5 years ago | Nutrition

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By: Joy Stephenson-Laws, J.D., Founder 

When we think of a child suffering from malnutrition, we usually have the image of a child who has stunted growth or is significantly underweight. We usually don’t think of average weight children as suffering from malnutrition – and even less so if they are overweight or obese. After all, these latter groups are clearly getting enough calories (and perhaps too many given the ongoing childhood obesity epidemic). 

But the latter groups may just as readily suffer from malnutrition as a child who is suffering from undernutrition (not getting enough calories). Just because you get an adequate or excessive intake of calories does not mean that you are not malnourished.

Let’s define malnutrition.

According to the World Health Organization (WHO), “Malnutrition, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight, obesity, and resulting diet-related noncommunicable diseases.”

Basically, there are three broad groups of conditions that fall under the malnutrition umbrella:

• Undernutrition
• Micronutrient-related malnutrition (having a lack of important vitamins and minerals. A person in this category can also have a micronutrient excess. This category may include people who are both underweight and overweight)
• Overweight, obesity (diet-related noncommunicable diseases include heart disease, stroke, diabetes (type 2) and some cancers)

According to UNICEF’s 2019 edition of The State of the World’s Children (SOWC), one third of the world’s nearly 700 million children under five years old are malnourished - either undernourished or overweight.

So many children affected by this malnourishment crisis are also suffering from what UNICEF calls “hidden hunger,” deficiencies of essential vitamins and minerals.

Hidden hunger falls within the category of micronutrient-related malnutrition, but UNICEF coined this term because it really can be a hidden issue.

"It's 'hidden' because you don't notice the impact until it is too late," said the editor-in-chief of the UNICEF report, according to one report discussing UNICEF’s findings.

"You don't notice that the child is running a little slower than everyone else, struggling a bit in school."

Appearances can also be very deceiving. While some children may be getting the right number of calories to achieve and maintain a healthy body weight, there is a good chance they are not eating enough nutrient-dense foods and, therefore, run the very real risk of being deficient in critical micronutrients (vitamins and minerals) their bodies need for healthy development. 

What’s especially concerning is that during the first 1,000 days of life it is extremely critical to get the proper nourishment in order to grow and develop as healthy as possible.

If a child is malnourished in his or her first 1,000 days and beyond, this child may suffer irreversible damage.

“These children may carry the burden of early stunting for the rest of their lives and may never meet their full physical and intellectual potential,” reports UNICEF.

The impact of micronutrient deficiencies is so pronounced that the U.S. Centers for Disease Control and Prevention (CDC) has confirmed that a “child's failure to eat fruits, vegetables and dairy products is associated with lower grades, while nutrient deficits, such as vitamins A, B6, B12, C, iron, zinc, folate and calcium, are linked to higher rates of absenteeism, tardiness and low grades.” From a health standpoint, missing vitamins and minerals, meanwhile, can lead to compromised immune systems, poor sight and hearing defects, anemia and poor bone development. 

So the triple threat to our children’s health across the globe is undernutrition, being overweight or obese and having hidden hunger. And some of these issues are now more prevalent in certain communities where they were not before.

“The problem [of obesity] was virtually non-existent in poor countries 30 years ago, but today at least 10 percent of under five year olds are overweight or obese in three-quarters of low-income nations,” according to the report referenced earlier that discusses the UNICEF findings.

Obesity is no longer a “rich people’s problem.”

Children who develop obesity run a higher risk of developing diabetes at a younger age and with greater frequency than children with a healthy weight. These children also have higher incidences of high cholesterol and hypertension. Making this situation even worse is that obese children have a much greater risk of becoming chronically obese adults who run a higher risk of bone and joint problems. An obese person, for example, is 60 percent more likely to develop arthritis than someone of normal body weight. Overweight children also run a higher risk of stroke, heart attack and some types of cancer including liver, colon, breast, kidney and ovarian as they reach adulthood. 

UNICEF also found that there can be multiple malnourishment issues in one family living under the same roof. For example, a mother may be obese while her children are suffering from undernutrition.

To add insult to injury, climate change does not make the battle against this triple threat to children’s health any easier.

“Research by scientists at Harvard University, meanwhile, have shown that the increased concentration of CO2 in the air is sapping staple food crops of those essential nutrients and vitamins, including zinc, iron and vitamin B,” according to the report discussing UNICEF’s findings.

"The impacts of climate change are completely transforming the food that is available and that can be consumed," said Victor Aguayo, head of UNICEF's nutrition programme.

Nutrient-void, processed junk foods are also accessible, cheap and marketed towards children.

To really understand the severity of this issue, check out some of the key findings from the UNICEF report:

• In 2018, almost 200 million children under 5 suffered from stunting or wasting while at least 340 million suffered from hidden hunger.

• Overweight and obesity continue to rise. From 2000–2016, the proportion of overweight children (5 to19 years old) rose from 1 in 10 to almost 1 in 5.

