Starved for Sustenance

Can you be obese and undernourished?

According to Jenny Ledikwe you can.

chocolate frosting donut

“There is a common misconception that people who are obese eat a lot and therefore must be etting plenty of vitamins and minerals,” says Ledikwe, a Penn State Ph.D. candidate in nutrition. But the issue isn't quantity; it's quality, she says. Many heavier individuals tend to eat foods high in calories but low in nutritional value.

This double whammy may be a particular problem for women, especially elderly women in rural areas, says Ledikwe. Along with researchers from the Geisinger Health Care System and Vanderbilt University, Ledikwe and her adviser, Helen Smiciklas-Wright, Penn State professor of nutrition, studied a group of 181 people over the age of 65 living in rural Pennsylvania. Using waist-circumference measurements and height-weight ratios, they determined that 80 percent of this sample population was overweight or obese, a figure even higher than the national average of 60 percent. Blood samples analyzed for plasma biomarkers told them how these subjects were faring nutritionally. Surprisingly, the researchers found that obese or overweight men in the study were not malnourished, while many of the obese women were.

bag of chips

To account for their findings, Wright and Ledikwe point to social and geographical challenges faced by rural elderly populations. Often in rural areas social services, health centers, and food-delivery services, such as Meals-on-Wheels, are far from home, Ledikwe notes. When getting to the grocery store is a challenge, cooking a nutritious meal isn't likely to be a frequent occurrence. Also, says Ledikwe, many of the people in the study live alone. “These people tend to snack more instead of having the social interaction of a meal. And convenience foods tend to be high in calories but low in nutrients.”

All of these factors, plus the sedentary lifestyle characteristic of this population, add up to obesity, which in turn leads to functional limitations like difficulty walking, and difficulty getting out of bed or up from a chair, which only perpetuates the cycle, Ledikwe says. And women in the study were more likely than men to live alone, eat alone, have a limited food budget and suffer from some kind of functional limitation. These differences could account for the gender discrepancy, she suggests.

Whatever the reason, the link between obesity and malnutrition spells trouble for women. “Obese and overweight women face many health problems—cardiovascular disease, susceptibility to illness, an early decline in cognitive function—and what we're seeing in their dietary intake could exacerbate these problems,” says Ledikwe. “Because of their weight status and nutrient intake they may be facing a double threat.”

pink ice cream

“There is still a lot we don't know about diet, health, and weight status in older adults,” adds Wright. “We do know that, compared to other populations, an older adult is more likely to have a poor diet pattern with low vitamin and nutrient intake.”

“What we're saying is: ‘Here is what we've found, let's do more,' ” Ledikwe says. “We are using this data to come up with follow-up questions for a group of 20,000 elderly. We will use a food-frequency questionnaire to find out what they eat, how much and how often. Ultimately, we will link diet data with quality of life and health-care use—trips to the doctor, medications used. We hope that future studies will show whether the link between obesity and malnutrition extends beyond Pennsylvania, beyond rural areas, and beyond the older population.”

Ledikwe says it's already time for older women who may be at risk to start making changes: “This is a population in dire need of nutritional intervention, specifically by selecting foods higher in nutrients and lower in calories like fruits, vegetables, and cereal. The big take-home message is that most older adults need to concentrate on choosing more high-nutrient foods, especially if they are overweight or obese.”

Jenny Ledikwe is a Ph.D. candidate in nutrition in the College of Health and Human Development, 5 Henderson Building, University Park, PA 16802; 814-865-1431; mhv111@psu.edu. Helen Smiciklas-Wright, Ph.D., is a professor of nutrition in the College of Health and Human Development, 5 Henderson Building, University Park, PA 16802; 814-863-2913; hsw@psu.edu. The research reported above was conducted in collaboration with Christopher Still, D.O., of the Geisinger Health Care System, and Gordon Jensen, M.D., Ph.D., of Vander-bilt University, and is supported by the United States Department of Agriculture.

Last Updated May 01, 2003