Weighing in on Weight Screening in the Dental Office
Practical Approaches
Anne Lenore Hague, RDH, MS, PhD, RD and
Riva Touger-Decker, PhD, RD
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ABSTRACT
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Background. Being overweight and being obese are systemic and oral health risks, as well as global health problems. The authors present weight-screening strategies for adults that are simple, reliable, valid and realistic to use in the dental practice.
Conclusions. Conducting routine weight screening in dental practices is supported by the multifaceted relationship among body weight, oral health and the "globesity" epidemic. Weight screenings may help reduce malnutrition and oral, chronic and systemic disease risks through early detection and referral to registered dietitians and physicians.
Clinical Implications. Oral health care professionals can measure patients’ height and weight and calculate their body mass index and percent weight change in dental offices to detect patients with nonnormal body weight.
Key Words: Risk assessment; obesity; weight loss; oral health; dental officesAbbreviations: BMI: Body mass index • IR: Insulin resistance • OHCP: Oral health care professional • PWC: Percent weight change • RD: Registered dietitian • TNF-
: Tumor necrosis factor-alpha • UWC: Unintentional weight change
In 2005, the Centers for Disease Control and Prevention estimated that there are 112,000 obesity-related deaths annually in the United States.1 Two-thirds of U.S. adults are overweight or obese.2,3 Patients whose weight can be classified as overweight or obesity are at risk of developing cardiovascular disease, type 2 diabetes mellitus, hypertension and metabolic syndrome.4–8
To assess and address body weight in clinical settings, the U.S. Preventive Services Task Force recommends that "clinicians screen all adult patients for obesity."9(p930) Although weight-screening strategies have been developed, none are specific to dental practices. Given the "globesity" epidemic (defined by the World Heath Organization as "an escalating global epidemic of overweight and obesity"10), the fact that people tend to see their dentists more regularly than they see their physicians11 and the results of studies that show a relationship between weight and oral disease,4,12–15 a simple, rapid, reliable strategy for weight screening in dental practices is needed.16 Early detection of nonnormal body weight and unintentional weight change (UWC), as well as a referral to a registered dietitian (RD) or physician, may help reduce the risks and comorbidities of select chronic diseases.17
Although the relationship between weight status and oral disease is one of association and not causality, the results of clinical and epidemiologic studies have demonstrated relationships between excess body fat and oral inflammatory diseases including periodontal disease.4,12–15 Unintentional weight loss also may reflect systemic disease or altered diet, both of which can affect nutritional, oral and systemic health.
Although weight screening fits in the comprehensive-care model of dentistry, the social stigma of being overweight or obese and the sensitivity that needs to be maintained when weighing someone present challenges for smoothly integrating weight screening into dental practices. In this article, we present weight-screening strategies for adults that are simple, nonthreatening, efficacious and realistic for the oral health care professional (OHCP).
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WHY CONDUCT WEIGHT SCREENINGS?
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Weight can be a risk factor for oral disease and an outcome marker of oral health. People who are overweight or obese and have diabetes are at an increased risk of developing adverse oral manifestations resulting from periodontal disease (Figure
).4 As shown in the figure, patients whose weight is classified as obesity are at an increased risk of developing insulin resistance and diabetes, and the hyperinflammatory state of the body that is associated with diabetes exacerbates periodontal infections.4 In contrast, UWC can be an outcome of compromised oral health18 and often occurs in people with ill-fitting dentures or those who are endentulous.13 Unintentional weight loss can indicate malnutrition and the need for intervention to determine potential nutrient deficits and chronic and systemic diseases. Weight screening is an inexpensive, noninvasive, rapid health risk assessment tool. For the purposes of this article, the results of weight screening are recorded as body mass index (BMI) and percent weight change (PWC).
