8.4-Undernutrition, Overnutrition, Malnutrition

Undernutrition, Overnutrition, and Malnutrition

For many, the word “malnutrition” produces an image of a child in a third-world country with a bloated belly, and skinny arms and legs. However, this image alone is not an accurate representation of the state of malnutrition. For example, someone who is 150 pounds overweight can also be malnourished.

Malnutrition refers to one not receiving proper nutrition and does not distinguish between the consequences of too many nutrients or the lack of nutrients, both of which impair overall health. Undernutrition is characterized by a lack of nutrients and insufficient energy supply, whereas overnutrition is characterized by excessive nutrient and energy intake. Overnutrition can result in obesity, a growing global health threat. Obesity is defined as a metabolic disorder that leads to an overaccumulation of fat tissue.

Although not as prevalent in America as it is in developing countries, undernutrition is not uncommon and affects many subpopulations, including the elderly, those with certain diseases, and those in poverty. Many people who live with diseases either have no appetite or may not be able to digest food properly. Some medical causes of malnutrition include cancer, inflammatory bowel syndrome, AIDS, Alzheimer’s disease, illnesses or conditions that cause chronic pain, psychiatric illnesses, such as anorexia nervosa, or as a result of side effects from medications. Overnutrition is an epidemic in the United States and is known to be a risk factor for many diseases, including Type 2 diabetes, cardiovascular disease, inflammatory disorders (such as rheumatoid arthritis), and cancer.

Health Risks of Being Underweight

The 2003–2006 National Health and Nutrition Examination Survey (NHANES) estimated that 1.8 percent of adults and 3.3 percent of children and adolescents in the United States are underweight.[1]

Being underweight is linked to nutritional deficiencies, especially iron-deficiency anemia, and to other problems such as delayed wound healing, hormonal abnormalities, increased susceptibility to infection, and increased risk of some chronic diseases such as osteoporosis. In children, being underweight can stunt growth. The most common underlying cause of underweight in America is inadequate nutrition. Other causes are wasting diseases, such as cancer, multiple sclerosis, tuberculosis, and eating disorders. People with wasting diseases are encouraged to seek nutritional counseling, as a healthy diet greatly affects survival and improves responses to disease treatments. Eating disorders that result in underweight affect about eight million Americans (seven million women and one million men).

Anorexia Nervosa

Anorexia nervosa, more often referred to as “anorexia,” is a psychiatric illness in which a person obsesses about their weight and about food that they eat. Anorexia results in extreme nutrient inadequacy and eventually to organ malfunction. Anorexia is relatively rare—the National Institute of Mental Health (NIMH) reports that 0.9 percent of females and 0.3 percent of males will have anorexia at some point in their lifetime, but it is an extreme example of how an unbalanced diet can affect health.[2]

Anorexia frequently manifests during adolescence and it has the highest rate of mortality of all mental illnesses. People with anorexia consume, on average, fewer than 1,000 kilocalories per day and exercise excessively. They are in a tremendous caloric imbalance. Moreover, some may participate in binge eating, self-induced vomiting, and purging with laxatives or enemas. The very first time a person starves him- or herself may trigger the onset of anorexia. The exact causes of anorexia are not completely known, but many things contribute to its development including economic status, as it is most prevalent in high-income families. It is a genetic disease and is often passed from one generation to the next. Pregnancy complications and abnormalities in the brain, endocrine system, and immune system may all contribute to the development of this illness.

The primary signs of anorexia are fear of being overweight, extreme dieting, an unusual perception of body image, and depression. The secondary signs and symptoms of anorexia are all related to the caloric and nutrient deficiencies of the unbalanced diet and include excessive weight loss, a multitude of skin abnormalities, diarrhea, cavities and tooth loss, osteoporosis, and liver, kidney, and heart failure. There is no physical test that can be used to diagnose anorexia and distinguish it from other mental illnesses. Therefore a correct diagnosis involves eliminating other mental illnesses, hormonal imbalances, and nervous system abnormalities. Eliminating these other possibilities involves numerous blood tests, urine tests, and x-rays. Coexisting organ malfunction is also examined. Treatment of any mental illness involves not only the individual, but also family, friends, and a psychiatric counselor. Treating anorexia also involves a dietitian, who helps to provide dietary solutions that often have to be adjusted over time. The goals of treatment for anorexia are to restore a healthy body weight and significantly reduce the behaviors associated with causing the eating disorder. Relapse to an unbalanced diet is high. Many people do recover from anorexia, however most continue to have a lower-than-normal body weight for the rest of their lives.

