When most people think of malnutrition, they usually envision undernutrition, marked by a visible wasting and stunted growth or development from of a deficiency of calories, protein or other critical nutrients. However, malnutrition is defined as a physical state of unbalanced nutrition that results in adverse effects on the body and growth of children. This can mean undernutrition or overnutrition. Ongoing overnutrition from an excess of calories often leads to excess weight gain or obesity.  Approximately 1 in 5 children are currently obese in the United States. Paradoxically, despite the high caloric intakes seen in overnutrition, high rates of micronutrient deficiencies frequently coexist in obese populations. These two serious nutrition issues are commonly found together. 

Micronutrients, or vitamins and minerals, are essential for supporting the growth and development of children, as well as maintaining overall health across the lifespan. When it comes to adequate vitamin and mineral intakes, slimmer Americans are not that much better off.  Data from National Health and Nutrition Examination Survey (NHANES) estimated that nearly one-third of Americans aged 9 years and over were at risk of at least one vitamin deficiency or anemia. Significantly higher deficiency risks were seen in subpopulations:  women (37%), African Americans (55%), individuals from low income households (40%), or without a high school diploma (42%). 

Many health experts blame the abundance of calories consumed from cheap, processed foods that offer little nutritional value as the root of this dual dilemma. Although plausible, research on the relationship between obesity and malnutrition continues to offer more complex insights. 

While a direct link between micronutrient deficiency and obesity is well established, causation is less clear. Micronutrients play an important factor in regulating the metabolic processes of the body. Data shows that obesity rates rise more rapidly in regions and populations where micronutrient deficiencies are more prevalent. Some studies indicate that deficient levels of specific micronutrients are associated with increased fat stores in the body, by way of altering serum leptin concentrations. Leptin is a hormone that helps control fat storage in the body through regulation of the appetite and energy expenditure. At the same time, other research points to overeating as a biological adaptation to nutrient deficiencies, suggesting that when the body doesn’t get adequate nutrition, it just keeps asking for more food in an attempt to satisfy basic requirements.  

In contrast, numerous studies show obesity itself may alter micronutrient levels in the body by impacting the body’s ability to absorb, store, and utilize important micronutrients.  More studies are needed to explore this disruption, as well as whether there is increased physiologic requirements in obesity or more rapid depletion.  We also can’t ignore stress. Both psychological and physiological stress, which is pervasive, leads to a more rapid depletion of micronutrients that correlate with the body mass index (BMI).  

So which comes first malnutrition or obesity? It’s not clear, but a growing body of evidence suggests that like an old, bickering married couple, they aggravate each other and exacerbate the problems.

External driving forces that act as contributing factors also warrant examination.  Rising rates of food insecurity might add to an increased risk of weight gain and malnutrition through various pathways. Not surprising, one response to household food insecurity involves increased purchases of inexpensive, low quality foods to stretch the food dollar further, limiting the amount of fresh foods like fruits and vegetables.  Food insecurity can be traumatic and might not just singularly change our purchasing behaviors, it also threatens to change our relationship with food and eating. 

A recent study showed adolescents from food insecure homes had increased likelihoods of developing a binge-eating disorder and obesity, suggesting food restrictions imposed by the external environmental conditions correlate with behavioral consequences such as disordered eating and unhealthy relationships with food. Food insecurity and the imposed constraints on food quality and quantity are associated with various behavioral and clinical consequences. 

Food insecurity among children is also linked to developmental and other behavioral problems, increased anxiety and depression, lowered academic performance, toxic stress, reduced immunity and increased risk of developing infectious and chronic diseases. 

Most chronic diseases do not develop in silos. Therefore, all of these scenarios, and many other influences such as genetics and perinatal nutrition, likely contribute and confound the risk, rate and coexistence of these health conditions. Clearly, we do not have all the answers, but one thing is abundantly obvious--- we are unlikely to successfully develop ways to mitigate these conditions if we approach them as mutually exclusive. In more ways than not, they are inseparable.


Bird, J., et al. (2017, June 24). Risk of Deficiency in Multiple Concurrent Micronutrients in Children and Adults in the United States. Retrieved September 09, 2020

García, O. P., et al. (2009). Impact of micronutrient deficiencies on obesity. Nutrition Reviews, 67(10), 559-572. doi:10.1111/j.1753-4887.2009.00228.x

Mckay, J., et al. (2020). Overweight & obese Australian adults and micronutrient deficiency. BMC Nutrition, 6(1). doi:10.1186/s40795-020-00336-9


These materials are provided to you by Blythedale Children’s Hospital and Kohl’s
Eat Well, Be Well Nutrition Outreach Program.
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Kohl's Eat Well, Be Well Program

Blythedale Children's Hospital, through the generosity of Kohl’s Department Stores, is proud to offer Blythedale and Kohl's Eat Well, Be Well, an innovative outreach program designed to bring health and nutrition education to schools throughout Westchester and Putnam counties. Through this program, Blythedale staff members teach healthy eating habits to children by providing curricula, training and educational tools to school districts throughout the area. The program provides general nutrition guidelines to students, parents and school faculty. Blythedale Children's Hospital offers experts in nutrition and health-education to speak with local parenting groups, PTAs and school personnel.

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