orthe Family Health Administration,Maryland Department orHealth and MentalHygiene, in Baltimore.

A s people put on years, it's okayfor them to put on a few extra

pounds, too. At least, that conclusionis being drawn from the third andlatest edition of the U.S. Depart­ment of Agriculture's DietaryGuidelines for Americans( 1). Previ­ous editions of the dietary guidelinesused the height-to-weight standardsfor ideal weight set 30 years ago bythe Metropolitan Life InsuranceCompany. The new guidelines adviseAmericans to maintain healthyweight, a term the Dietary Guide­lines Advisory Committee sees asless ambiguous and more easily de­fined than ideal weight. Instead ofa single weight measurement, ahealthy weight satisfies three criteria:

1. The weight falls within theweight-far-height ratios in the guide­lines table (see box at right). Bodymass index (8MI) determines theweights in this table.

2. The ratio of waist-to-hip mea­surement does not exceed 0.95 formen and 0.80 for women. A 68-year­old woman with a 29-inch waist and32-inch hips, for example, wouldhave a waist-to-hip ratio of 0.91 (29 +

32) -too high for a woman, fine fora man. Exceeding the ratio, accord­ing to the new guidelines, raises therisk of developing diabetes, cardio­vascular disease, gallbladder disease,and hypertension.

3. The person does not need togain or lose weight to control ahealth problem. Take the case of a72-year-old man with diabetes andhypertension, whose weight-for­height and waist-to-hip ratios arewithin the acceptable ranges. Hemay, nevertheless, according to the

94 Geriatric Nursing Marchll\prill991

NUTRITION NEWS WATCH

Nurses on the Move inLong-Term Care

Obtaining a better picture of the24-hour blood pressure pattern wouldhelp detect mild hypertension andbetter evaluate patient response to aspecific therapy.

BALTIMORE, MD-BeverlyBaldwin, PhD, RN, has been appoint­ed to the Sonya Ziporkin Gershowitz

Chair of Ger­ontologicalNursing at theUniversity ofMaryland atBaltimore andwas named"EminentScholar" ofthe state ofMaryland. Be-

BUFFALO, NY-Margaret A.Gray-Vickrey, RN-C, MS, receivesthe Dychtwald Student Award at theAmerican Society on Aging's annualmeeting being held this month in NewOrleans, LA. The award, presented toa student pursuing a degree with agerontology focus, was first given in1985. Ms. Gray-Vickrey, one ofthefew nurses to receive the award, haswritten extensively on care of elders.She is an editorial advisor for Geri­atric Nursing and was the content ex­r--~~~-~""""""""" pert and script

writer for twovideos, Alz­heimer's Dis­ease: Copingwith Confu­sion and Dis­charge Planning.

The awardis named afterKen Dych t­

wald, president of Age Wave, a con­sulting firm that works withbusinesses, including hospitals, to helpthem prepare for the growing num­bers of elders.

Blood Pressure's CircadianRhythm

continuedfrom page 62

hospitalization, and aid the transitionto alternative care settings. GCMSidentifies high-cost, high-risk Medi­care patients before or upon admis­sion and assigns them to nurses withspecialized geriatric training and caremanagement experience. These spe­cialists work with hospital staff, pa­tients, and family to manage careduring hospitalization.

With Medicare reim burserneri trates stable or declining, hospitals facerises both in the numbers of Medicarepatients and in associated costs. Ac­cording to the American Hospital As­sociation (AHA), nearly two thirds ofall hospitals willlose money caring forMedicare patients in 1990. AHA pre­dictions place the 1990 Medicareshortfall at an average of 8 to 9 per­cent nationwide-a total of $4 to 6 bil­lion or an average loss per hospital of$850,000.

NEW ORLEANS, LA-Check­ing blood pressure during an office orclinicvisitmay give a false picture of apatient's hypertension. Normal varia­tions in blood pressure, the circadianrhythm, occur during the day and cor­respond to environmental factorssuch as physical activity, emotionalstimulation, and sleep.

Norman Kaplan, of the Universityof Texas Southwestern Medical Schoolin Dallas, reported at the AmericanHeart Association meeting inNew Or­leans that important information canbe obtained by monitoring the heartduring sleep and daily routines.

The lowest blood pressure level oc­curs at 3:00 AM, rising significantly be­tween 3:00and 6:00AM. There followsa dramatic surge between 6:00 and10:00AM as a person begins his or herdaily activities.This is also the time ofday when patients are at the greatestrisk of sudden cardiac death, stroke,or mycardial infarction.

REFERENCE

Still, the weights in the table aregetting a lot of public attention forallowing "heavier" weights thanhealth professionals are used to. Thecommittee actually stayed on theconservative side, primarily becausethey had applied the same weightranges to both men and women andbecause they used only two age cate­gories-19 to 34 years and 35 andover. (The Metropolitan Life tablesdo not have age categories.) BettyPeterkin, former acting administra­tor of the Department of Agricul­ture's Human Nutrition InformationService, has commented that recentresearch shows no difference be­tween men and women with respectto their healthy weight for height.

Apples Versus Pears

Waist-to-hip ratio is an indicatorof fat distribution patterns. Extra fatcarried at the waist (resulting in an"apple-shaped" figure) puts adults atgreater risk of certain diseases thanextra fat carried around the hips("pear shaped")(3). Fat in the ab­domen is an independent marker forhigher risk of several chronic dis­eases. Women generally deposit ex­cess fat in the hip region, while mentend to accumulate fat in the abdom­inal area. As they grow older, thistendency accelerates and may makeweight gain for men less advisablethan for women.

The dietary guidelines do not sug­gest that different patterns of weightgain are needed for older men versusolder women, but future editionsmay reflect additional research intothis area. The guidelines committeewelcomes comments from healthprofessionals on their use of thehealthy weight standards in theirpractice.

1. Reportofthe Dietary Guidelines AdvisoryCommit­tee 011 the DietaryGuidelines[or Americans. U.S..Dept. of Agriculture. Hyattsville. MD.June 1990.

2. Dietand Health: ImplicationsforReducing ChronicDiseaseRisk. National Academy of Sciences. Na­tional ResearchCouncil.Food and NutritionBoard.Washington. DC:NationalAcademyPress,1989.

3, Sugarman, C. "Better to be a pear than an apple."Washington Post, Nov.7.1990. p. E-8.

Geriatric Nursing Murch/Aprill991 95