Bulimia

Bulimia, like anorexia, is a psychiatric illness that can have severe health consequences. The NIMH reports that 0.5 percent of females and 0.1 percent of males will have bulimia at some point in their lifetime.[3]

Bulimia is characterized by episodes of eating large amounts of food followed by purging, which is accomplished by vomiting and with the use of laxatives and diuretics. Unlike people with anorexia, those with bulimia often have a normal weight, making the disorder more difficult to detect and diagnose. The disorder is characterized by signs similar to anorexia such as fear of being overweight, extreme dieting, and bouts of excessive exercise. Secondary signs and symptoms include gastric reflux, severe erosion of tooth enamel, dehydration, electrolyte imbalances, lacerations in the mouth from vomiting, and peptic ulcers. Repeated damage to the esophagus puts people with bulimia at an increased risk for esophageal cancer. The disorder is also highly genetic, linked to depression and anxiety disorders, and most commonly occurs in adolescent girls and young women. Treatment often involves antidepressant medications and, like anorexia, has better results when both the family and the individual with the disorder participate in nutritional and psychiatric counseling.

Binge-Eating Disorder

Similar to those who experience anorexia and bulimia, people who have a binge-eating disorder have lost control over their eating. Binge-eating disorder is not currently diagnosed as a distinct psychiatric illness, although there is a proposal from the American Psychiatric Association to categorize it more specifically. People with binge-eating disorder will periodically overeat to the extreme, but their loss of control over eating is not followed by fasting, purging, or compulsive exercise. As a result, people with this disorder are often overweight or obese, and their chronic disease risks are those linked to having an abnormally high body weight such as hypertension, cardiovascular disease, and Type 2 diabetes. Additionally, they often experience guilt, shame, and depression. Binge-eating disorder is commonly associated with depression and anxiety disorders. According to the NIMH, binge-eating disorder is more prevalent than anorexia and bulimia, and affects 3.5 percent of females and 2.0 percent of males at some point during their lifetime.[4] Treatment often involves antidepressant medication as well as nutritional and psychiatric counseling.

The Healing Process

With all wounds, from a paper cut to major surgery, the body must heal itself. Healing is facilitated through proper nutrition while malnutrition inhibits and complicates this vital process. The following nutrients are important for proper healing:[5]

  • Vitamin A. Helps to enable the epithelial tissue (the thin outer layer of the body and the lining that protects your organs) and bone cells form.
  • Vitamin C. Helps form collagen, an important protein in many body tissues.
  • Protein. Facilitates tissue formation.
  • Fats. Play a key role in the formation and function of cell membranes.
  • Carbohydrates. Fuel cellular activity, supplying needed energy to support the inflammatory response that promotes healing.

 

  1. Prevalence of Underweight among Children and Adolescents: United States, 2003–2006. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/data/hestat/underweight/underweight_children.htm. Updated November 6, 2015. Accessed April 15, 2018. ↵
  2. Eating Disorders. The National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml#part_155061. Accessed April 15, 2018. ↵
  3. Eating Disorders. The National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml#part_155061. Accessed April 15, 2018. ↵
  4. Eating Disorders. The National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml#part_155061. Accessed April 15, 2018. ↵
  5. MacKay D, Miller AL. Nutritional Support for Wound Healing. Alternative Medicine Review. 2003 8(4),  359–77. https://www.ncbi.nlm.nih.gov/pubmed/14653765. Accessed April 15, 2018. ↵

Food Insecurity

Addressing Hunger

Government agencies also play an important role in addressing hunger via federal food-assistance programs. The agencies provide debit cards (formerly distributed in the form of food vouchers or food stamps) to consumers to help them purchase food and they also provide other forms of aid to low-income adults and families who face hunger and nutritional deficits. This topic will be discussed in greater detail later in this chapter.

