Instructions for WAVE
Assessment | Recommendations

Assessment

Weight Determine if patient is overweight using the Body Mass Index (BMI>25).  Visually assess for fat distribution associated with higher health risk (abdominal fat) and body tone.  Consider checking waist circumference to document visceral obesity (>35 inches for women, >40 inches for men).  If overweight, inquire briefly about weight history and weight-loss attempts. Ask what weight the patient thinks is healthy for him or her. Address underweight or recent unintentional weight loss in patients who are at risk for undernourishment: the elderly, young women (eating disorders), some low-income individuals, and disease-specific conditions affecting food intake. Note responses for incorporation into your recommendations at the completion of WAVE assessment.

Activity Ask if patient does regular physical activity (goal = 30 minutes per day, 5 or more days per week).  Share examples: brisk walking, jogging, swimming, aerobics, gardening, golf, biking, dancing, team sports, etc.  How often? Ask if patient adds activity into lifestyle when possible, i.e. taking stairs instead of elevators/escalators, parking further away, etc. This could also include physical activity that occurs as part of someone's job (i.e.construction, waitressing, etc). Ask how many hours the patient devotes to sedentary activities (television/videos, or computer use, etc.) per day. Note responses for incorporation into your recommendations at the completion of WAVE assessment.

Determine Variety and Excess Find out what the patient usually eats utilizing one of several methods: Qualitative review of food intake compared to the Food Guide Pyramid One day recall: Ask patient to briefly describe everything he or she had to eat or drink yesterday beginning with the first thing eaten after waking up.  Probe about portion sizes, preparation methods, and condiments, i.e., butter, margarine, sour cream, and salad dressing, gravies, etc. Self-administered food habits questionnaires (i.e. NAA-REAP, Rate Your Plate, etc.). Ask how many meals per week the patient eats out (or gets take-out).  How often are these meals from fast food restaurants, i.e. McDonalds, KFC, etc.? Compare patient's intake with the recommended servings from the Food Guide Pyramid (meats, dairy, fruits and vegetables, grains). Look at patient’s food choices to see if they appear to be eating too much fat, salt, sugar, calories, etc.  Is patient eating any of the following foods in large amounts: high fat meat, high fat dairy products (whole milk, cheese, ice cream), fried foods, high fat/sugar snacks and desserts, butter, mayonnaise, cream cheese, salad dressing and other added fats, high sugar beverages, processed meats, salty snacks, canned/frozen meals, fast foods, and/or eating out >4 meals/week? Determine if patient eats for reasons other than hunger (emotional, boredom, depression, social). It is often helpful to ask whether the pataient takes supplements or herbal products.

The WAVE nutrition pocket guide was developed by Claudia Barner PhD, RD, Judith Wylie-Rosett EdD, RD, Kim Gans PhD, MPH, LDN and members of the Patient and Practice Resources Committee, NIH Nutrition Academic Award with funds from NIH NAA grant HL03924.