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SKILLS TRAINING MATERIAL BOOK

ANTHROPOMETRY FOR HEALTH RISK SCREENING

BLOCK 3.6

Skills Laboratory
Faculty of Medicine
Universitas Gadjah Mada
Yogyakarta
2015
ANTHROPOMETRY FOR HEALTH RISK SCREENING

CONTRIBUTORS
Santosa Budihardjo Neni Tri Lusiana Rahmawati
Staff of Department of Anatomy and Staff of Department of Bio- &
Embryology Paleoanthropology
Faculty of Medicine UGM Faculty of Medicine UGM

Istiti Kandarina
Staff of Department of Public Health
Faculty of Medicine UGM
PREFACE

Students of medical school need to learn and practice some clinical skills as
preparing to enter clinical rotation before they become real doctor. Medical school is
nowadays convinced that students should master the skills before they make contact with
real patients. Therefore, an early skills training is needed. Skills laboratory allows
students to learn and practice their clinical skills.
The topic in this manual book is one of the topics under the main topic: General
Physical Examination which will be studied continuously within blocks during
undergraduate studies. The skill included in this book is based on Competency-Based-
Curriculum 2007. The topics included under General Physical Examination in Year 3 are
listed as follows:

No. Skills Training Topic Block


1 Heart 2 and Lung 2 3.2
(pathology) (Chest Complaint)

2 Abdominal Exam 2 3.3


(Ascites, any complication) (Abdominal Complaint)

3 ESP 1 3.5
(Neuro-sensory Complaint)
4 ESP 2 3.6
(Life-style related Complaint)
5 Anthropometry for health status screening 3.6
(Life-style related Complaint

It is important for students to be aware that all topics included are related to each
other. Therefore, students are hoped to be able to group those topics under their main
topic so that the continuity of the topics is obtained. We hope this skills training manual
book will be useful for the students to improve their skills especially in physical
examination and for instructors who involved in the skills training.

Yogyakarta, April 2015


Contributors
ANTHROPOMETRY FOR HEALTH STATUS SCEENING

GENERAL OBJECTIVES OF SKILLS TRAINING YEAR 3


1. Students are able to make and maintain doctor-patient interaction
2. Students are able to determine differential diagnosis from patients problems
3. Students are able to plan a rational medication
4. Students are able to negotiate CARE PLAN with patient by considering bio-socio-
cultural aspects (the involvement of family, use of traditional remedy, and
patients perception and behavior)

LEARNING OBJECTIVE:
1. Collecting data for health screening using anthropometry methods nutritional
status assessment.; body composition, and risk factors,
2. Skillful in measurement of anthropometry professionally including good
interpersonal relationship, subject satisfaction, and clinical reasoning.
3. Analyze data and presentation

LESSON PLAN:
Session one (2 hours at Skills Lab)
1. Tasks description Review material with instructor (20 minutes)
2. Collecting data (measurement) (80 minutes)

Independent Learning
1. Analyzing and interpreting the data
2. Reporting the conclusion and negotiating future plan