Hunger relates to appetite and is the body’s response to a need for nourishment. Through stomach discomfort or intestinal rumbling, the body alerts the brain that it requires food. This uneasy sensation is easily addressed with a snack or a full meal. However, the term “hunger” also relates to a weakened condition that is a consequence of a prolonged lack of food. People who suffer from this form of hunger typically experience malnourishment, along with poor growth and development.

Hunger

Adequate food intake that meets nutritional requirements is essential to achieve a healthy, productive lifestyle. However, millions of people in North America, not to mention globally, go hungry and are malnourished each year due to a recurring and involuntary lack of food. The economic crisis of 2008 caused a dramatic increase in hunger across the United States.[1]

In 2010, 925 million people around the world were classified as hungry. Although this was a decrease from a historic high of more than one billion people from the previous year, it is still an unbearable number. Every night, millions and millions of people go to sleep hungry due to a lack of the money or resources needed to acquire an adequate amount of food. This graph shows the division of hungry people around the globe. A number of terms are used to categorize and classify hunger. Two key terms, food security and food insecurity, focus on status and affect hunger statistics. Another term, malnutrition, refers to the deficiencies that a hungry person experiences.

Food Security

Most American households are considered to be food secure, which means they have adequate access to food and consume enough nutrients to achieve a healthy lifestyle. However, a minority of US households experiences food insecurity at certain points during the year, which means their access to food is limited due to a lack of money or other resources. This graphic shows the percentage of food-secure and food-insecure households in the United States during the year 2010.

Food Insecurity

Food insecurity is defined as not having adequate access to food that meets nutritional needs. According to the USDA, about 48.8 million people live in food-insecure households and have reported multiple indications of food access problems. About sixteen million of those have “very low food security,” which means one or more people in the household were hungry at some point over the course of a year due to the inability to afford enough food. The difference between low and very low food security is that members of low insecurity households have reported problems of food access, but have reported only a few instances of reduced food intake, if any.[2] African American and Hispanic households experience food insecurity at much higher rates than the national average.[3]

Households with limited resources employ a variety of methods to increase their access to adequate food. Some families purchase junk food and fast food—cheaper options that are also very unhealthy. Other families who struggle with food security supplement the groceries they purchase by participating in government assistance programs. They may also obtain food from emergency providers, such as food banks and soup kitchens in their communities.

Malnutrition

A person living in a food-insecure household may suffer from malnutrition, which results from a failure to meet nutrient requirements. This can occur as a result of consuming too little food or not enough key nutrients. There are two basic types of malnutrition. The first is macronutrient deficiency and relates to the lack of adequate protein, which is required for cell growth, maintenance, and repair. The second type of malnutrition is micronutrient deficiency and relates to inadequate vitamin and mineral intake.[4] Even people who are overweight or obese can suffer from this kind of malnutrition if they eat foods that do not meet all of their nutritional needs.

Worldwide, three main groups are most at risk of hunger: the rural poor in developing nations who also lack access to electricity and safe drinking water, the urban poor who live in expanding cities and lack the means to buy food, and victims of earthquakes, hurricanes, and other natural and man-made catastrophes.[5]

In the United States, there are additional subgroups that are at risk and are more likely than others to face hunger and malnutrition. They include low-income families and the working poor, who are employed but have incomes below the federal poverty level.

Senior citizens are also a major at-risk group. Many elderly people are frail and isolated, which affects their ability to meet their dietary requirements. In addition, many also have low incomes, limited resources, and difficulty purchasing or preparing food due to health issues or poor mobility. As a result, more than six million senior citizens in the United States face the threat of hunger.[6]

One of the groups that struggles with hunger are the millions of homeless people across North America. According to a recent study by the US Conference of Mayors, the majority of reporting cities saw an increase in the number of homeless families.[7] Hunger and homelessness often go hand-in-hand as homeless families and adults turn to soup kitchens or food pantries or resort to begging for food.

