A patient's overall diet and other nutritional issues are often overlooked during a routine doctor's visit because of time constraints. Nutritionists at UT Southwestern, however, have developed a plan called the WAVE Nutrition Pocket Guide for Primary Care, which allows providers to assess a patient's diet and physical activity in about five to 10 minutes during routine visits. WAVE, an acronym for weight, activity, variety and excess, was developed primarily to:

• Provide a quick tool for primary-care providers to discuss weight, physical activity and eating habits with adult patients
• Present a four-letter acronym that is easy to remember and utilize in provider-patient interactions
• Identify weight, nutrition and physical activity issues to be addressed during an office visit or by referral to a dietitian
• Reinforce the importance of nutrition and physical activity in health promotion and disease prevention

"The intent of the pocket guide is to present a consistent method for physicians to address nutrition. The guide allows physicians to assess patients' weight, physical activity and diet in terms of variety and excess," said Dr. Jo Ann Carson, associate professor of clinical nutrition at UT Southwestern. "Patients are more likely to initiate behavioral changes when providers stress the importance of nutrition and physical activity."

Weight is the first issue addressed in the assessment."It's important to address obesity and weight in patients because of diseases associated with obesity," she said." If patients are overweight or obese, they are at greater risk for heart disease, some types of cancer, hypertension, diabetes and a variety of other medical problems." To determine if a patient is overweight or obese, physicians measure body mass index (BMI), or a person's weight in kilograms divided by height in meters squared. A BMI of 25 or greater indicates a patient is overweight.

"If patients are overweight, providers should express concern that weight could be affecting their health and give specific advice about making one or two changes in eating habits. Some examples are limiting calorie-containing beverages such as fruit drinks and sodas. Providers should also recommend that patients gradually increase activity," Dr. Carson said. Patients with healthy BMIs should be given information about physical activity and dietary changes that will allow them to maintain their weight, she added.

Activity is the second assessment. Questions in the 5- by 7-inch pocket guide allow the provider to assess a patient's physical activity. If a patient does not participate in 30 minutes of moderate physical activity or lifestyle activities, such as taking the stairs instead of the elevator on most days of the week, and spends more than two hours daily watching television, a gradual increase in physical activity is advised. "If a patient is ready to make behavioral changes, then jointly set goals for a plan of action and arrange for follow-up," Dr. Carson said. "Patients should also be encouraged to decrease the time spent watching television or videos, or incorporate an exercise regimen when watching television."

The third and fourth pocket guide assessments examine variety and excess in the diet. "If a patient's diet lacks variety, he or she is probably consuming too much of some foods and too little of others," Dr. Carson said. Providers should discuss eating habits to determine if patients are getting adequate variety or an excess of foods in their diet. "It's important to emphasize the good things patients are doing in their diets and the things that should be changed or minimized. It may be a simple change from whole milk to 2 percent milk. Referral to a dietitian for more extensive counseling and support may also be required," she said.

Dr. Carson is currently instructing third-year medical students on how to use the WAVE pocket guide. In 1998 the Center for Human Nutrition received the Nutrition Academic Award, a five-year grant from the National Heart, Lung and Blood Institute. The grant's purpose is to increase opportunities for students, house staff, faculty and practicing physicians to learn nutrition principles and clinical practice skills, with an emphasis on preventing cardiovascular diseases, obesity, diabetes and other chronic diseases.

Dr. Claudia Barner, a retired faculty member in clinical nutrition, coined the WAVE acronym and contributed to the development of the pocket guide.