Social Innovations – A Nutrition Overview & Public Schools in the US offer a Free Lunch

I am sharing this information to try to connect the dots in a way that will be meaningful and helpful. I will be illustrating life experiences with scientific evidence-based corroborating. material. I am not a doctor so do check with your own health care provider for personal changes you may wish to try. Regarding social innovation programs, I want the whole world to have access to ideas, so we all have the best quality of life.

This article discusses the types, symptoms and causes of malnutrition and provides information about prevention and treatment.


What Is Malnutrition?

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Written by Lizzie Streit, MS, RDN, LD October 10/2018 – Photo courtesy of Healthline Magazine

Malnutrition is a condition that results from a nutrient deficiency or overconsumption.

Types of malnutrition include:

  • Undernutrition: This type of malnutrition results from not getting enough protein, calories or micronutrients. It leads to low weight-for-height (wasting), height-for-age (stunting) and weight-for-age (underweight).
  • Overnutrition: Overconsumption of certain nutrients, such as protein, calories or fat, can also lead to malnutrition. This usually results in overweight or obesity.

People who are undernourished often have deficiencies in vitamins and minerals, especially iron, zinc, vitamin A and iodine.

However, micronutrient deficiencies can also occur with overnutrition.

It’s possible to be overweight or obese from excessive calorie consumption but not get enough vitamins and minerals at the same time.

That’s because foods that contribute to overnutrition, such as fried and sugary foods, tend to be high in calories and fat but low in other nutrients.

SUMMARY Malnutrition includes undernutrition and overnutrition, both of which can lead to health problems and nutrient deficiencies if not addressed.

Signs and Symptoms

The signs and symptoms of malnutrition depend on the type.

Being able to recognize the effects of malnutrition can help people and healthcare providers identify and treat issues related to under- or overnutrition.


Undernutrition typically results from not getting enough nutrients in your diet.

This can cause:

  • Weight loss
  • Loss of fat and muscle mass
  • Hollow cheeks and sunken eyes
  • A swollen stomach
  • Dry hair and skin
  • Delayed wound healing
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Depression and anxiety

People with undernutrition may have one or several of these symptoms. Some types of undernutrition have significant effects.

Kwashiorkor, a severe protein deficiency, causes fluid retention and a protruding abdomen. On the other hand, the condition marasmus, which results from severe calorie deficiency, leads to wasting and significant fat and muscle loss.

Undernutrition can also result in micronutrient deficiencies. Some of the most common deficiencies and their symptoms include:

Vitamin A: Dry eyes, night blindness, increased risk of infection.

Zinc: Loss of appetite, stunted growth, delayed healing of wounds, hair loss, diarrhoea.

Iron: Impaired brain function, issues with regulating body temperature, stomach problems.

Iodine: Enlarged thyroid glands (goiters), decreased production of thyroid hormone, growth and development issues.

Since undernutrition leads to serious physical issues and health problems, it can increase your risk of death.

In fact, it’s estimated that stunting, wasting and zinc and vitamin A deficiencies contributed to up to 45% of all child deaths in 2011.


The main signs of overnutrition are overweight and obesity, but it can also lead to nutrient deficiencies.

Research shows that people who are overweight or obese are more likely to have inadequate intakes and low blood levels of certain vitamins and minerals compared to those who are at a normal weight.

One study in 285 adolescents found that blood levels of vitamins A and E in obese people were 2–10% lower than those of normal-weight participants.

This is likely because overweight and obesity can result from an overconsumption of fast and processed foods that are high in calories and fat but low in other nutrients.

A study in over 17,000 adults and children found that those who ate fast food had significantly lower intakes of vitamins A and C and higher calorie, fat and sodium consumption than those who abstained from this type of food.

Assessing Malnutrition

Symptoms of malnutrition are assessed by healthcare providers when they screen for the condition.

Tools that are used to identify malnutrition include weight loss and body mass index (BMI) charts, blood tests for micronutrient status and physical exams.

If you have a history of weight loss and other symptoms associated with undernutrition, your doctor may order additional tests to identify micronutrient deficiencies.

Identifying nutrient deficiencies that result from overnutrition, on the other hand, can be more difficult.

If you’re overweight or obese and eat mostly processed and fast foods, you may not get enough vitamins or minerals. To find out if you have nutrients deficiencies, consider discussing your dietary habits with your doctor.

SUMMARY Symptoms of undernutrition include weight loss, fatigue, irritability and micronutrient deficiencies. Overnutrition can result in overweight, obesity and a lower intake of certain vitamins and minerals.

Long-Term Effects

Malnutrition can lead to the development of diseases and chronic health conditions.

