How Can People Be Overweight and Malnourished?

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Celebrities, such as Ben Affleck, singer Josh Groban and actor Tom Hiddleston, drew attention to world hunger last week by eating only $1.50 worth of food per day -- most for five days, although Affleck chose a 1-day challenge. It’s easy to see the connection between malnutrition and starving children, but in a country where obesity has become the hot-button health topic, is it possible to be both overweight and malnourished?

In theory, yes, nutritionists and registered dietitians say.

“It does happen because people choose to eat the wrong foods,” said Dee Sandquist, a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics.

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It’s one reason many Americans are plagued by chronic diseases, she said.

“When we don't get nutrients, our internal functions don't work as well and we are vulnerable to disease,” she said.

Statistics on malnutrition in the United States aren’t detailed, although about 2,000 to 3,000 Americans die each year due to malnutrition-related causes. Joanne Slavin, a nutrition professor at the University of Minnesota, said the main culprit of malnutrition is usually poor protein.

“If you don’t get enough protein, you might still get enough calories without getting enough nutrients,” she said.

And although Americans may not realize it, the country has a contingency plan for ensuring most people meet the dietary guidelines for many essential nutrients: fortification.

“You don’t see overt deficiencies in the U.S. as a population because there is so much fortification -- in cereals, bread, etc.,” Slavin said.

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Iodized salt, for example, has been available in the United States since 1924, and prevents mental retardation from iodine deficiency. Folic acid is added to flour; it can prevent neural tube defects. Niacin has been added to bread since 1938, which prevents a disease called pellagra (symptoms include dermatitis, dementia and diarrhea).

Even kids who eat a lot of fast food might be protected from malnutrition, Slavin said, because most fast food is high in animal protein.

The main “shortfall” nutrients, according to the U.S. Department of Agriculture, are calcium, fiber, potassium and vitamin D.

“You may be overweight, but you still need to think about nutrients,” Slavin said.

If you suspect you may be deficient in certain nutrients, a doctor can order blood tests, Sandquist said.

To eat enough nutrients on $1.50 a day would be extremely challenging, Sandquist and Slavin said.

A school lunch costs $2.76, Slavin pointed out, “and that’s really hard to put together with 1/3 of the recommended daily allowances ... $1.50 basically buys nothing. But I think cost is an important factor, especially when we talk about fresh fruits and veggies. That’s a good concept for the wealthy, but if you’re poor and having to balance a budget, you’re probably thinking about how to get protein. If you want to really control costs, get closer to production. Raise chickens in the backyard.”

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