Panel Discussion
1. Report presentation
2. Reflection
ANTHROPOMETRY FOR HEALTH STATUS SCREENING
ANTHROPOMETRY SCOPE
Anthropometry is the measurement of man and is often referred to as the study
of body dimensions. Anthropometry is the technique of expressing quantitatively the
form of the body (Cameron, 1978). Hrdlicka (1947), cit. Cameron (1978), defines it as a
system of techniques, the systematized art of measuring and taking observation of man,
his skeleton, his brain, and other organs, by the most reliable means and methods for
scientific purposes. Thus, anthropometry consists of systemized measuring techniques
that express in a quantitative manner the dimensions of the human body (Roche &
Malina, 1983).
The science of anthropometry developed mostly in an anthropological context,
frequently anthropometry is viewed as the traditional and perhaps the most basic tool in
physical anthropology, but it also has a long tradition of use in physical education.
Anthropometry developed as a study for the classification and identification of racial
differences and the effects of diet and living conditions on growth (auxological
anthropometry). Lately, anthropometry has become important in the rapidly expanding
field of ergonomics, the science and ad of adapting machines and working space to the
people who use them (Olivier, 1968). Roche and Molina (1983) noted that
anthropometry has many diverse applications. It is an essential element of growth
studies, morphological comparisons among population nutritional status assessment,
constitutional medicine, human engineering and studies of human performance.
Anthropometry appears deceptively simple. However, the development of an
anthropometrists touch is seldom achieved without extensive practice. Most individuals
seem to establish reasonable competence after triple measurement and spot checking
for systematic error on 100 or more subjects. By definition, a criterion anthropometrist is
one who purportedly does not make systematic errors from a prescribed technique. As a
service to the international scientific community, the International Working Group in
Kinanthropometry (IWGK) holds certification courses and workshops that are designed
primarily for established investigators to learn I~ protocols.
Anthropometry involves the use of carefully defined body landmarks for
measurements, specific subject positioning for these measurements, and the use of
appropriate instruments. The number of measurements that can be taken on an
individual is almost limitless. They are generally divided into measurements on mass
(weight), lengths and heights, breadths or widths, depths, circumferences or girths,
curvatures or arcs, and soft tissue measurements (skin folds). In addition, numerous
special measurements for specific body parts can be defined, as in cephalometry for the
head and face. In other words, the measurements either treat the body as a whole (e.g.,
stature), or divide the body into specific parts (e.g., limb lengths).
Implicit in studies utilizing anthropometric methods is the assumption that every
effort is made to ensure accuracy of measurement and standardization of technique.
Further, it is assumed that measurements are made by trained observers. In
anthropometry we consider observer error, to err is human. Differences between
observers (inter-observer error) and imperfect replications by a single observer (intra-
observer error) contribute significantly to measurement error in anthropometric studies.
Therefore, quality control and careful monitoring of the measurement process is
essential.
Accurate instrumentation has overcome many of the inherent errors in
anthropometry, but the greatest source of error comes from the measurer himself.
Hirdlicka (1947), in his treatise on practical anthropometry, described the qualities
needed by an anthropometrist: good eyesight for distance and color, freedom from
halitosis and other unpleasant odors, sympathy, perseverance, orderliness, honesty and
carefulness. He should be careful of the sensibilities of his subjects, careful in technique,
careful in reading the scale of his subject, careful in recording and capable of
concentration on his work. The lack of these qualities has produced more errors than all
other causes together. It is interesting to note that he thought men to be superior to
women as anthropometrists, although women excelled in carefulness and devotion to
work, they lacked the stamina for field work and marriage would seriously hamper their
careers. Though this is only a reflection of the times in which he practiced medicine, and
holds little credence today.
Body measurements have multiple uses in many disciplines, including pediatrics,
orthopedics, dentistry, orthodontics, physical education, general education, human
engineering, sports medicine, public health, and nutrition. Before any measurement is
made, certain questions should be asked. What is the purpose of this measurement?
What information will this measurement provide? Thus, a necessary preliminary to the
application of anthropometry is through logical analysis beginning with a clear concept of
the knowledge sought and leading to a selection of the measurements needed to obtain
an acceptable answer.
Anthropometric data are relevant to the design of workspace, clothing, furniture,
and toys. Subject comfort, safety, and function are of basic importance, yet a broad
range of normal variability must be accommodated. For example, seating for elementary
school children must be wide enough and long enough to accommodate larger children
in the age group but not uncomfortable for a small child. To solve such problems,
designers and manufactures need data on anthropometric dimensions.
We can take the data from subjects both static, i.e., measurements made while
the subjects in a fixed, standardized position, and functional or dynamic, i.e.,
measurements made while the subjects is in the position required for a specific task or
while the body is in motion (e.g., functional arm or leg lengths).
Measurements of body composition are more complex than the measurement of
body size and dimensions. Although studies of stature and weight provide information
that is valuable in understanding growth processes, these external dimensions represent
many tissues. Stature is the sum of a large number of bone lengths, plus the intervening
cartilages less an amount due to the fact that the long axes of the bones that contribute
to stature are not in the same straight line. Similarly, body weight is the sum of weight of
muscle, fat, the skeleton and numerous organs.
Indirect estimates of body composition are usually based upon a two
compartment model, i.e., body weight is partitioned into a fat component and a lean
component. The weight of one component is measured indirectly, while the weight of the
other is derived by subtraction from total body weight.
However, definition of the lean component varies. It is referred to as either lean
body mass (LBM), lean body weight (LBW), fat free mass (FFM) or fat free weight
(FFW). Some treat these terms as synonymous, but there are basic differences between
them. LBM and LBW are in vivo concepts, while FFM and FFW are based on in vitro
concepts. The two differ in that essential lipids, variously estimated from 2 to 10% of
FFW, are included with LBM and LBW but not with FFM or FFW.

