Nutrition in Pregnancy and Lactation: A Report to the Children's Bureau (1967)

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56 QUESTIONNAIRE AND PROCEDURE FOR A DIETARY INTERVIEW WITH A PRENATAL PATIENT 1. How are you feeling today? • 2. Since you knew you were pregnant have you made any changes in your eating habits? 3. What changes have you made? 3a) Do you skip meals? What meal? Why? How often? 4. Why did you make the changes? (Probe for reason) 5. Do you think that women should eat differently when they are pregnant? Why? How? 6. What kinds of food do you like most? 6a) Do you like foods such as: candy pop colas tonic hot dogs kool aid potato chips pastries carbonated beverages pie coffee and tea with doughnuts sugar and cream 7.. What kinds of food do you like least? 7a) Do you like salty foods, such as bacon, corned beef, ham? 8. What kinds of food do you think people generally jshould eat?

57 9. wow tell me something about how you eat in your home. 9a) When do you eat first? (Get an account of the meal and snacking patterns and a summary of intake.) 9b) What kinds of seasonings do you use in cooking? at the table? Example: salt, tabasco, chile sauce, and catsup. 9c) Do you drink milk? If so, how much? What kind of milk do you prefer? Whole, skim, chocolate, etc. Do you eat custards, puddings, ice cream, creamed soups, and creamed foods? Do you eat cheese? If so, what kind? How much? 9d) Who prepares the meals in your family and how are they prepared? Example: fry, broil, bake, etc. 10. Do you take any medicine or pills? (If yes, who told you to take iL (01. Lheiu) and what are they?) 11. Since you have known you were going to have a baby, have you craved anything in particular? What? How much? 12. Evaluate the patient's diet and discuss the evaluation, the corrections which might be made, if any. 13. Ask the patient whiqh of the changes would be possible in in her household and which she would like to make first. Then help her to plan for making the change, i.e., including more milk, etc. Set a goal which she accepts and a time within which she would propose to make it.

58 MATERIAL ON HEIGHT AND WEIGHT Body weight is made up of a number of components. Those which cause greatest variation in weight at a given age, sex, and height in most normal individuals are fat, muscle, and bone. Because a number of components contribute to total weight, an individual may be overweight relative to some arbitrarily chosen standard on the basis of either his bony structure or musculature and yet not be obese or excessively fat. It is also true that an individual may be of average weight and yet excessively fat if he has relatively small musculature or bony structure. uals of the same sex and of approximately the same age is impressed with the need to consider, each person's body structure on AN INDIVIDUAL BASIS. The ratio of bony structure, musculature and fat and the distribution of the fat are of far MORE IMPORTANCE in arriving at an assessment of weight status THAN THE BLIND APPLICATION of even the BEST HEIGHT-WEIGHT TABLE. There is no sub- stitute for good clinical judgment in the determination of the desirable weight for an individual based on his actual weight, his appearance, and some idea of his subcutaneous fat pads. (26) A table is presented which compares various tables of desirable weights for women at age 25. The tables used for the comparison arer 1. Metropolitan Life Insurance Company Table of Desirable Weights for Women.

59 2. Desircible Weights for Women from the 1964 edition of Recommended Dietary Allowances (adapted from Heights and Weights of Adults in U.S., Hoir.e Economics Research Report No. 10, ARS, USDA). 3. Average Weights for Women .Ages 20-24 from the Build and Blood Pressure Study, 1959. 4. Smoothed Average and 25th and 75th Percentile from Weight by Height and Age of Adults. 5. The Baldwin-Wood Table of Height for Weight at Age 18. Clinical judgment is of first importance in assessing weight status. The use of weight standards and tables, without intelligent clinical judgment, is often only an academic exercise,

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61 D3SIRABIE WEIGHT FOIi WOMEN AG3D 25 AND OVER Height Weight Feet Inches Small Frame . Medium Frame Large Frame 4 6 89 - 95 93 - 104 101 - 116 4 9 91 - 98 95 - 10? 103 - 119 4 10 93 - 101 98 - 110 106 - 122 4 11 96 - 104 101 - 113 109 - 125 5 0 99 - 10? 104 - 116 112 ~ 128 5 1 102 - 110 10? - 119 ' 115 - 131 5 .2 105 - 113 110 - 123 118 - 135 5 3 108 - 116 113 - 12? 122 - 139 i 5 4 111 - 120 11? - 132 126 - 143 5- 5 115 - 1 24 121 - 136 130 - 14? 5 6 119 - 12? 125 - 140 134 - 151 5 7 123 - 132 129 - 144 138 -- 155 5 8 12? - 137 133 - 148 142 -'160 V 5 9 131 - 141 137 - 152 146 - 165 5 10 135 - 145 141 - 156 150 - 170 Adjusted to bare-foot height by subtraction of 2 inches for heels and to nude %/eight by deduction of 3 pounds for clothing fror.i tables of Metropolitan Life Insurance Com- pany. Derived prirnarily from data of the Build and Blood Pressure Study, 1959, Society of Actuaries.

