Healthy Weight Management

Maintaining a healthy weight is important to achieve optimum quality of life, maintain physical functions and reduce medical complications.

Healthy body weight is defined as a body mass index (BMI) of 18.5 to 24.9 kg/m2. Overweight is defined as a BMI between 25 and 29.9 kg/m2, and obesity is defined as a BMI >30 kg/m2.

Unplanned Weight Loss

The Centers for Medicare and Medicaid Services (CMS) defines significant weight loss as:

• Loss of 5 percent of body weight in a 30-day period
• Loss of 7.5 percent of body weight in a 90-day period
• Loss of 10 percent of body weight in a 180-day period

CMS defines severe weight loss as:

• More than 5 percent of body weight in a 30-day period
• More than 7.5 percent of body weight in a 90-day period
• More than 10 percent of body weight in a 180-day period

Weight loss of more than 10 percent of body weight during a 30-day period is considered to represent protein-energy malnutrition. Contributing factors to weight loss must be identified to implement appropriate care.

Unplanned Weight Gain

Significant weight gain occurs when BMI increases from overweight (25-29.9 kg/m2) to obesity (>30 kg/m2). In addition to identifying contributing factors, the person's readiness to change their food intake and change their amount of physical activity must be determined. An individualized plan for weight management includes both caloric reduction and physical activity.

Resources Created By HHSC

• Best Practice Prevention and Management of Unintended Weight Loss (PDF) provides evidence-based best-practice guidelines for addressing unintended weight loss in the long-term care setting.

• Best Practice Prevention and Management of Unintended Weight Gain (PDF) provides evidence-based best-practice guidelines for addressing unintended weight gain in the long-term care setting.

• Best Practices in Nutrition Care at End-of-Life (PDF) provides evidence-based recommendations for nutritional support at end-of-life.

• Care Plan – Unintended Weight Loss – Dependence (PDF) is an example of a care plan for managing unintended weight loss in people who need assistance with eating.

• Care Plan – Unintended Weight Loss – Depression and Diet Restrictions (PDF) is an example of a care plan for managing unintended weight loss in people with depression.

• Care Plan – Unintended Weight Gain – Obesity and Sleep Apnea (PDF) is an example of a care plan for managing unintended weight gain in the long-term care setting.

• Care Plan – Weight Loss at the End of Life (PDF) is an example of a care plan for managing weight loss at the end of life in the long-term care setting.

• Weight Loss Notification Form (PDF) can be used to document notifications to the physician, dietitian and family members, as well as updated plans for managing weight loss.

Resources from Other Organizations

• The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obese Adults (PDF) provides the basic tools needed to appropriately assess and manage people who are overweight or obese.

• Mini Nutritional Assessment is a screening and assessment tool that can help identify people age 65 and older who are malnourished or at risk of malnutrition.

• AMDA – The Society for Post-Acute Care and Long-term Care Medicine has an extensive selection of educational resources and problem-solving tools for practitioners and medical directors in long-term care settings. AMDA’s tools and products are developed through its Clinical Practice Committee. Individual titles may be selected. Anyone can order a product, with members getting a significant discount.

• Academy of Nutrition and Dietetics (formerly the American Dietetic Association) provides trustworthy, science-based food and nutrition information for the public and health professional. Topics for the public include Healthy Weight, Eat Right Nutrition Tips, Good Nutrition Reading List and a body mass index (BMI) calculator. Resources for health professional include medical nutrition therapy and position papers such as: Weight Management; Individualized Nutrition Approaches for Older Adults in Health Care Communities; and Ethical and Legal Issues in Nutrition, Hydration and Feeding.

• Weight Management is a resource from the National Institutes of Health that provides up-to-date, science-based information on weight control, obesity, physical activity and related nutritional issues.

• Texas Diabetes Council Toolkit is a resource for treatment algorithms, guidelines and patient education handouts.

• Interactive Dietary Reference Intake (DRI) for Healthcare Professionals can be used to calculate daily nutrient recommendations based on the Dietary Reference Intakes (DRIs). Individual requirements may be higher or lower than the DRIs.

• New Dining Practice Standards (PDF) are nationally agreed upon new food and dining standards of practice support individualized care and self-directed living versus traditional diagnosis-focused treatment for people living in nursing homes.