Nutrition Wheel

Undernutrition is a form of ‘malnutrition’, which simply means ‘poor nutrition’. It affects 10-15% of people over 65 years of age. A person can become undernourished when they don’t eat enough of the right foods to keep them healthy. Undernutrition has serious consequences because the body isn’t getting the right nutrition to work properly. Some consequences of undernutrition include reduced ability to fight infections, reduced mobility, increased risk of falls, poor wound healing and more frequent GP visits and hospital admissions. Undernutrition is not well recognised or treated in the community.

In view of this, we have worked in collaboration with the Patients' Association and Bournemouth University to develop the Nutrition Wheel. The Nutrition Wheel is an interactive version of the Patients Association Nutrition Checklist and has been designed to be a conversation starter.

We are delighted that both the Nutrition Wheel and the Patients Association Nutrition Checklist have been endorsed by the British Dietetic Association.

We have created an Evaluation Report (available from the 'resources' section) which tells the journey of the Nutrition Wheel from initial concept to scoping, development, launch and post-launch research. 

Please note: the Nutrition Wheel itself is made from durable coated card, and as such, Nutrition Wheels can be used many times. The Nutrition Wheel is a tool to be kept by the volunteer or care worker. It is not a patient resource, and as such is not appropriate to give out to patients or clients.

When you order the Nutrition Wheel, you will sent a Nutrition Wheel, along with a copy of the advice sheet (to be given to anyone the Nutrition Wheel identifies as 'at risk') and an explanatory guide. The following resources form part of the Nutrition Wheel toolkit, and can be downloaded through the 'resources' section:

On 24 September 2019, the Health Innovation Wessex ran a webinar on the Nutrition Wheel for the other HINs. The purpose of the webinar was to share the research, development and next steps for the Nutrition Wheel. To view and listen to the webinar, please click here to be taken to our video section.

The need for an interactive tool originated from a project we undertook using the PaperWeight Nutrition Armband with Age Concern Hampshire volunteers in 2016. The volunteers reported to like using armbands, as it helped them to start a conversation around nutrition. However the armband measures if someone is already thin, and whilst designed to be used in conjunction with questions to determine recent unintentional weight loss, we found that volunteers were often not always asking these questions and were using the armband in isolation. A PDF copy of our evaluation report for this project can be downloaded from the 'resources' section. The initial prototype of the Nutrition Wheel was developed by a group of Adult Nursing and Midwifery students at Bournemouth University as part of their assignment on service improvement. It has since been modified and developed further by the Health Innovation Wessex with multidisciplinary support.

In clinical practice, undernutrition should be identified using the ‘Malnutrition Universal Screening Tool’ (‘MUST’). The Nutrition Wheel has been developed primarily for use by non-clinical people who work with older people in the community who may not be accessing traditional health and social care services, such as carers, care workers and volunteers. It provides a framework for having a conversation to explore the factors that could increase someone’s risk of undernutrition in a pro-active way.

The Nutrition Wheel aims to identify whether someone is at increased risk of undernutrition by asking 4 simple questions, which are labelled 1-4 around the outer edge of the Nutrition Wheel. The 4 questions are the same questions as those found on Section A of the Patients Association Nutrition Checklist, which have been validated against 'MUST' in a research project. This research was published in the Journal of Human Nutrition and Dietetics in October 2019. For more information on our validation work, please visit our page about the Nutrition in Older People Programme.

For people found to be at increased risk of undernutrition through using the Nutrition Wheel, there are an additional 4 questions to ask the person, which focus the discussion around the reasons the person has become undernourished or at increased risk. The Nutrition Wheel also features an 'advice window', which provides basic advice and signposting to help support the person to improve their nutrition and wellbeing. 

The following organisations produce useful downloadable leaflets and have additional information on undernutrition: