10:19
Faizan
One of my RDNs posed this question recently related to BMI levels for older adults:
I've been seeing transfer notes from the hospital and other nursing homes with diet/nutrition histories where RDNs are charting that BMIs of less than 23 is underweight. For example, one note documented that a BMI of 21.3 was underweight "for age" for a man who was 92. State surveyors are also asking for a list of residents with BMI under 21 and wanting to see interventions on them. The MDS does not trigger for a low BMI until under 19. Do we need to adapt our practices?
The National Institute of Health classification of overweight and obesity by body mass index (BMI) is as follows:
Classification - Normal
Obesity Class - None
BMI (kg/m2) - 18.4-24.9
Classification - Overweight
Obesity Class - None
BMI (kg/m2) - 25.0-29.9
Classification - Obesity
Obesity Class - I
BMI (kg/m2) - 30.0-34.9
Classification - Obesity
Obesity Class - II
BMI (kg/m2) - 35.0-39.9
Classification - Extreme Obesity
Obesity Class - III
BMI (kg/m2) - > 40
BMI is interpreted based on age, health history, usual body weight, and weight history.
Adults should be assessed for indicators of nutritional status and decline using body mass index (BMI) as one of many factors. Data suggests that a higher BMI range may be protective in older adults and that the standards for ideal weight (BMI of 18.5 to 25) may be too restrictive in the elderly. A lower BMI may be considered detrimental to older adults due to association with declining nutrition status, potential pressure ulcers, infection and other complications. A BMI of 19 or less may indicate nutritional depletion, while a BMI of 30 or above indicates obesity.
In the literature, there is a lot of conversation about a BMI of 21-23 (rather than 18/19) as considered on the low side for older adults. At the same time, there is a lot of conversation about the "obesity paradox" saying a higher BMI might be protective against some diseases and death. There is still a lot of controversy regarding the efficacy of BMI for older adults, regardless of what is considered "too low" or "too high".
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