Rising hunger rates in the United States particularly affect children. Nearly one out of four children, or 21.6 percent of all American children, lives in a food-insecure household and spends at least part of the year hungry.[8] Hunger delays their growth and development and affects their educational progress because it is more difficult for hungry or malnourished students to concentrate in school. In addition, children who are undernourished are more susceptible to contracting diseases, such as measles and pneumonia.[9]

Government Programs

The federal government has established a number of programs that work to alleviate hunger and ensure that many low-income families receive the nutrition they require to live a healthy life. A number of programs were strengthened by the passage of the Healthy, Hunger-Free Kids Act of 2010. This legislation authorized funding and set the policy for several key core programs that provide a safety net for food-insecure children across the United States.

The federal poverty level (FPL) is used to determine eligibility for food-assistance programs. This monetary figure is the minimum amount that a family would need to acquire shelter, food, clothing, and other necessities. It is calculated based on family size and is adjusted for annual inflation. Although many people who fall below the FPL are unemployed, the working poor can qualify for food programs and other forms of public assistance if their income is less than a certain percentage of the federal poverty level, along with other qualifications.

USDA Food Assistance Programs

Government food and nutrition assistance programs that are organized and operated by the USDA work to increase food security. They provide low-income households with access to food, the tools for consuming a healthy diet, and education about nutrition. The USDA monitors the extent and severity of food insecurity via an annual survey. This contributes to the efficiency of food assistance programs as well as the effectiveness of private charities and other initiatives aimed at reducing food insecurity.[10]

The Supplemental Nutrition Assistance Program

Formerly known as the Food Stamp Program, the Supplemental Nutrition Assistance Program (SNAP) provides monthly benefits for low-income households to purchase approved food items at authorized stores. Clients qualify for the program based on available household income, assets, and certain basic expenses. In an average month, SNAP provides benefits to more than forty million people in the United States.[11] The program provides Electronic Benefit Transfers (EBT) which work similarly to a debit card. Clients receive a card with a certain allocation of money for each month that can be used only for food. In 2010, the average benefit was about $134 per person, per month and total federal expenditures for the program were $68.2 billion.[12]

The Special, Supplemental Program for Women, Infants, and Children

The Special, Supplemental Program for Women, Infants and Children (WIC) provides food packages to pregnant and breastfeeding women, as well as to infants and children up to age five, to promote adequate intake for healthy growth and development. Most state WIC programs provide vouchers that participants use to acquire supplemental packages at authorized stores. In 2010, WIC served approximately 9.2 million participants per month at an average monthly cost of about forty-two dollars per person.[13]

The National School Lunch Program

The National School Lunch Program (NSLP) and School Breakfast Program (SBP) ensure that children in elementary and middle schools receive at least one healthy meal each school day, or two if both the NSLP and SBP are provided. According to the USDA, these programs operate in over 101,000 public and nonprofit private schools and residential child-care institutions.[14] In 2010, the programs provided meals to an average of 31.6 million children each school day. Fifty-six percent of the lunches served were free, and an additional 10 percent were provided at reduced prices.

Meals on Wheels

An organization known as Meals on Wheels delivers meals to elderly people who have difficulty buying or making their own food because of poor health or limited mobility. It is the oldest and largest program dedicated to addressing the nutritional needs of senior citizens. Each day, Meals on Wheels volunteers deliver more than one million meals across the United States. The first Meals on Wheels program began in Philadelphia in the 1950s. In the decades since, the organization has expanded into a vast network that serves the elderly in all fifty states and several US territories. Today, Meals on Wheels remains committed to ending hunger among the senior citizen community.[15]

Nutrition and Your Health

The adage, “you are what you eat,” seems to be more true today than ever. In recent years, consumers have become more conscientious about the decisions they make in the supermarket. Organically grown food is the fastest growing segment of the food industry. Also, farmers’ markets and chains that are health-food-oriented are thriving in many parts of North America. Shoppers have begun to pay more attention to the effect of food on their health and well-being. That includes not only the kinds of foods that they purchase, but also the manner in which meals are cooked and consumed. The preparation of food can greatly affect its nutritional value. Also, studies have shown that eating at a table with family members or friends can promote both health and happiness.

