Jordyn Yeater

Malnutrition and Obesity

4/9/14
FN 4110
Dr. Carrie Hamady

Table of Contents

Introduction .......................................................................................................................................................................3

Methods ................................................................................................................................................................................6

Results ...................................................................................................................................................................................7

Nutrient Table ...................................................................................................................................................................8

Discussion............................................................................................................................................................................9

References ...........................................................................................................................................................................10

Introduction
Malnutrition is defined as 'poor nutrition' and can refer to individuals who present
themselves as either underweight or overweight, making it more difficult to identify. It can
also be stated that malnutrition is not wholly defined by weight, but also by the quality of
the food an individual is consuming (1). Malnutrition is a very broad term and can be
reciprocated in many different ways. Most would assume malnutrition solely means those
who are underweight and ignore the fact that those who are overweight or obese are
considered malnourished, as well. While being underweight is a big deal, being obese is an
even bigger deal that causes many more problems. Obesity is defined as an excess
proportion of bodily fat and technically defined in terms of body mass index. Obesity class
1 is determined by having a BMI of 30-34.9 and obesity class 2 is determined as 35-39.9.
Around 35 percent of Americans are obese, and 67 percent are either obese or overweight
(2). Obesity is caused by many things such as, genetic, environmental, and sociological
factors. Other causes can be illnesses such as hyperthyroidism, polycystic ovary syndrome,
and depression (3). Obesity is found to be hereditary and run in the family. It appears that
a genotype-overfeeding interaction component exists for body fat, which suggests that the
sensitivity of an individual to changes in body fat following overfeeding is genotype
dependent. (3) Although they may not be able to help prevent these genetics, they are able
to control the factors that contribute to obesity. Another factor listed is environmental.
The environment includes the world around us; it influences access to healthy food and
safe places to walk. (3) The people around us and the lifestyle we live can really affect the
way we do things. Eating out with friends can affect the amount of food we eat depending
on how comfortable we are. Also, our access to exercise plays a role in how much we are
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able to actually participate in those types of activities. Some may not have a gym nearby, or
even a safe neighborhood to run in and that can definitely make a difference. Another
contributing factor is sociological and economic issues. Those who are in poverty are more
likely to be obese. It has been suggested that one reason why poverty and lower
educational levels are risk factors for obesity is that high-calorie, processed food is less
expensive and quicker to prepare than fresh fruits and vegetables (3). Many energy-dense
foods are less expensive, particularly if consumers super-size food choices (4). Some of
these people might not even have the experience or education on how to shop and cook for
healthier options, so they resort to the easy route which consists of microwavable meals
packed with sodium.
Non-fatal problems that occur in older adults due to obesity consist of respiratory
issues, arthritis, and skin conditions. When someone is obese, their lungs are smaller and
they have to work harder to push oxygen through the airways. This can turn into issues
such as sleep apnea and other respiratory problems. Doing endurance exercises and
including a weight loss diet can increase maximal oxygen consumption (3). Arthritis is said
to be a leading cause of disabilities in older adults due to all the weight being put onto their
joints (3). A way to prevent this from happening is by exercising. While many people with
arthritis believe that exercise will cause their joints to flare up, it is the opposite.
Stretching exercises of all muscle groups should be done ten minutes a day as well as daily
active range of motion for all joints. (3).
On the other side of obesity, there are some life-threatening conditions that should
be taken care of starting with cardiovascular disease. Coronary heart disease is