• The number of stunted children has declined in all continents, except in Africa while the number of overweight children has increased in all continents, including in Africa.

• Hidden hunger harms children and women. Iron deficiency reduces children’s ability to learn and iron deficiency anaemia increases women’s risk of death during or shortly after childbirth.

• Only 2 in 5 infants under six months of age are exclusively breastfed, as recommended. Breastfeeding could save the lives of 820,000 children annually worldwide.

• Millions of children are eating too little of what they need, and millions are eating too much of what they don’t need: poor diets are now the main risk factor for the global burden of disease.

These are just a handful of the key findings from the report. I highly recommend taking the time to read the full report in order to fully grasp an understanding of this crisis to our children’s health.

If you live in the United States, you may be well aware of the child obesity epidemic here.

(The incidence of childhood obesity in the United States has more than tripled since the 1970s. Currently, one in five school-aged children (ages 6-19) are obese). 

But also know that hidden hunger and undernutrition are major issues in the U.S. as well. 

“About 85% of Americans do not consume the US Food and Drug Administration’s recommended daily intakes of the most important vitamins and minerals necessary for proper physical and mental development,” according to one report.

“More than half of American children do not get enough of vitamins D and E, while more than a quarter do not get enough calcium, magnesium or vitamin A, according to a recent Journal of Nutrition study. This can result in a compromised immune system, stunted physical growth, reduced mental ability, chronic disease and even death.”

Furthermore, reportedly 1 in 7 children in the United States lives with hunger, which obviously puts them at a great risk of being undernourished.

My point is, the triple threat of malnutrition is a worldwide problem.

How can we be proactive?

When considering that the effects of climate change, extreme poverty and perhaps certain government policies need to be addressed, this problem may seem very daunting. But do not get discouraged. Change can start within your home.

Education and Access are Key

Successfully addressing this triple threat to our children’s health requires educating them about healthy eating from the earliest possible age as well as making healthy foods available. There are also are things that we, as parents, can do to help promote healthy eating habits that will last our kids a lifetime. 

On the educational front, nutrition and healthy eating education need to be just as commonplace as language skills, math skills and physical education. Children should be told what nutrients they need to stay healthy and the foods they can get these nutrients from such as fruits and vegetables. They also need to understand why certain foods, such as junk food, should be eaten in moderation if at all. And healthy lifestyle habits, such as meal prepping with nutritious foods, should comprise a portion of those instructional hours. 

Knowing about healthier eating and being motivated to do so will be of little benefit to our kids if they don’t have access to healthy foods. And, given that children spend more waking hours in school than anywhere else, it only makes sense that having healthy food available – and accessible – to students is one of the best places to start. It also has been shown by various studies to be the most successful in helping to reduce obesity and ensure children are getting the nutrients they need (as well as for educating them on healthy eating). 

One recent study from Japan, for example, shows the kind of impressive results that can be achieved by combining education with making healthy food available in schools. A recent report by UNICEF gives Japan high scores for nutrition and for low obesity rates. In fact, it has the lowest childhood obesity rate among the 41 developed countries in the Organization for Economic Cooperation and Development and European Union. The country also has low rates of infant mortality and very few underweight children. 

How does Japan do it? 

Experts give a lot of credit to that country’s nationwide school lunch program along with regularly mandated health check-ups for children. An important element of the school program is that school lunches are mandatory (children are not allowed to bring lunches from home). The lunches are subsidized to make sure they are accessible to all children. In this way, children are guaranteed to have at least one nutritionally balanced meal that can help compensate for possibly less nutritious meals at home. To complement these lunches, schools also have various age-appropriate activities to teach students about the nutritional elements of the school lunch they will be having each day. Students also help in serving and cleaning up afterward, which gets them more involved in the whole process of healthy eating. 

A little closer to home, a recent study, conducted by the Yale School of Public Health, found evidence that in-school nutrition education helped middle school students limit increases in their body mass index (BMI). Researchers found that the schools with “enhanced nutrition policies and programs” overall had students with an increase in BMI percentile of less than 1%, while the schools without these policies and programs had students with increases of 3-4%. 

Remember to Set a Good Example 

Parents play a key role in helping their children learn about healthy eating and developing healthy habits. One of these is knowing how to select and prepare healthy foods at home and involving our children in these tasks. Take your child to the farmer’s market. Make it fun!

Finally, be sure to have your child take routine nutrient tests in order to identify any nutritional imbalances or deficiencies. If the test reveals an issue, a competent healthcare professional can work with you to make the necessary dietary changes and recommend quality supplements if necessary.

Let’s fight the triple threat of malnutrition. Our kids deserve nothing less from us.

Enjoy your healthy life!

The pH professional health care team includes recognized experts from a variety of health care and related disciplines, including physicians, attorneys, nutritionists, nurses and certified fitness instructors. This team also includes the members of the pH Medical Advisory Board, which constantly monitors all pH programs, products and services. To learn more about the pH Medical Advisory Board, click here.