  1. Hunger in America: 2016 United States Hunger and Poverty Facts. World Hunger Education Service. Retrieved from http://www.worldhunger.org/articles/Learn/us_hunger_facts.htm. Accessed April 15, 2018. ↵
  2. Coleman-Jensen A. Household Food Security in the United States in 2010. US Department of Agriculture, Economic Research Report, no. ERR-125. 2011.  https://www.ers.usda.gov/publications/pub-details/?pubid=44909. Accessed April 15, 2018. ↵
  3. Coleman-Jensen A. Household Food Security in the United States in 2010. US Department of Agriculture, Economic Research Report, no. ERR-125. 2011.  https://www.ers.usda.gov/publications/pub-details/?pubid=44909. Accessed April 15, 2018. ↵
  4. Hunger in America: 2016 United States Hunger and Poverty Facts. World Hunger Education Service. Retrieved from http://www.worldhunger.org/articles/Learn/us_hunger_facts.htm. Accessed April 15, 2018. ↵
  5. SOFI: Questions and Answers. Food and Agriculture Organization of the United Nations. http://www.fao.org/3/a-BT851E.pdf. Accessed April 15, 208. ↵
  6. About Meals on Wheels. Meals on Wheels. https://www.mealsonwheelsamerica.org/signup/aboutmealsonwheels. Accessed April 15, 2018. ↵
  7. Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America’s Cities, a 27-City Survey. The United States Conference of Mayors. https://endhomelessness.atavist.com/mayorsreport2016. Accessed April 15, 2018.    ↵
  8. Coleman-Jensen A. Household Food Security in the United States in 2010. US Department of Agriculture, Economic Research Report, no. ERR-125. 2011.  https://www.ers.usda.gov/publications/pub-details/?pubid=44909. Accessed April 15, 2018. ↵
  9. 2011 World Hunger and Poverty Facts and Statistics. World Hunger Education Service.https://www.worldhunger.org/articles/Learn/old/world%20hunger%20facts%202002in2011.htm. Accessed April 15, 2018. ↵
  10. Coleman-Jensen A. Household Food Security in the United States in 2010. US Department of Agriculture, Economic Research Report, no. ERR-125. 2011.  https://www.ers.usda.gov/publications/pub-details/?pubid=44909. Accessed April 15, 2018. ↵
  11. Coleman-Jensen A. Household Food Security in the United States in 2010. US Department of Agriculture, Economic Research Report, no. ERR-125. 2011.  https://www.ers.usda.gov/publications/pub-details/?pubid=44909. Accessed April 15, 2018. ↵
  12. Coleman-Jensen A. Household Food Security in the United States in 2010. US Department of Agriculture, Economic Research Report, no. ERR-125. 2011.  https://www.ers.usda.gov/publications/pub-details/?pubid=44909. Accessed April 15, 2018. ↵
  13. Coleman-Jensen A. Household Food Security in the United States in 2010. US Department of Agriculture, Economic Research Report, no. ERR-125. 2011.  https://www.ers.usda.gov/publications/pub-details/?pubid=44909. Accessed April 15, 2018. ↵
  14. National School Lunch Program. US Department of Agriculture. https://www.fns.usda.gov/nslp/national-school-lunch-program-nslp. Accessed April 15, 2018. ↵
  15. The Problem and Our Solution. Meals on Wheels. https://www.mealsonwheelsamerica.org/theissue/problemandsolution. Accessed April 15, 2018. ↵

License

Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

LWTECH Infectious and Chronic Diseases of Public Health Importance Copyright © by Lake Washington Institute of Technology is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

Share This Book