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Determine Your Nutritional Health




The Warning Signs of poor nutritional health are often overlooked.
Use this checklist to find out if you or someone you know is at nutritional risk.  



Read the statements below.  Check the number in the yes column for those that
apply to you or someone you know.  For each yes answer, score the number in
the box.  Total your nutritional score.

 
YES
2 I have an illness or condition that made me change the kind and/or amount of food I eat. 
3 I eat fewer than 2 meals per day.
2 I eat few fruits or vegetables, or milk products.
2 I have 3 or more drinks of beer, liquor or wine almost everyday. 
2 I have tooth or mouth problems that make it hard for me to eat.  
4 I do not always have enough money to buy the food I need.
1 I eat alone most of the time. 
1 I take 3 or more different prescribed or over-the-counter drugs a day.
2 Without wanting to, I have lost or gained 10 pounds in the last 6 months.
2 I am not always physically able to shop, cook and/or feed myself. 

TOTAL

Total Your Nutritional Score.  If It's...



0-2  GOOD! Recheck your nutritional score in 6 months.



3-5  You are at moderate nutritional risk.



See what can be done to improve your eating habits lifestyle. Your office on
aging, senior nutrition program, senior citizens center or health department
can help. Recheck your nutritional score in 3 months.



6 or More  You are at high nutritional risk.



Bring this checklist the next time you see your doctor, dietician or other
health or social service professional. Talk with them about any problems
you may have. Ask for help to improve your nutritional health.



Remember that warning signs suggest risk, but do not represent diagnosis
of any condition.
 
 
 
© 2007 Highland Valley Elder Services
320 Riverside Drive, Suite B
Florence, MA 01062
Email: qll@highlandvalley.org
Phone: (800) 322-0551 or
(413) 586-2000;
Fax: (413) 584-7076
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