responsible for significant morbidity and mortality in older patients who are 65 years and
older. It remains a leading cause of mortality in the US with 84% of persons 65 years or
older dying from this disease. (3). Obesity is an underlying risk factor along with other
things like high blood pressure, low HDLs, high cholesterol, etc. Obesity has also been
linked to issues causing Type 2 diabetes, gall bladder infections, and some types of cancers.
There are many ways to control weight gain and overcome obesity. Most
importantly, start with diet and exercise. For elderly people, it is harder to determine a
weight loss goal because they are already frail and losing weight may contribute to loss of
lean body mass, when they could do weight bearing exercises instead. It is important that
the diet continue to contain 1.0g/kg of protein and include 1500mg Ca/d, as well as 1000
IU vitamin D/d. (3). Exercise is another good option. Increasing flexibility, endurance, and
strength are the goals of regular exercise in older adults who are obese. Stretching, aerobic,
and strengthening exercises are recommended by the American Society for Nutrition and
the North American Association for the Study of Obesity and the Obesity Society, even for
very old or frail persons. (3). If a person is just starting out with an exercise program, it is
important that they are not rushed right into a full exercise program. They should be able
to start out doing easy, weight-bearing exercises that will help them ease into more difficult
activities later on. There are many weight loss programs in local communities that will
offer support for everyone who joins. Awareness of the problems associated with obesity
is increasing and current programs are targeted toward decreasing obesity in our health
care systems, work sites, communities, states, and nation (4). Older adults who exercise
regularly have shown an improvement in balance, strength, coordination, and motor control
flexibility endurance. Participating in regular physical activity can reduce the risk of falls among
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older adults and improve their mental health and cognitive function. Exercising can also help

with the prevention of depression, which is common in those who are obese (5). I suspect
that a patient who is obese has a high fat and sodium diet with a lack of physical activity,
therefore showing them a healthier way of living can provide a future lifestyle filled with
healthful benefits.
Methods
For my methods, I sat down with my step dad who is considered obese in the terms
of his BMI. I asked him to describe his everyday routine, including diet preferences, work
place, eating times, and to note any physical activity. I asked him to keep track of a three
day food record and to keep track of how much he ate and drank of each item such as a cup
or tablespoon of foods or cans and bottles of any fluids he consumed. I gathered his
information after three days and talked to him about his food choices. I made sure to ask
him about any condiments he added to his foods such as butter, sour cream, and salad
dressings. I had also asked him about any complications or medical issues he has because
of his weight and if he was on any medications to help control the issues. I calculated the
amount of calories he should be eating based on his weight and after I entered the data into
the Super Tracker program, I showed him what the actual amount of calories was in his
diet.
Mifflin St. Jeor Kcal needs: 5+10(104.5) + 6.25(177.8)-5(59)= 1,866kcals
SuperTracker kcals based on 2000 kcal diet
Actual Average kcals consumed = 2,602kcals

Results
My stepdad is 59 years old and stands at 5 foot 10 inches and weighs 230 pounds.
He has a BMI of 33, so he is considered in the obese weight class 1. He did have high
cholesterol of 209, but with medication, his cholesterol is now at 138. He takes a dose of
Zocor every day along with a baby aspirin. In 2002, he had triple bypass surgery and has
been trying to eat healthier. His blood pressure is currently 138/93 which makes him
prehypertension, but does not take any medications for that. He consumes a lot of sugary
drinks and has a can of pop with almost every meal. He has a habit of snacking throughout
the day mostly on salty chips or something sweet because he is a truck driver and has to
deliver things on a schedule, so he does not always have the time to sit down and eat lunch.
He leaves pretty early in the mornings, so he usually grabs something quick and rarely ever
packs his lunch. He has a sweet tooth and loves his pizza. He also has a big family that live
nearby so he enjoys getting together every once in a while to go out and eat. During the
warmer months, he enjoys walking our dog and going to the bike trail with his brothers.
The amount of cholesterol in his diet is way over the limit, so it is a good thing he takes
medication. Also, his sodium intake was almost double the recommended allowance. I did
suggest to him to eat more whole grains when choosing bread options because he
consumed a lot of refined grains in his diet. He also needs to include more calcium into his
diet because lack of calcium and vitamin D become an issue as you grow older. He needs to
choose more iron enriched foods as well. He does enjoy eating salads a lot, but usually uses
iceberg lettuce and a cream based dressing. I suggested trying romaine or even spinach and
try to use oil based dressings like Italian dressing, for example. Another issue we talked
about was all the snacks he buys. He goes to the store and buys potato chips and little
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Debbie snacks and when these types of foods are lying around the house it makes it that
much easier and convenient to grab. We also discussed trying to pack a lunch to take to his
work place so he is not tempted to buy something from the vending machine. Although he
may not have much time in the mornings, he can always do it the night before for a few
days a week until he gets used to a routine. One final thing we discussed was the amount of
pop he consumes on a daily basis. Although he tries to limit the pop he does drink to diet,
it still can become an issue. I know it is hard for someone to stop cold turkey because they
need their caffeine fix, but I suggested drinking more water in place of a pop for one meal
out of the day. Even the smallest improvements can help.
Nutrients

