8
Assessing Weight Change
Procedures for Obtaining Accurate Measurements
Weight
Weigh women on a platform beam balance scale with movable weights or on a high-quality electronic scale that is graduated to the nearest 0.25 lb (100 g), and use the same scale each time.
Be consistent in the amount of clothing allowed during weighing. If weighing must be done in street clothes, it is desirable to ask patients to remove shoes, outer clothing such as sweaters and jackets, and purses.
The person who measures the weight should adopt a nonjudgmental demeanor regarding weight and weight change. If this person comments about a change in weight, that comment and its tone should be consistent with the message being given by all the other health professionals.
Measurement or assessment of the weight of women with disabilities may require alternative approaches. For example, wheelchair-bound women can be weighed using a special wheelchair scale and subtracting the weight of the chair. If such a scale is unavailable, one can be improvised by building two bathroom scales into a frame with a short ramp (each wheel rests on a scale). Or the woman can be weighed by difference if her partner is accustomed to carrying her.
Estimates of weight-for-height status are affected if one or more limbs are missing (a visual impression should be sufficient), but changes in weight are unlikely to be affected if there is no change in any prosthetic device used. (A typical prosthesis weighs approximately 3 to 5 lb [1.5 to 2.5 kg].)
Height
The most accurate method is to measure height before pregnancy or as early in the pregnancy as possible to reduce errors caused by changes in posture. Use a stadiometer, either one constructed at the health center or a commercial one that is not built into a weighing scale. Push the vertical board flat against the wall and lower it along the metal measuring tape until the horizontal board touches the woman's scalp. A less accurate method (but one that is better than self-reported height) is to use a stadiometer that is built into a weighing scale.
Quality Control Measures
To help achieve consistent, accurate measurements by different staff members, four additional steps are recommended:
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Zero the scale daily.
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Calibrate the scale regularly (about once a month). Record the amount of drift.
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Provide in-service training concerning standard procedures for measuring weight and height.
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Monitor measurement techniques regularly.
Promoting Weight Gain
Substantial weight gain is recommended during pregnancy, as shown in the weight gain grid in Tab 1.
Weight gain may also be recommended for very thin women who are not pregnant, especially for those planning a pregnancy.
Identify the Cause of Low Weight Gain
Potential causes include lack of food, concern about body image, poor appetite, prolonged nausea and vomiting, alcohol abuse, excessive activity leading to high energy expenditure or skipping of meals, and health problems.
Questions and suggestions include:
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Do you need some help in getting enough food to eat?
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Have you picked up your WIC vouchers? Food stamps?
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Were you able to use them?
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Take a look at your activity level. Do you need to slow down?
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Do you need to set aside or plan more time for meals?
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Are you worried about gaining too much weight?
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Do some problems at work or home cause you to lose your appetite? Would you like help coping with them?
Find Solutions
Suggestions include:
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Eat small amounts frequently. Plan ahead for some nutritious snacks.
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Fruit juices, milk, or milkshakes can be good substitutes for noncaloric beverages such as water, coffee, or sugar-free soft drinks.
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Whole-grain bread and rolls are quick, tasty, nutritious, and easy to digest.
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Here are some places you can go to get some food if you run out . . . (e.g., a local hunger hotline and food pantry).
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This is how to enroll in the . . . (e.g., Expanded Food and Nutrition Education Program [EFNEP]).
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Let me introduce you to our social worker, who will try to help you obtain some extra assistance.
Promoting a Lower Rate of Weight Gain
The following suggestions are targeted specifically to pregnant women, but most of them are applicable to nonpregnant women who want to control their weight.
Suggestions include:
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Be sure to continue to eat foods such as fruits, vegetables, whole-grain breads, low-fat milk, legumes, and lean meat, chicken, or fish.
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Aim to gain at the rate shown on your weight gain grid even if you have already gained more than the recommended amount. Your baby still needs to gain weight.
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If you gained weight fast because you ate a lot, look for ways to cut back on foods high in fat and sugar. Also try to avoid situations that lead you to overeat.
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Club soda or mineral water, plain or mixed with fruit juice, makes a good substitute for soft drinks.
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If you are not getting much exercise, what can you do safely to use up more energy? Walk? Swim? Dance? Even moderate exercise may be contraindicated for women with multiple gestations, cervical incompetence, or certain other complications of pregnancy.