PROTOCOL
The measurement protocol outlined is summarized notes, based on
Anthropological view: Comas (1960) and Olivier (1968), Auxological anthropometry:
Cameron (1978), Ergonomics Perspectives: Pheasant (1978), Pulat (1986),
Bhattacharya & McGlothlin (1994), Sports and Kinanthropometry view: Ross & Marfell-
Jones (1991), and Norton (2004)

INSTRUMENTS
The anthropometry instruments consist of various types, such as field or portable
instruments, and others with digital display counters or not. The instruments are
anthropometer (portable), calibrated weighing beam or scale, flexible steel tape, and
skinfold calipers. The instruments are manufactured by many licensed and well-known
factories such as Siber-Hegner GPM of the Martin, Creative Health Product, TNM
Product, Cambridge Scientific Industries, and Cambridge Maryland. It is important to use
instruments that are produced by licensed firms, so that high reliability and
reproducibility can be ensured.
The anthropometer is used to measure heights, length, and span. The weighing
beam measures weight. Flexible steel tape is used to measure circumferences. The
skinfold calipers measure skinfold thickness.

Anthropometric

Skin-fold Caliper Steel tape


Calibrated Weighing Landmark
Beam pencil

Anthropometry instruments

CONVENTIONS AND SURFACE LANDMARKS/ANTHROPOMETRIC POINTS


The following surface landmarks are described in some detail because of their
importance to accuracy of measurement. Student anthropometrics should take time to
become fully acquainted with the techniques of palpation and learn some surface
anatomy (Anthropometric points) before attempting to measure.
Because the body can assume a variety of postures, Anthropometric description
always refers to the anatomical position, but there is an exception in facing the palms,
i.e. facing medially. The Standard Anthropometric position is a standing position (erect
position) on a horizontal surface (called ground) with the head and eyes directed
forward, the upper limbs hanging by the sides with palms downward, facing medially
(turned inward), and the fingers pointing directly downward, and the feet together, the
heels in contact and the toes pointing directly forward. This position is utilized, except
when there are specifications for marking the subject mentioned.
The landmarks of measurements refer to the anthropometric points. The
anthropometric points are firstly the name of parts of bones, and on living man can be
identified from the body surface, especially on a lean body. There are odd or sagittal
anthropometric points, i.e. vertex, and paired or lateral anthropometric points, i.e.
acromiale. For paired anthropometric points, both are measured, but it is recommended
to use the right measurement in data analysis.

TECHNIQUES FOR TAKING THE MEASUREMENTS


1. Stature
Stature can be measured by four general techniques yielding slightly different
values: freestanding stature, stature against a wall, recumbent length and stretch
stature. The standard method used is stretch stature. This stature requires precise
positioning of the subject to obtain useful measurements. The measurement is taken as
the maximum distance from the floor to the vertex of the head.
Anthropometric point and landmark

2. Body Weight
Body mass, or ideally body weight, should be obtained on an accurately
calibrated beam-type balance and recorded to the nearest tenth of a kilogram. The
subject should be weighed nude or in clothing of a known weight so that a correction to
nude weight can be made. The most stable values for monitoring weight change are
those obtained routinely in the morning (12 hours).

Taking body height (stature)


Taking body weight Waist circumference Hip circumference

3. Circumferences (girths)

Waist circumference/ abdominal circumference


Abdominal circumference is described as the maximal horizontal circumference
at the level of the navel. The waist circumference is the minimum circumference of the
waist. Generally the waist circumference descriptions tend to suggest a measurement as
the minimum circumference of the abdomen between the iliac crests and the lowest ribs.
Sometimes the waist circumference and abdominal circumference are at the same level.

Hip circumference
Hip circumference is taken at the symphysion (the upper point at the symphysis pubis)
and the maximal posterior of the buttock.