63 SMOOTHED AVKUG3 W3IGHT FO?. V70:-3M BY AGE AND K3IGHT: U.S. 1960-62 Height Age Feet, Inches as - 24 25 - 34. g-5 _ , 4 9 114 110 129 4 10 116 114 132 •4 11 118 118 134 5 0 120 . 122 136 5 1 123 126 138 5 2 125 130 141 5 3 127 134 143 5 4 129 138 145 5 5 132 142 147 '5 6 134 146 150 5 7 136 150 152 5 8 138 154 154 Adjusted frou National Center Health Statistics: Weight by Height and A<?e of Adults, United States 1960-62 Vital Health Statistics-, P.H.S. Publication No. lOOO-Series 11-Mo. 14, Data from National Health Survey. Adjusted by deducting 2 pounds for clothing.

64 MEDIAK '/SIGHT FOR WCI-3N BY AC-2 AND EIGHT: U.S., 1960-62 Feet Inchss 18 - 2k 25 - 34 35 - 44 4 9 114 110 123 4 10 105 100 116 4 11 110 116 •126 5 0 115 . 121 130 5 1 119 113 128 5 2 123 125 133 .5 3 121 126 136 5 4 124 031 138 5 5 130 132 135 5 6 135 134 140 5 7 132 . 145 148 5 8 12? 145 146. Adjusted from national Center for Health Statistics: Weight by Height and Age of Adults, United States 1960-62 Vital Health Statistics. P.H.S..Publication No. ICOO-Series 11-Ko. 14. Data from National Health Survey. Adjusted by deducting 2 pounds for clothing.

65 AVERAGE WEIGHT FOR WOMEN BY AGE AMD IEIGHT: U.S., 1960-62 Height Arre Feet Inches IS -' 24 2$_3Zt 35 - 44 4 9 115 126 120 4 10 119 119 115 4 11 119 116 1 136 5 0 120 122 136 5 1 122 125 135 5 2 126 131 141 5 3 124 133 144 5 4 124 * 138 145 5 5 133 140 138 5 6 140 137 146 $ 7 138 152 152 5 8 129 148 158 Adjusted fro:n National Center for Health Statistics: Weight by Height and Age of Adults, United States 1960-62 Vital Health Statistics P.H.S. Publication Ko. 1000-Series 11 No. 14. Data fror-i National Health Survey, Adjisted by deducting 2 pounds for clothing.

66 AVERAGE VJ3IGHT FOR HEIGHT OF GIRLS FROM 9 - 18 YEARS Height . Weij^i Years Feet Inches j? 10 11 12 13," 3A I£ 16 12 48 74 76 76 77 79 61 49 78 80 80 SO 82 86 90 4 10 82 84 84 86 91' 94 99 4 11 85 88 83 90 94 98 101 102 50 89 93 93 95 99 103 106 107 51 97 98 99 103 106 110 in 5 2 102 103 104 107 111 113 115 5 3 103-. 108 no 114 115 117 54 H2 113 115 117 118 120 5 5 116 118 n9 120 121 . 123 124 5 6 122 122 123 126 12? 128 5 7 126 128 .129 131 131 132 5 8 129 131 133 134 136 136 5 9 133 135 136 138 140 5 10 134 136 338 140 142 5 11 136 138 140 142 143 6 0 Baldwin-Wood, adjusted to nude weight by deducting 2 pounds' for clothing.

67 WEIGHT FOR PLIGHT 0? GIR1S AT 50th PEPwCSNTILE 9-18 YEARS Height K?li2lli. Years Feet Inches 910111212.1^.15. i6i2iS 4 4.2 63.6 4 6.2 71.0 4 9.0 82.0 • 4 11.5 94.4 5 2.2 105.5 5 3.1 113.0 5 3.8 120.0 5 4.1 123.0 5 4.2 125.8 5 4.4 • 126.2 Adapted from Falkner , F., Pediatrics 29:467-474, 1962-in Obe'sity and Health P.K.S. Publication No. 1485, 1966.