Morbid Malnutrition: the other side of the spectrum

By 2030, over half of Americans will be obese.  More than 2 in 3 adults are overweight or obese.  People who are overweight or obese are at higher risks for other co-morbid conditions.  Sound familiar? Obesity has been in the spotlight for quite some time now, and maybe it’s time to share the stage with malnutrition.

The World’s Health Organization defines malnutrition as, “deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients”.  This may be caused by inadequate intake of foods/nutrients, a medical condition, or malabsorption of nutrients. It is a condition that affects people of all ages and sizes and can have serious implications if not diagnosed and treated.

One out of five pediatric patients are malnourished and nearly half of the deaths of children under five years of age are linked to undernutrition.  Malnutrition in children can cause developmental delays and increase medical complications and mortality.

Children are not the only affected population.  Malnutrition affects anywhere from 30-50% of hospitalized patients 60 or older.  Malnutrition in older adults is personal to me-it is how my sweet grandma died.  This population is susceptible to malnutrition because of limited income, oral health issues, medications, poor appetite, loneliness, limited access to food, and/or cognitive disorders.  It is an issue that deserves attention because of its negative impact (i.e., higher risk of hospitalization, falls/fractures, weakened immune system, and death). With the estimated 30-50% of older adults having malnutrition, only about 5-11% have the diagnosis, which is not even half.  Malnutrition is important to diagnose to assure prompt and appropriate medical nutrition therapy.

Malnutrition may have a morbid connotation, however, the same language is not used when talking about it and obesity.  For instance “severe malnutrition” is less fear-evoking than “morbid obesity”. Living in a culture where being overweight is frowned upon may contribute to the underdiagnosis, and therefore treatment of malnutrition.  As a culture, we have been so focused on the “obesity epidemic” that we may have thrown a blind eye to the other side of the spectrum.

People do not die of obesity.  A 2018 study of roughly 54,000 men and women concluded that “a person of normal weight with no other metabolic risk factors is just as likely to die as the person with obesity and no other risk factors”.  This is exciting news because it means people can focus on improving their health without the stress of weight loss, to improve their health status, quality of life, and mortality risk. Did you hear about this study?  I’m not surprised because that would mean it would be ok to be overweight and obese, and that is a message our society is not ready for.  Do you know what people can die from? Malnutrition.

Instilling fear of obesity has its implications.  I believe it plays a significant role in why malnutrition is so underdiagnosed.  As a Registered Dietitian working in long-term care, I also experience the consequences of fearing weight gain.  Some of my residents prefer to be underweight and choose to refuse meals and/or supplements. It is so sad and frustrating at times to see people striving to be thin in their 70s, 80s, and even beyond when additional calories would help improve their health and quality of life.

Malnutrition is a serious and prevalent condition that may lead to impaired health outcomes without proper diagnosis and treatment.  The language around it and obesity imply that obesity should be feared more than malnutrition. However, malnutrition may have more detrimental effects.  As a culture, we should strive to find a balance in spreading awareness of malnutrition while promoting healthy behaviors in both under and overnourished populations.

This one’s for you, Gram.