4. The skin folds thickness


The skinfold is often described as a pinch but the action to obtain it is to sweep
the index or middle finger and thumb together over the surface of the skin from about 6-8
cm apart and collect the subcutaneous tissue pushed away from the underlying muscle
fascia by this action.
To pinch the subject suggests a very small and painful pincer movement of the
fingers, and this is not the movement made. First, the measurement of skin folds should
not cause undue pain to the subject, who may be apprehensive anyway from the
appearance of the calipers and will tend to pull away from the measurer. Secondly, a
pincer or pinching action does not collect the quantity of subcutaneous tissue normally
measured.
The experienced anthropometrist knows that this measurement is prone to many
errors. Location of the correct sites is critical, but the variation in the consistency of
subcutaneous tissue and the individual way in which each measurer collects the fold of
tissue seem to be the main sources of error. A search of the relevant literature shows
that the technique of skin fold measurement is hardly ever described, even by eminent
workers in the field, and it is therefore not surprising to encounter very poor reliabilities
and standard errors in written work, if indeed they are mentioned at all.
The standard deviation of the differences between duplicate measurements
taken by a single observer at the triceps, subscapular, and suprailiac sites is 0.3 - 0.6
mm at a jaw opening of 7 mm. The equivalent figures for different observers were
roughly twice these values even when the sites of measurement were marked. This
accuracy is described as being sufficient for any presently conceivable purpose. At
greater openings, the absolute error increases but the percentage error between
duplicate readings stays constant at about 5% for two thirds of repeated readings.
Only proper training, experience, a good deal of practice, and repeated
consistency tests will provide the efficiency needed for this measurement, and expert
advice should always be sought before embarking on skin fold measurements.

Triceps skinfold thickness


The subject stands with his back to the measurer and his arm relaxed with the
palm facing the lateral thigh. The tips of the acromial process and olecranon are
palpated, and a point halfway between is marked on the skin. The skinfold is picked up
over the posterior surface of the triceps muscle 1 cm above the mark, on a vertical line
passing upwards form the olecranon to the acromion, and the caliper jaws are applied at
the mark. The caliper is held as illustrated in Figure number 2, and the fingers of the
right hand relax their grip to ensure that the caliper exerts its full pressure of 10 g/mm 2.
The left hand maintains the pinch throughout the measurement.
This usually results in a stable reading, up to 20 mm, but above this, the
measurement registered sometimes decreases as the measurer watches the dial. A
firmer grip by the left hand may prevent this. If not, then the reading should be calibrated
to 0.2 mm, but the measurement can be conveniently estimated to the last completed
0.1 mm. It is advantageous to request that the subject bend the arm before taking the
skinfold and straighten it before applying the caliper.This causes any muscle which may
have been picked up by the overzealous measurer to be pulled out from the skinfold by
the contracting action of the triceps at arm extension.

Measuring triceps skinfold


Source: Norton, K.; Olds, T., 2004. Anthropometrica. Australia, UNSW Press.

Biceps skinfold thickness


The subject faces the measurer with the arm held relaxed at his side and the
palm facing forwards. The skinfold is picked up over the belly of the biceps and 1 cm
above the line marked for the upper-arm circumference and triceps skinfold on a vertical
line joining the center of the antecubital fossa to the head of humerus. The caliper jaws
are applied to the marked level.
Measuring biceps skinfold
Source: Norton, K.; Olds, T., 2004. Anthropometrica. Australia, UNSW Press.

Infrascapular skinfold
The subject stands as for triceps skinfold with the shoulders and arms relaxed. It
is quite easy on an average subject to determine the inferior angle of the scapula below
which the skinfold should be taken, but it is not so simple on the obese subject. To
locate this point, palpate the medial border of the scapula and run the fingers of the left
hand downwards along its full length until the inferior angle is located. The skinfold is
picked up immediately below the inferior angle of the scapula with the fold either in the
vertical line or slightly inclined, downwards and laterally, in natural cleavage of the skin.

Measuring infrascapula skinfold

Supraspinale skinfold
With the subject standing sideways with his arm folded, the skinfold is picked up
vertically about 1 cm above and 2 cm medial to the anterior suprailiaca spine. The
caliper is applied just below the fingers. This site varies, depending on the position of the
superior anterior iliac spine and may be in the mid-axillary line or anterior to it.
Measuring supraspinale skinfold
Source: Norton, K.; Olds, T., 2004. Anthropometrica. Australia, UNSW Press.