Long-term effects of undernutrition include a higher risk of obesity, heart disease and diabetes.

One study in 50 adolescents in Brazil found that boys who had stunted growth as a result of undernutrition early in life gained 5% more fat mass over three years compared to their peers who did not have stunting.

Additional research found that 21% of adolescents with stunted growth in Brazil had high blood pressure compared to less than 10% of adolescents without stunting.

Researchers suspect that childhood undernutrition causes changes in metabolism that may lead to a higher likelihood of developing chronic diseases later in life.

Overnutrition can also contribute to the development of certain health issues.

Specifically, overweight or obese children have a higher chance of heart disease and type 2 diabetes.

A study in over 369,000 children found that those who were obese were more than four times as likely to develop type 2 diabetes compared to their peers who had a normal BMI.

Since the long-term effects of malnutrition can increase your risk of certain diseases, preventing and treating malnutrition may help reduce the prevalence of chronic health conditions.

SUMMARY Research has linked undernutrition in childhood with a higher risk of developing high blood pressure and obesity later in life. Overnutrition may also increase your likelihood of chronic diseases, such as type 2 diabetes and heart disease.

Common Causes of Malnutrition

Malnutrition is a worldwide problem that can result from environmental, economic and medical conditions.

The WHO estimates that over 460 million adults and 150 million children are undernourished, while more than two billion adults and children are overweight or obese.

Common causes of malnutrition include:

  • Food insecurity or a lack of access to sufficient and affordable food: Studies link food insecurity in both developing and developed nations to malnutrition.
  • Digestive problems and issues with nutrient absorption: Conditions that cause malabsorption, such as Crohn’s disease, celiac disease and bacterial overgrowth in the intestines, can cause malnutrition.
  • Excessive alcohol consumption: Heavy alcohol use can lead to an inadequate intake of protein, calories and micronutrients.
  • Mental health disorders: Depression and other mental health conditions can increase malnutrition risk. One study found that the prevalence of malnutrition was 4% higher in people with depression compared to healthy individuals.

Inability to obtain and prepare foods: Studies have identified being frail, having poor mobility and lacking muscle strength as risk factors for malnutrition. These issues impair food preparation skills.

SUMMARY Causes of malnutrition include food insecurity, certain health conditions and mobility issues.

Populations at Risk

Malnutrition affects people in all parts of the world, but some populations are at a higher risk.

Populations that are prone to malnutrition include:

People living in developing countries or areas with limited access to food: Undernutrition and micronutrient deficiencies are especially common in Sub-Saharan Africa and Southern Asia.

Individuals with increased nutrient needs, especially children and pregnant or breastfeeding women: In some developing countries, 24–31% of pregnant and breastfeeding mothers are malnourished.

People that live in poverty or have low incomes: Low socioeconomic status is associated with malnutrition.

Older adults, particularly those who live alone or have disabilities: Research shows that up to 22% of older adults are malnourished and over 45% are at risk of malnutrition.

People with issues that affect nutrient absorption: People with Crohn’s disease or ulcerative colitis may be up to four times more likely to have malnutrition than those without these conditions.

SUMMARY Older individuals, people living in poverty and those with digestive problems or an increased nutrient need are at high risk of malnutrition.

Prevention and Treatment

Preventing and treating malnutrition involves addressing the underlying causes.

Government agencies, independent organizations and schools can play a role in preventing malnutrition.

Research suggests that some of the most effective ways to prevent malnutrition include providing iron, zinc and iodine pills, food supplements and nutrition education to populations at risk of undernutrition.

In addition, interventions that encourage healthy food choices and physical activity for children and adults at risk of overnutrition may help prevent overweight and obesity.

You can also help prevent malnutrition by eating a diet with a variety of foods that include enough carbs, proteins, fats, vitamins, minerals and water.

Treating malnutrition, on the other hand, often involves more individualized approaches.

If you suspect that you or someone you know is undernourished, talk to a doctor as soon as possible.

A healthcare provider can assess the signs and symptoms of undernutrition and recommend interventions, such as working with a dietitian to develop a feeding schedule that may include supplements.

SUMMARY Interventions that encourage a healthy lifestyle or provide nutrition education and supplements may help decrease the prevalence of malnutrition. Treatment usually involves assessment by a doctor and recommendations from a dietitian.

The Bottom Line

Malnutrition refers to overnutrition and undernutrition.

People who are undernourished may experience weight loss, fatigue and mood changes or develop vitamin and mineral deficiencies. Overnutrition can lead to overweight, obesity and inadequate micronutrient intakes and deficiencies.

Both types can lead to health issues if not addressed.