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Figure. A proposed model for the relationship between obesity and oral inflammatory processes. TNF-: Tumor necrosis factor-alpha. IR: Insulin resistance. Reproduced with permission from the American Academy of Periodontology from Genco and colleagues.4
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SCREENING METHODS
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BMI is a widely used weight-screening index representing body weight in proportion to height ([weight in pounds/{height in inches x height in inches}] x 703).19 BMI weight classifications are underweight, normal, overweight, obesity (class I or II) and extreme obesity (class III) (Table).20 BMI is "reliable and valid for identifying adults at increased risk for morbidity and mortality due to overweight/obesity."9(p930) An online BMI calculator is available at "www.nhlbisupport.com/bmi/bmi-m.htm". Although BMI correlates well with estimates of body fatness (the amount of adipose tissue in the body),20–22 it must be interpreted with caution, since it does not measure body fat distribution or variation in fatness due to race, age or fitness level.21,22 OHCPs can measure body fat distribution by measuring waist circumference. Waist circumference is a measure of abdominal fat that is an independent predictor of the risk of developing obesity-related diseases.9 Although it is unlikely that OHCPs would assess patients’ body fat distribution in a dental setting, they can determine it easily by using a flexible tape measure.19 The table lists BMI classifications and disease risks associated with waist circumference.20 The box lists techniques that can be used to estimate body fatness in research and nutrition practice.23,24
OHCPs should measure their patients’ height annually by using a stadiometer, since a decrease in a patient’s height may occur with aging.25 Stadiometer models range from electronic digital systems to a measuring tape with a wall stop. Clinicians should measure a patient’s height while the patient is not wearing shoes. The patient should stand with his or her heels together, legs straight, arms at the sides and shoulders relaxed; the stadiometer’s headboard should touch the top of the patient’s head.19
OHCPs should measure patients’ weight while patients are not wearing shoes or outerwear. Electronic scales are preferred by registered dietitians over balance-beam scales because they are more portable and easier to use than are balance-beam scales. The scale base should be wide, sturdy and able to measure more than 350 pounds.23 OHCPs should place stadiometers and scales on hard, flat, noncarpeted surfaces.19
PWC is an intentional or unintentional change in body weight that is calculated by using actual and usual weight ([actual weight/usual weight] x 100). Clinicians should ask their patients whether their measured weight reflects a change from usual weight and if the weight change was intentional or unintentional. A UWC of 5 percent or more in three months or less or of 10 percent or more in six months or less indicates a risk of experiencing malnutrition, and an RD or a physician should assess the risk.26
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INTEGRATION OF WEIGHT SCREENING INTO DENTAL PRACTICE
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An important component of weight screening is introducing the concept to patients. OHCPs should tell patients that they have integrated weight screening into their practices and explain the purpose for the screening. For example, OHCPs could say, "Our dental office measures height and weight and change in weight on a regular basis as part of our assessment of your overall health and well-being. The scales we use are calibrated regularly to ensure accuracy." OHCPs should note in patients’ dental records if patients request not to have their height and weight measured. It is important to maintain sensitivity toward body size; OHCPs can demonstrate this sensitivity by asking patients’ permission to weigh them24 and taking measurements in an area that ensures privacy and confidentiality. Height and weight should be measured in an area that provides adequate space for people of all sizes.
Effective communication between OHCPs and patients is critical, since patients with nonnormal body weight often feel uncomfortable discussing their weight, having their weight measured or both. Demonstrating nondiscriminatory behavior and having a nonjudgmental attitude that "distinguishes between the weight problem and the patient with the problem" are crucial24(p1) and help reduce patients’ discomfort and anxiety.
OHCPs should record BMI and PWC as part of patients’ medical history updates and share the findings with patients23 privately during their appointments. OHCPs should focus discussions with patients who have nonnormal body weight or UWC on the relationship between attaining and maintaining a healthy weight relative to oral and systemic health and refer patients to an RD or physician for in-depth assessment and intervention whenever necessary.20
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CONCLUSIONS
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The multifaceted relationship among body weight, oral health and the globesity epidemic, as well as the frequency with which most patients visit their dentists, support OHCPs’ conducting routine weight screenings in the dental office.4,12,14,15,18 Early detection of nonnormal body weight and UWC and intervention in the form of an OHCP’s referring a patient to an RD or physician may help reduce the patient’s risk of developing chronic and systemic diseases and malnutrition via early intervention and treatment.
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FOOTNOTES
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Dr. Hague is an assistant professor, Division of Dental Hygiene, College of Dentistry, The Ohio State University, 305 W. 12th Ave., P.O. Box 182357, Columbus, Ohio 43218-2357, e-mail "hague.23{at}osu.edu". Address reprint requests to Dr. Hague.
Dr. Touger-Decker is a professor and the director, Division of Nutrition, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, and the chair, Department of Nutritional Sciences-School of Health Related Professions, University of Medicine and Dentistry of New Jersey. She also is the editor of JADA’s Nutrition section.
Disclosure. The authors did not report any disclosures.
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REFERENCES
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- Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293(15):1861–1867.[Abstract/Free Full Text]
- Trust for America’s Health. F as in fat: how obesity policies are failing in America, 2007. "http://healthyamericans.org/reports/obesity2007/". Accessed May 3, 2008.