SCENARIO FOR TRAINING

Measure this body dimensions with the proper instrument and procedures! Use and fill
the anthropometric form Furthermore during you measure, check your work by check
list.
1. Nutritional status: body weight, body height

2. Body Composition: body weight, body height, 4 skinfolds location (biceps,


triceps, supra-iliaca, infrascapular)

3. Risk factors: hip-waist ratio (hip circumference, waist circumference), body


frame index (wrist circumference, body height)

1. Body mass index (Nutritional status)


Body mass index is body weight in kg divided by square of body height in meter
Please consult your result to this classification:
According to Bardeen-Gould-Kauf, Body weight in gram, and stature in cm so there are
constitutional classification according its index.

BMI (Index of Bardeen-Gould-Kauf) = body weight (kilogram) divided by square of


stature (meter)
Classification BMI
(Asian people-adult)
Morbidity Obese over 40
Obese 27,6-40
Overweight 23-27,5
Healthy / normal 18,5-22,9
Underweight 15-18,4
Starving < 14,9
2. Percentage of body fat (Body Composition)

Estimating Body Fat and Fat-Free Mass According to the Method of Durnin and
Wormesley

Method. (1) Determine the patients age and weight (in kgs). (2) Measure the following
skinfolds (in mms): biceps, triceps, subscapular and suprailiac / supraspinale. (3)
Compute the sum by adding the four skinfolds. (4) Compute the logarithm of the sum. (5)
Apply one of the equations from Table [equations for estimating Body Density from the
sum of 4 skinfolds measurement] to compute body density (D, g/mL). (6) Fat mass is
calculated as follows:

Fat mass (kg) = body weight (kg) x [(4.95/D 4.5]

Where D is obtained from the formulas shown in Table. (7) Fat-free body mass (FFM) is
calculated as follows:
FFM (kg) = body weight (kg) fat mass (kg)

Sum your four skinfold thickness i.e. Triceps, biceps, infrascapular and suprailiaca (mm)
Please consult your result to this table.

Body fat (%) state classification (Irianto, 2000)

% Body fat males % Body fat


Classification 18-34 years females
18-34 years
Very good 10.0 10.8 15.0 15.8
Good 11.7 15.0 16.7 20.0
Enough 16.1 23.8 21.1 28.8
Bad 25.0 35.0, and 30.0 40.0
over
Tabel: konsultasi % lemak tubuh laki-laki Tabel: konsultasi % lemak tubuh wanita
_________________________________________ ____________________________________________
Tebal total usia: 17 29 30 39 40 49 50+ Tebal total usia: 16 29 30 39 40 49 50+
Mm persentase lemak tubuh Mm persentase lemak tubuh
15 4,8 15 10,5
20 8,1 12,20 12,20 12,60 20 14,1 17,00 19,80 21,40
25 10,50 14,20 15,00 15,60 25 16,80 19,40 22,20 24,00
30 12,90 16,20 17,70 18,60 30 19,50 21,80 24,50 26,60
35 14,70 17,70 19,60 20,80 35 21,50 25,68 28,20 30,30
40 16,40 19,20 21,40 22,90 40 23,40 26,90 29,60 31,90
45 17,70 20,40 23,00 24,70 45 25,00 28,20 31,00 33,40
50 19,00 21,50 24,60 26.50 50 26,50 29,40 32,10 34,60
55 20,10 22,50 25,90 27,90 55 27,80 30,60 33,20 35,70
60 21.20 23.50 27.10 29,20 60 29,10 31,60 34,10 36,70
65 22,20 24.30 28.20 30,40 65 30,20 32,50 35,10 37,70
70 23.10 25.10 29,30 31.60 70 31,20 33,40 35,90 38,70
75 24.00 25.90 30.30 32.70 75 32,20 34,30 36,70 39,60
80 24.80 26.60 31.20 33.80 80 33,10 35,10 37,50 40,40
85 25.50 27.20 32.10 34.80 85 34,00 35,80 38,30 41,20
90 26.20 27.80 33,00 35.80 90 34,80 36.50 39,70 41,90
95 26,90 28.40 33.70 36,60 95 35,60 37,20 40,40 42,60
100 27.60 29.00 34.40 37,40 100 36,40 37,90 41,00 43,30
105 28.20 29,60 35.10 38.20 105 37,10 38,60 41,50 43,90
110 28.80 30,10 35.80 39.00 110 37,80 39,10 42,00 44,50
115 29.40 30,60 36.40 39.70 115 38,40 39,60 42,50 45,10
120 30.00 31,10 37.00 40.40 120 39,00 40,10 43,00 45,70
125 30.50 31.50 37.60 41.10 125 39,60 40,60 43,50 46,20
130 31.00 31,90 38.20 41.80 130 40,10 41,11 44,00 46,70
135 31.50 32.30 38.70 42.40 135 40,80 41,60 44,50 47,20
140 32.00 32,70 39.20 43.00 140 41,30 42,10 45,40 47,70
145 32.50 33.10 39.70 43.60 145 41,80 42,60 45,80 48,20
150 32.90 33.50 40.20 44.10 150 42,30 43,10 46,20 48,70
155 33.30 33.90 40.70 44.60 155 42,80 44,00 46,60 49,20
160 33.70 34.30 41.20 45.10 160 43,30 44,40 47,00 49,60
165 34.10 34.60 41.60 45.60 165 43,70 44,80 47,40 50,00
170 34.50 34.80 42.00 46.10 170 44,10 45,20 47,80 50,40
175 34.90 - - - 175 45,60 48,20 50,80
180 35.30 - - - 180 45,80 48,50 51,20
185 35.60 - - - 185 46,20 48,90 51,60
190 35.90
Durnin & Womersley, 1974 Body fat assessed from total body body
density and its estimation from skinfold thickness measurements on
481 men and women aged from 16-72years. Br. J. Nutr., 32:77.

