Anatomy And Physiology

As you begin the physical examination, you will survey the patient's general ap-earance and measure the patient's height and weight. These data provide in-rmation about the patient's nutritional status and amount of body fat. Body fat consists primarily of adipose in the form of triglyceride and is stored in sub-itaneous, intra-abdominal, and intramuscular fat depots. These stores are inaccessible and difficult to measure, so it will be important to compare your measurements of height and weight to standardized ranges of normal. In the past, tables of desirable weight-for-height have been based on life insurance data, which often did not adjust for the effects of smoking and selected weight-inducing medical conditions such as diabetes, and tended to overstate desirable weight. For those wishing to continue using such tables, see Table 3-1, p._.

ha ore recently, however, many government and scientific health organizations ave promoted use of the Body Mass Index, which incorporates estimated but more accurate measures of body fat than weight alone. BMI standards are derived from two surveys: the National Health Examination Survey, consisting of three survey cycles between 1960 and 1970, and the National Health and Nutrition Examination Survey, with three cycles from the 1970s to the 1990s.

More than half of U.S. adults are overweight (BMI >25), and nearly one fourth are obese (BMI >30), so assessing and educating patients about their BMI are vital for promoting health. Being overweight or obese are proven risk factors for diabetes, heart disease, stroke, hypertension, osteoarthritis, and some forms of cancer. Remember that these BMI criteria are not rigid cutpoints but guidelines for increasing risks for health and well-being. Note that persons over age 65 have a disproportionate risk of undernutrition when compared to younger adults.

Height and weight in childhood and adolescence reflect the many behavioral, cognitive, and physiologic changes of growth and development. Developmental milestones, markers for growth spurts, and sexual maturity ratings can be found in Chapter 17, Assessing Children: Infancy Through Adolescence. With aging, some of these changes reverse—height may decrease, posture may become more stooping from kyphosis of the thoracic spine, and extension of the knees and hips may diminish. The abdominal muscles may relax, changing the abdominal contour, and fat may accumulate at the hips and lower abdomen. Be alert to these changes and those described in the sections called "Changes With Aging" in the upcoming chapters.

Calculating the BMI. There are a number of ways to calculate the BMI. Choose the method most suited to your practice. The National Institute of Diabetes and Digestive and Kidney Diseases cautions that people who are very muscular may have a high BMI but still be healthy. Likewise, the BMI for elderly or other individuals with low muscle mass and reduced nutrition may appear inappropriately "normal." If you find the BMI difficult to use, you can use the nomogram on p.__, which gives BMI values for weight in pounds or kilograms and height in feet or centimeters.

Methods to Calculate Body Mass Index (BMI)

Unit of Measure

Method of Calculation

Weight in pounds, height in inches

(2) Body Mass Index Nomogram (see table on p._)

Weight in kilograms, height in meters squared

Either

Height (inches)

(5) "BMI Calculator" at website www.nhlbisupport.com/bmi

■'Several organizations use 704.5, but the variation in BMI is negligible. Conversion formulas: 2.2 lbs = 1 kg; 1.0 inch = 2.54 cm; 100 cm = 1 meter

Source: National Institute of Diabetes and Digestive and Kidney Diseases. www.niddk.nih.gov/health/nutrit/pubs/ atobes.htm, Accessed 2/1/01.

■'Several organizations use 704.5, but the variation in BMI is negligible. Conversion formulas: 2.2 lbs = 1 kg; 1.0 inch = 2.54 cm; 100 cm = 1 meter

Source: National Institute of Diabetes and Digestive and Kidney Diseases. www.niddk.nih.gov/health/nutrit/pubs/ atobes.htm, Accessed 2/1/01.

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Osteoarthritis

Osteoarthritis

Thank you for deciding to learn more about the disorder, Osteoarthritis. Inside these pages, you will learn what it is, who is most at risk for developing it, what causes it, and some treatment plans to help those that do have it feel better. While there is no definitive “cure” for Osteoarthritis, there are ways in which individuals can improve their quality of life and change the discomfort level to one that can be tolerated on a daily basis.

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