- Centers for Disease Control and Prevention. U.S. obesity trends 1985–2006. "www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/". Accessed May 3, 2008.
- Genco R, Grossi S, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 2005;76(11 suppl):2075–2084.[Medline]
- Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003;42(5):878–884.[Abstract/Free Full Text]
- Pearson TA, Blair S, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update—consensus panel guide to comprehensive risk reduction for adult patents without coronary or other atherosclerotic vascular diseases. Circulation 2002;106(3):388–391.[Free Full Text]
- Grundy SM, Cleeman JI, Daniels SR, et al.; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/ National Heart, Lung, and Blood Institute scientific statement (published online ahead of print Sept. 12, 2005) (published corrections appear in Circulation 2005;112[17]:e297. e298). Circulation 2005; 112(17):2735–2752.[Free Full Text]
- Gregg EW, Cheng YJ, Cadwell BL, et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults (published correction appears in JAMA 2005;294[2]:182). JAMA 2005; 293(15):1868–1874.[Abstract/Free Full Text]
- U.S. Preventive Services Task Force. Screening for obesity in adults: recommendations and rationale. Ann Intern Med 2003;139(11): 930–932.[Abstract/Free Full Text]
- World Health Organization. Nutrition: controlling the global obesity epidemic. "www.who.int/nutrition/topics/obesity/en/index.html". Accessed May 30, 2008.
- Glick M, Greenberg BL. The potential role of dentists in identifying patients’ risk of experiencing coronary heart disease events. JADA 2005;136(11):1541–1546.[Abstract/Free Full Text]
- Wood N, Johnson R, Streckfus CF. Comparison of body composition and periodontal disease using nutritional assessment techniques: Third National Health and Nutrition Examination Survey (NHANES III). J Clin Periodontol 2003;30(4):321–327.[Medline]
- Ritchie CS, Joshipura K, Hung HC, Douglass CW. Nutrition as a mediator in the relation between oral and systemic disease: association between specific measures of adult oral health and nutrition outcomes. Crit Rev Oral Biol Med 2002;13(3):291–300.[Abstract/Free Full Text]
- Al-Zahrani MS, Borawski EA, Bissada NF. Periodontitis and three health-enhancing behaviors: maintaining normal weight, engaging in recommended level of exercise, and consuming a high-quality diet. J Periodontol 2005;76(8):1362–1366.[Medline]
- Dalla Vecchia CF, Susin C, Rösing CK, Oppermann RV, Albandar JM. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol 2005;76(10):1721–1728.[Medline]
- Glick M. A concern that cannot weight. JADA 2005;136(5): 572–573.[Free Full Text]
- Friedlander AH, Weinreb J, Friedlander I, Yagiela JA. Metabolic syndrome: pathogenesis, medical care and dental implications. JADA 2007;138(2):179–187.[Abstract/Free Full Text]
- Ritchie C, Joshipura K, Silliman R, Miller B, Douglas C. Oral health problems and significant weight loss among community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2000;55(7):M366–M371.[Medline]
- Lee RD, Nieman DC. Anthropometry. In: Nutritional Assessment. 3rd ed. New York: McGraw-Hill; 2003:63–215.
- National Institutes of Health, National Heart, Lung, and Blood Institute and the North American Association for the Study of Obesity. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, Md.: National Institutes of Health; 2000:1–13. NIH publication 00-4084.
- Prentice AM, Jebb SA. Beyond body mass index. Obes Rev 2001;2(3):141–147.[Medline]
- Centers for Disease Control and Prevention. About BMI for adults. "www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm". Accessed May 8, 2008.
- Blatner DJ, Kushner R. Weighing patients: the importance of having the right scale. Obes Manage 2006;2(2):76–77.
- National Institutes of Health, National Heart, Lung, and Blood Institute. Three steps to initiate discussion about weight management with your patients. "www.nhlbi.nih.gov/health/prof/heart/obesity/aim_kit/steps.pdf". Accessed May 3, 2008.
- Lata PF, Elliott ME. Patient assessment in the diagnosis, prevention, and treatment of osteoporosis. Nutr Clin Pract 2007;22(3): 261–275.[Abstract/Free Full Text]
- Shopbell J, Hopkins B, Shronts E. Nutrition screening and assessment. In: Gottschlich M, ed. The Science and Practice of Nutrition Support: A Case-Based Core Curriculum. Dubuque, Iowa: Kendall/Hunt; 2001:119.
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ABSTRACT
WHY CONDUCT WEIGHT SCREENINGS?