3. The pattern of fat distribution/WHR =Waist and hip ratio


The formula is waist circumference is divided by hip circumference
The result:
Over 0.9 : apple or android pattern
Under 0.9 : pear or gynecoid pattern
Male waist : over 40 inch is considered dangerous/risk for health problems
Female waist : over 35 inch is considered dangerous/risk for health problems
REFERENCES
Carter JEL & Heath BH. 1990 Somatotyping, Development, and Applications.
Cambridge University Press., New York.
Day, JAP. 1986. Perspectives in Kinanthropometry. Human Kinetics Publisher, Inc.
champaign.
Durnin, JVGA. & Wormersley,J 1974. Body fat assested from total body density and its
estimation from skinfold thickness measurements. Br. J. Nutr.,32:77
Grant,JP. 1980. Handbook of Total Parental Nutrition. WB. Saunders Company,
Philadelphia.
Irianto, DP. 2000. Panduan Latihan Kebugaran yang efektif dan aman. Lukman offset,
Yogyakarta.
Noel, C. 1978. The Methods of Auxological Anthropometry in Falkner, F & Tanner,
JM(eds): Human Growth 11. Plenum Press, New York.pp. pp.35-90.
Olivier,G. 1969. Practical Anthropology. Charles C Thomas Publisher,Springfield.
Pheasant, S.1986. Body Space. Taylor & Francis, London.
Ross, WD & Marfell-Jones, MJ 1990. Kinanthropometry in MacDougall, JD., Wenger,
HA. & Green, HJ. (eds): Physiological Testing of the High-Performance Athlete.
Human Kinetics Books, Champaign.
Norton, K.; Olds, T., 2004. Anthropometrica. Australia, UNSW Press.

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ANTHROPOMETRIC SKILLS CHECK LIST FOR TRAINING SESSION
NUTRITIONAL STATE

Case: Measure the patient on stature and body weight. Determine the body patient mass index of
the patient.
No Point of Adjustment Feedback
1. Introducing and build interpersonal relationship
Explaining the purpose of the procedure to patients
2. Mentioning the goal of measuring to the patient and informed consent
3. Taking the identity and fill in the anthropometric form
Performing steps of procedural skills
4. Instruments preparation properly
5. Order to wear clothes minimized, put off shoes, giving proper instruction
6. Choose the right instruments
7. Measure body-weight properly
8. Measure body-height / stature properly
9. In measuring; Observer, instruments and subject in proper Position
10. Before Read the completed unit and Record the mark, recheck the correct
position of patient and tool
11. Three times measurement each parameter (repeat the procedure) and
count the average
Communicating the conclusion of examination result
12. Record the mark, and filled in the correct form and tell the result (average)
to the patient or observer
13. Conclusion
Negotiating treatment plan for patient with patient and patients family
14. Future plan