If you believe that you or someone you know may be malnourished, especially undernourished, talk to a doctor as soon as possible.


Rainy Day Social Innovations

Free Lunch Comes to All NYC Public Schools

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Written by Amy Zimmer, September 6/2017 – Photo courtesy of DNAinfo/Amy Zimmer

FAR WEST SIDE, NYC — All of the city’s roughly 1.1 million students heading back to public schools Thursday will have access to free school lunch this year, city officials announced Wednesday.

For years, hunger advocates have been urging the city to implement universal school lunch, and Mayor Bill de Blasio pledged during his mayoral campaign four years ago that he supported free lunch for all.

Making the meals free for all students, rather than just those who are low-income, helps break down the “poor kid” stigma and negative associations attached to school food, advocates believe. It will also help reduce the shame and bullying some kids experience when they are identified as getting free or reduced lunch, or when they can’t cover the costs of the meals, many said.

“There is now such things as a free lunch at New York City public schools,” said City Councilman Ben Kallos, who recalled how he wanted to hide his free lunch status from his friends when growing up on the Upper East Side.

“I had to chose between friends and food,” he said. “I told friends I wasn’t hungry — that’s because I was starving.”

Liz Accles — executive director of Community Food Advocates, which spearheaded the Lunch 4 Learning campaign of parents and union workers pushing for universal lunch — called the move “enormous” in terms of equity, given the notion of public school means that all kids are supposed to receive the same services.

“We’re erasing all the terrible history of the school food program not only in New York City, but nationally, that has divided children by income,” she said. “We’re done with that. This is a new day.”

Her group will now focus on the implementation of the program, to ensure that families are taking advantage of it.

The city has offered free breakfast since 2003 and rolled out free lunch to standalone middle schools in 2014. Middle schools saw participation in the lunch program increase by 6 percent under the program, DOE officials said.

Roughly 75 percent of the city’s students qualified for free lunch under federal guidelines. But because of problems with data collection from families, the city had previously been unable to qualify for the federal government’s Community Eligibility Provision, allowing districts to provide meals to all students free of charge, officials said.

Last year, roughly 30 percent of city students attended a school providing free lunch for all, DOE officials said.

In June, the City Council extended the existing free lunch program in the budget, which was expected to cover an additional 250,000 students, DOE officials said.

But now, free lunch will reach roughly 200,000 more students than that — and at no cost to the city, since the federal government will subsidize the food.

The move to cover all students was made possible after the state Education Department implemented a new data-matching engine demonstrating that the city qualified for the highest level of school food reimbursement from the federal government.

That new data program streamlined the process of identifying eligible families who qualify for other government assistance like Medicaid and food stamps, helping the city qualify for additional federal and state funding for the school meals.

Oddette Manzano, a mom to a fourth-grader and a kindergartner at P.S. 51 on Manhattan’s West Side, attended Wednesday’s press conference at the school to announce the initiative.

She said that when all kids had access to the food — P.S. 51 already offers universal free lunch — it felt more like “one big happy community.”

But when her older children moved on to middle school and then high school, before free lunch was universal, the students felt singled out for accepting free lunch, the mom said.

“It’s like we’re low-income, poor children,” she said. “Now they won’t feel any different than anyone else.”

The program will also save Manzano money, since her kids previously wanted to go out and buy lunch because they felt embarrassed eating free lunch.

“It makes a difference to my pocket,” she said. “Now they can stay inside with their friends.”

Roughly two-thirds of families qualified for free lunch by earning at or below 185 percent of the federal poverty level, which is $34,911 for a family of three. However, more than 110,000 city families that earned between 185 percent to 275 percent of the federal poverty level — between $35,000 and $52,000 for a family of three — still had to pay the full price in the past.

Many struggled, and when their families accrued lunch bills, students had to rely on the kindness of teachers or lunch workers since schools are not allowed to let children go hungry.

But that informal policy only placed more of a burden on children to identify themselves as needy, advocates said.

Those with outstanding bills from last year will receive refunds, school officials said.

At full price, students had been paying $1.75 for the meals, which were already subsidized to bring down the roughly $3.32 cost per meal.

Families can now save, on average, $300 a year on school lunch, said Schools Chancellor Carmen Fariña.

“Equity goes two ways,” she added. “Equity means all children should have the same services no matter where you are on the economic ladder.”

For those families who can afford the meals, Fariña hoped they would consider helping out their schools.

“How about giving some of that money back to your school, to your local PTA?” she said.

City schools have been striving to improve the quality of the food, increasingly sourcing from local farms, using hormone-free chicken and expanding salad bars in cafeterias. Schools will continue to use whole grains despite loosening guidelines from the Trump administration, DOE officials noted.