Target

Average Eaten Status

Total Calories
Protein (g)***
Protein (% Calories)***
Carbohydrate (g)***
Carbohydrate (% Calories)***
Dietary Fiber
Total Fat
Saturated Fat
Linoleic Acid (g)***
Linoleic Acid (% Calories)***
-Linolenic Acid (g)***
Cholesterol

2000 Calories
46 g
10 - 35% Calories
130 g
45 - 65% Calories
25 g
20 - 35% Calories
< 10% Calories
12 g
5 - 10% Calories
1.1 g
< 300 mg

2602 Calories
93 g
14% Calories
295 g
45% Calories
16 g
41% Calories
15% Calories
19 g
7% Calories
2.0 g
513 mg

Minerals

Target

Average Eaten Status

Calcium
Potassium
Sodium**
Copper
Iron
Magnesium
Phosphorus
Selenium
Zinc

1000 mg
4700 mg
< 2300 mg
900 g
18 mg
310 mg
700 mg
55 g
8 mg

761 mg
3275 mg
4226 mg
1350 g
17 mg
271 mg
1364 mg
123 g
16 mg

Vitamins

Target

Average Eaten Status

Over
OK
OK
OK
OK
Under
Over
Over
OK
OK
OK
Over

Under
Under
Over
OK
Under
Under
OK
OK
OK

Vitamin A
Vitamin B6
Vitamin B12
Vitamin C
Vitamin D
Vitamin E
Vitamin K
Folate
Thiamin
Riboflavin
Niacin
Choline

700 g RAE
1.3 mg
2.4 g
75 mg
15 g
15 mg AT
90 g
400 g DFE
1.1 mg
1.1 mg
14 mg
425 mg

541 g RAE
2.2 mg
4.5 g
81 mg
2 g
8 mg AT
66 g
531 g DFE
1.7 mg
2.0 mg
24 mg
423 mg

Under
OK
OK
OK
Under
Under
Under
OK
OK
OK
OK
Under

Discussion
As I discussed in my introduction, obesity is associated with high blood pressure,
cholesterol, and respiratory problems. My stepdad has prehypertension and has to control
his high cholesterol with medications because of his unhealthy eating habits. When he
walks the dog, I notice shortness of breath at times. These small contributions could
possibly lead to potentially dangerous issues as he gets older. Convenience foods such as
chips and little Debbie snacks are filled with empty calories, sodium, and fat that he does
not need. Along with those bad habits is his love for pizza and pop. He also needs to work
on portion control when he eats out with family. He is trying to make healthier options by
eating more salads and fruits while he is home. He does eat a high sodium and fat diet, but
that can easily be altered with some help. He does not have much experience with cooking
nice, healthy meals but it is never too late to learn! He does enjoy the exercise that he
does get and my mom wants to encourage him whenever she works out too, so it helps to
have that social support. It seems as if he knows what a healthy diet looks like and what
choices he should be making, he just needs to be set in the right direction and have a little
help.
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References
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April 2, 2014]; S25-S31. Available from: Academic Search Complete.
2. Callahan D. Obesity: Chasing an Elusive Epidemic. Hastings Center Report [serial on
the Internet]. (2013, Jan), [cited April 6, 2014]; 43(1): 34-40. Available from:
Academic Search Complete.
3. Nursingworld.org. Obesity in Older Adults. [Online] Available from:
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodi
cals/OJIN/TableofContents/Vol142009/No1Jan09/Obesity-in-Older-Adults.html
[Accessed 8 Apr 2014].
4. Smith A, Lopez-Jimenez F, McMahon M, Thomas R, Wellik M, Hensrud D, et al. Action
on obesity: report of a mayo clinic national summit. Mayo Clinic Proceedings [serial
on the Internet]. (2005, Apr), [cited April 8, 2014]; 80(4): 527-532. Available from:
MEDLINE with Full Text.
5. News-medical.net. Obesity, What Can be Done?. [Online] Available from:
http://www.news-medical.net/health/Obesity-What-Can-be-Done.aspx [Accessed 8
Apr 2014].

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