Item for Global Rating Scale Professionalism


No. Scale
Items
1 2 3 4 5
1. Dealing with one-self: Demonstrating confidence as a health-professional
2. Dealing with others: Ethics (Respect the patient, demonstrate local values
and norms)
3. Dealing with task: Minimal Error during performing the skills (systematic in
procedures, harmless)

Item for Global Rating Scale Doctor-Patient Interaction


Scale
No. Skills Scientific basis and explanation 1 2 3 4 5
Unexpected Below Meet Exceeding Excellent
expectation expectation expectation

1. Building and Ability to build a good relationship


maintaining (through active listening, response properly,
adequate empathy, interpersonal communication and putting
relationship with patient at ease)
patients during the
whole consultation
2. Exploration on Ability to build a good relationship, explore
patient problem and patients problem and summarize it (through
summarize the exploration, data gathering, history taking, allo-
problem anamnesis, checking and summarization)

3. Patient education Ability to build a good relationship, explore


and counseling patients problem, summarize it, formulate working
plan and negotiating it with patient and family
(through education and counseling)
ANTHROPOMETRIC FORM
NUTRITIONAL STATE

Case : Measure the patient on stature and body weight. Determine the body patient mass index of the
patient

I. Identity

No Variable
1 Name of subject
2 Age
3 Sex
4 Race / Ethnic
5 Measurer
6 Assistance
7 Place/Date/Time

II. Base Data

No Variable 1st measure 2nd measure 3rd measure Average


1. Stature
2. Body mass (kg)

III. Data Analyze

Body Mass Index / Nutritional Status


Body Mass Index = weights in kg/square of Stature (meter)
=
Conclusion

Classification BMI
(Asian people-adult)
Morbidity Obese over 40
Obese 27,6-40
overweight 23-27,5
Healthy / normal 18,5-22,9
underweight 15-18,4
Starving < 14,9

Recommendation for patient: ..


Yogyakarta, .......................................
Measurer

Name: .............................................
ANTHROPOMETRIC SKILLS CHECK LIST FOR TRAINING SESSION
BODY FAT PERCENTAGE

Case: Measure the patient on the biceps, triceps, infrascapula, and supraspinale skinfold.
Count the total of fourth skinfold consult the table and find the body fat percentage

No Feedback
Point of Adjustment
1. Introducing and build interpersonal relationship
Explaining the purpose of the procedure to patients
2. Mentioning the goal of measuring to the patient
3. Taking the identity and fill in the anthropometric form
Performing steps of procedural skills
4. Instruments preparation properly
5. Order to wear clothes minimized, put off shoes, giving proper instruction
6. Choose the right instruments
7. Measure biceps skinfold properly
8. Measure triceps skinfold properly
9. Measure infrascapula skinfold properly
10. Measure suprailiaca / supraspinale skinfold properly
11. In measuring; Observer, instruments and subject in proper position
12. Before Read the completed unit and Record the mark, recheck the correct
position of patient and tool
13. Three times measurement each parameter (repeat the procedure) and count
the average
Communicating the conclusion of examination result
14. Record the mark, and filled in the correct form and tell the result (average)to
the patient or observer
15. Conclusion
Negotiating treatment plan for patient with patient and patients family
15. Future plan
Item for Global Rating Scale Professionalism
No. Items Scale
1 2 3 4 5
1. Dealing with one-self: Demonstrating confidence as a health-professional
2. Dealing with others: Ethics (Respect the patient, demonstrate local values
and norms)
3. Dealing with task: Minimal Error during performing the skills (systematic in
procedures, harmless)
Item for Global Rating Scale Doctor-Patient Interaction
Scale
No. Skills Scientific basis and explanation 1 2 3 4 5
Unexpected Below Meet Exceeding Excellent
expectation expectation expectation

1. Building and maintaining Ability to build a good relationship


adequate relationship with (through active listening, response properly,
patients during the whole empathy, interpersonal communication and
consultation putting patient at ease)
2. Exploration on patient Ability to build a good relationship, explore
problem and summarize patients problem and summarize it (through
the problem exploration, data gathering, history taking,
allo-anamnesis, checking and
summarization)
3. Patient education and Ability to build a good relationship, explore
counseling patients problem, summarize it, formulate
working plan and negotiating it with patient
and family
(through education and counseling)
ANTHROPOMETRIC FORM
BODY FAT PERCENTAGE

