Fri | Dec 14, 2018

Attacking malnutrition in the population that is ... Overfed & Undernourished

Published:Wednesday | April 11, 2018 | 12:47 AMPatricia Thompson/Contributor

Years ago, the main nutrition challenges were with babies and children up to five years. Malnutrition in children was defined as the lack of some or all nutritional components needed for growth and good health. The main deficiencies then were protein and total calorie intake and was described as protein energy malnutrition (PEM) in children, but as ‘starvation’ in adults.

Today, the main nutrition concerns have shifted to adults and the presentation of obesity, with similar concerns for children, and the challenges are more diverse and complex.

Today, we differentiate malnutrition as the extremes of under-nutrition and over-nutrition, primarily obesity, and occurring in all age groups. Excessive intake of calories which exceed calories expended will lead to obesity.

Obesity coupled with nutritional imbalances, such as iron, calcium, vitamin A, among others, suggest the existence of ‘various obesities’, some of which lead to the chronic diseases of diabetes, hypertension and heart conditions, etc. A common description is that the population is overfed but undernourished with multiple factors implicated.

Apart from the re-emergence of PEM today, 40 years later, there has been a gradual rise in the incidence of obesity and chronic diseases, but they are only now fully recognised as public health problems.

To finally bring PEM under control back then required the training of nutrition professionals at the University of The West Indies in large numbers, who were employed to the Ministry of Health to work in the community clinics with women and children, and to tackle their specific challenges.

Once the statistics improved, however, the authorities cut back on the services of these professionals, to the detriment of the population. By the time the epidemic of obesity was recognised, the government had reduced the cadre of nutrition professionals, not only in hospital care, but also in the community.


Obesity and the related chronic conditions take a long time to develop and often go unnoticed until an acute attack leads to hospitalisation. Only then is nutrition intervention usually considered, when the situation could have been arrested much earlier and prevented.

Just like with PEM, the initial limited nutrition intervention resulted in frequent, acute attacks with hospital re-admittance of the same persons ­ now with diabetes, heart conditions and kidney disorders.

Costly healthcare

Patients who do not receive adequate nutrition intervention will develop complications, placing a heavy cost burden for treatment (care) on individuals, the health care system and the country. Nutrition treatment requires time and consistency, so stopgap measures tend to be merely tokenism.

Promoting health overall while still reducing disease risk requires much more than short-term weight-loss challenges, weight loss products, and token measures of food product targeting. It is simplistic to expect that single-sided strategies, such as removing sugar or removing fat from food, will solve the problem.

While we focus our attention on only reformulation of food products or even on fast-food merchants, we ignore the fact that eating is a behavioural challenge requiring each person to take responsibility for their own eating. Behavioural strategies require relevance of interventions and much time for change to occur.

Teachers and parents are the main ‘gatekeepers’ of children’s eating behaviours, and may often be the source of much misinformation in the school-community environment. The ubiquity of nutrition information from other sources such as the Internet and media, as well as untrained individuals, may also be responsible for misleading claims.


Many companies offer meals at work as an employee benefit, and the nutritional ignorance of most caterers and workers alike lie at the bottom of much of the obesity in the workforce.

Likewise, children eat lunch and other meals or snacks at school since mothers are now in the workforce. While there are standards to be enforced in schools, cooks and ordinary classroom teachers are often not equipped to understand or meet the standards.

To ensure that standards are met requires the services of trained nutrition professionals to audit the meals and information. What we are seeing now is just the tip of the iceberg, unless we ensure the proper training/certification of adequate nutrition personnel to work at different levels in the food and nutrition sector.

The strategy of employing increased members of nutrition personnel to service the population is once again needed, but the approach should change to include all sectors. Indeed, this is a total population problem; this is not limited to just the poor, as was the case with the PEM epidemic.

Increased access to qualified nutrition professionals should not only be through the government sector, but also in the private sector among the workforce, schools, civil society and the general communities.
Workplaces often underwrite the cost of healthcare of employees and their children, so the cost savings to them could be enormous if nutrition services were routinely included under welfare benefits.

This approach would minimise the burgeoning financial costs while enhancing the productivity of the nation.

The Jamaica Island Nutrition Network can assist the Government and private sector in formulating and implementing this new approach.