A clinical examination should include the measurement of weight and height, both for their immediate value and for I'ulure reference. Measurements such as span, sitting height and pubis to ground height are made only where a more precise evaluation of growth and development is required, especially in infants and young children.
In an adult 70-kg male, total body water (42 kg) accounts for 60% of body weight and fat accounts for about 10 kg. In females, there is a greater percentage of total body water and, in the premenopausal, there arc often marked fluctuations in weight owing to premenstrual fluid retention. Body weight may fluctuate by several kilograms from year to year.
In adults, nutritional status is best assessed in terms of body mass index (BMI), which is derived from the formula Wt/Ht-. measured in kg/nr. BMI can be readily calculated from this formula or derived from the nomogram (Fig. 2.5), which also indicates the relationship between BMI and nutritional status as follows.
Underweight Normal Overweight Obese
The normal oral temperature is 37°G. Circadian variations of 0.5"C occur, the lowest temperature being in the early morning. Rectal temperature is usually about ().5"C higher than thai in the mouth, which in turn is 0,5LC higher than in the axilla. Body temperature is best recorded either beneath the tongue, which is convenient, or in the rectum, which is reliable. Alternative sites, the axilla, groin or natal cleli, should be avoided as much as possible. Digital thermometers arc becoming increasingly available.
□ Assess any abnormalities in stature.
D Measure height on a vertical scale with a rigid, adjustable arm-piece with the patient standing erect and without shoes.
□ Determine the weight of outpatients in indoor clothing without shoes, and of inpatients with pyjamas and dressing gown.
□ Where necessary determine the BMI.
□ Determine waist-hip ratio in the erect patient by measuring the girth at the level equidistant between costal margin and iliac crest and at the level of the greater trochanters.
Weight kg lb
Height cm in
Body mass index
— 200 - 190 -180 170 f—160 -150 -140 -130 -120 ■ 110
125 — 130— 135— 140145150 155—1 160 16S^J 170 175 180 185 — 190 195 H
Fig. 2.5 Desirable weights of adults according to body mass index.
□ Look for any evidence of malnutrition or abnormal fat distribution.
□ Take the temperature either by using a digital thermometer inserted into the external auditory meatus, or with a mercury thermometer beneath the tongue or in the rectum. Use a low-reading thermometer if there is a possibility of hypothermia.
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Many women who have recently given birth are always interested in attempting to lose some of that extra weight that traditionally accompanies having a baby. What many of these women do not entirely realize is the fact that breast-feeding can not only help provide the baby with essential vitamins and nutrients, but can also help in the weight-loss process.