Case: Measure the patient on the biceps, triceps, infrascapula, and suprailiaca skinfold. Count
the total of fourth skinfold consult the table and find the body fat percentage

I. Identity

No Variable
1 Name of subject
2 Age
3 Sex
4 Race / Ethnic
5 Measurer
6 Assistance
7 Place/Date/Time

II. Base Data

No Variable 1st 2nd 3rd measure Average


measure measure
1. Biceps
2. Triceps
3. Infrascapula
4. Suprailiaca / supraspinale

III. Data Analyze


Estimating Body Fat and Fat-Free Mass According to the Method of Durnin and Wormesley

Fat mass is calculated as follows:

Fat mass (kg) = body weight (kg) x [(4.95/D 4.5]

Where D is obtained from the formulas shown in Table. (7) Fat-free body mass (FFM) is calculated as
follows:
FFM (kg) = body weight (kg) fat mass (kg)

Conclusion
Classified the % body fat = bad / enough / good / very good
=

Recommendation for patient: ..


ANTHROPOMETRIC SKILLS CHECK LIST FOR TRAINING SESSION
WAIST-HIP RATIO

Case: Measure the patient on waist and hip circumferences count the waist-hip ratio

No
Point of Adjustment Feedback
1. Introducing and build interpersonal relationship
Explaining the purpose of the procedure to patients
2. Mentioning the goal of measuring to the patient
3. Taking the identity and fill in the anthropometric form
Performing steps of procedural skills
4. Instruments preparation properly
5. Order to wear clothes minimized, put off shoes, giving proper instruction
6. Choose the right instruments
7. Measure waist circumferences properly
8. Measure hip circumferences properly
9. In measuring; Observer, instruments and subject in proper position
10. Before Read the completed unit and Record the mark, recheck the correct
position of patient and tool
11. Three times measurement each parameter (repeat the procedure) and count
the average
Communicating the conclusion of examination result
12. Record the mark, and filled in the correct form and tell the result (average)to
the patient or observer
13. Conclusion
Negotiating treatment plan for patient with patient and patients family
14. Future plan

Item for Global Rating Scale Professionalism


No. Items Scale
1 2 3 4 5
4. Dealing with one-self: Demonstrating confidence as a health-professional
5. Dealing with others: Ethics (Respect the patient, demonstrate local values
and norms)
6. Dealing with task: Minimal Error during performing the skills (systematic in
procedures, harmless)
Item for Global Rating Scale Doctor-Patient Interaction
Scale
No. Skills Scientific basis and explanation 1 2 3 4 5
Unexpected Below Meet Exceeding Excellent
expectation expectation expectation
4. Building and maintaining Ability to build a good relationship
adequate relationship with (through active listening, response properly,
patients during the whole empathy, interpersonal communication and
consultation putting patient at ease)
5. Exploration on patient Ability to build a good relationship, explore
problem and summarize patients problem and summarize it (through
the problem exploration, data gathering, history taking,
allo-anamnesis, checking and
summarization)
6. Patient education and Ability to build a good relationship, explore
counseling patients problem, summarize it, formulate
working plan and negotiating it with patient
and family
(through education and counseling)
ANTHROPOMETRIC FORM
WAIST-HIP RATIO

Case: Measure the patient on waist and hip circumferences count the waist-hip ratio

I. Identity
No Variable
1 Name of subject
2 Age
3 Sex
4 Race/Ethnic
5 Measurer
6 Assistance
7 Place/Date/Time

II. Base Data

No Variable 1st 2nd 3rd Average


measure measure measure
1. Waist circumference
2. Hip circumference

III. Data Analyze


Waist and Hip Ratio/fat distribution
WHR = waist circumference is divided by hip circumference
=

Conclusion
WHR:
Over 0.9 : apple or android pattern
Under 0.9 : pear or gynecoid pattern
Male waist : over 40 inch is considered dangerous/risk for health problems
Female waist : over 35 inch is considered dangerous/ risk for health problems

Recommendation for patient: ..

---------------------------------------------------------------------------------------------------------------------------------
TABULATION DATA SHEET
(Average)

Group :
Date/time :
Place :
Measurer :

No Initial Sex umur BB TB SFT SFT SFT SFT Waits Hip


Nama (kg) (m) Biceps Triceps Infsca Supill Girth Girth
(mm) (mm) (mm) (mm) (cm) (cm)
1

10

11

12