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Malnutrition is Both Obesity and Starvation

Important Points:

  • Obesity
  • Malnourished
  • Nutrient intake
  • Vitamin deficiency
  • Starvation

Malnutrition is Both Obesity and Starvation

Malnutrition is a word we usually associate with the tragically thin figures from TV news reports of third world famines. In fact, it’s a shockingly common problem the world over. Though not at starvation level, there are millions of patients who aren’t getting sufficient calories, protein, vitamins, and minerals.

Doctors say our growing reliance on fast food coupled with mounting rates of binge-drinking means many people lack the vitamins and minerals essential for health. The result, in the most extreme cases, is pot-bellies, wasted limbs and emaciated bodies – all conditions more often associated with famine victims in the developing world. While malnutrition can be fatal, in more mild forms it can cause a host of symptoms that impact our everyday life, from hair loss and muscle wastage to food cravings and lethargy.  It is possible to be obese and still be malnourished.

1.  What is Malnutrition?

Malnutrition is a serious condition that occurs when a person’s diet doesn’t contain the right amount of nutrients. Malnutrition means “poor nutrition” and can refer to:

  • undernutrition – when you don’t get enough nutrients
  • overnutrition – when you get more nutrients than you need

2.  Who is Affected by Malnutrition?

Malnutrition is a common health problem. There are an estimated 3 million malnourished people in the UK at any time, with many more at risk of becoming malnourished. Around one in three people admitted to hospital or care homes in the UK are found to be malnourished or at risk of malnourishment.

Malnutrition is caused by having an inadequate diet or a problem absorbing nutrients from food which can be caused by having reduced mobility, a long-term health condition, or a low income.

3.  What are the Signs of Malnutrition?

The most common symptom of undernutrition is unintentional weight loss (losing 5-10% or more of your body weight over three to six months), and other signs include weak muscles, fatigue, low mood, and an increase in illnesses or infections. 

The main sign of overnutrition is being overweight or obese, however, people with undernutrition can also be overweight if they eat a diet high in energy (calories) but low in other nutrients.

4. Malnutrition of Excess: Obesity

The number of people who are malnourished despite being obese is shocking, a leading weight loss surgeon has said today. A recent study showed despite high levels of obesity in the U.S., many people are undernourished. 

A diet of pizza, fries, crisps, pasta, rice, biscuits, cakes leaves many people consuming a lot of calories but few nutrients, says Dr Sally Norton, an NHS consultant specializing in weight loss and upper gastrointestinal surgery. 

Drug companies push the sales of expensive drugs which treat the symptoms of the disease but not the cause. The multi-million-dollar drug industry encourages doctors to treat type 2 diabetes, high cholesterol, heart disease and other conditions related to poor nutrition with expensive drugs rather than healthier food.

Hippocrates, the father of medicine, was so right when he said, over 2,000 years ago: ‘let food be thy medicine’. And yet, fast-forward to the 21st century and a recent study of Americans shows that many Americans, despite their access to plenty of food, are undernourished. 

5. Can obese people really be malnourished? 

Picture a malnourished hospital patient…..

The person you’re imagining probably doesn’t weigh 300 pounds, does she? Yet obese patients can develop malnutrition, before or during hospitalization and have worse outcomes as a result.

In fact, according to a recent study, malnutrition counteracts the “obesity paradox,” which holds that, among the critically ill, heavier patients do better than normal- or underweight patients. Researchers who looked specifically at malnourished obese patients showed that they had a higher risk of mortality than well-nourished patients of similar body mass index, according to results published in the January issue of Critical Care Medicine.

Yet these patients’ nutritional deficiencies often pass under hospital clinicians’ radar, according to experts. “We as physicians don’t necessarily have a great handle on who is malnourished,” said Kenneth B. Christopher, MD, co-author of the study. “You can always tell if someone’s profoundly malnourished, because they start appearing to be cachectic, but it’s less severe degrees of malnutrition that are actually harder to see.”

In addition to judgments based on appearance, a number of other factors can make it difficult to diagnose or prevent malnutrition in obese inpatients, including shortcomings in history taking, limitations of lab testing, and challenges in nutrition delivery. According to experts, hospitalists can help correct these deficits by raising their own index of suspicion and working with the health care team to focus on patients’ nutritional status.

While malnutrition can be fatal, in more mild forms it can cause a host of symptoms that impact our everyday life. How many nutrients do you get in biscuits, pieces of cake, crisps, fries, pizza, white rice, pasta and bread? Not a whole lot. So, if you are eating these ‘nutrient deficient’ foods regularly, you should make sure to get nutrients from real, fresh, whole foods, too.

6. Diagnosing Malnutrition

Accurate screening for malnutrition begins with the recognition that you can’t see it with your eyes or even a scale. “Nutritional status is not body mass index,” summarized Dr. Christopher, who is a nephrologist and critical care specialist at Brigham and Women’s Hospital in Boston. For one thing, excess weight may not represent body fat.

Obesity could also distract from recent weight loss, an important marker of malnutrition. “Somebody could be obese but have a gastrointestinal problem and have been losing weight. Even though they’ve lost a considerable amount of weight, they started off so obese that they’re still technically obese,” said Dr. Mechanick.

Because our society has so much stigma around overweight and obesity, when many obese people lose weight, however they lose it, they get more positive feedback,” said Charlene W. Compher, PhD, a professor of nutrition science at the University of Pennsylvania in Philadelphia. If a patient lost weight due to bariatric surgery, he is particularly at risk for malnutrition. “The odds of having vitamin deficiencies are very high with patients with gastric bypass, especially if they do not take all of the vitamin and mineral supplements that they are instructed to,” said Dr. Compher. And obese individual could be getting enough calories, but not enough protein or other nutrients due to an unhealthy diet.

7. How Can You Tell if You’re Malnourished?

“There’s no lab test for malnutrition,” said Dr. Kirkland. “People rely on albumin. It’s not helpful for malnutrition. Albumin just reflects the acuity of illness or the duration of malnutrition, but not the severity of it or the presence of it.”

Whatever your weight, ensure to always have well balanced healthy meals, with regular supplementation where necessary, as malnutrition could potentially lead to other chronic illnesses such as type 2 diabetes, heart issues and others.

References:

  • International Journal of Obesity (2019): Overfed but undernourished: recognizing nutritional inadequacies/deficiencies in patients with overweight or obesity. Retrieved from

https://www.nature.com/articles/s41366-018-0143-9

  • NCBI (2012): The Malnutrition of Obesity: Micronutrient Deficiencies That Promote Diabetes. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313629/

  • ACP Hospitalist (2015): Obesity and malnutrition are not mutually exclusive. Retrieved from

https://acphospitalist.org/archives/2015/02/nutrition.htm

  • Critical Care Medicine (2015):  The True Obesity Paradox

Obese and Malnourished? Retrieved from

https://journals.lww.com/ccmjournal/Citation/2015/01000/The_True_Obesity_Paradox__Obese_and_Malnourished__.33.aspx

  • NHS Inform (2019): Malnutrition. Retrieved from

https://www.nhsinform.scot/illnesses-and-conditions/nutritional/malnutrition