Hidden health problem of malnutrition

An estimated 45,000 people in south London are at risk of malnutrition and prone to hospital admission, longer hospital stays and likely to have a poorer quality of life.

With this startling figure in mind, experts at Guy’s and St Thomas’ have begun a project to find out the exact extent of malnutrition in Lambeth, Southwark and Lewisham so that they can improve the care of people most at risk. The project team also want to know why people at risk find it difficult to get the treatment they need.

Project lead, consultant dietitian, Dr Liz Weekes says: “There has been a huge amount of media coverage about what is often referred to as the “obesity time bomb” but malnutrition is a very real problem too, not just overseas but right here in our own communities.”

People are considered to be at risk of malnutrition if they are thin (a Body Mass Index (BMI) of less than 20 kg/m2) or are losing weight without meaning to - putting them more at risk of complications and longer stays in hospital if they become ill, injured or have surgery.

Dr Weekes says: “It’s all too easy to prescribe nutrition supplements when a patient complains of loss of appetite but it’s important to consider why people lose weight without meaning to and to address their specific problems.

“The loss of a close relative or friend, feelings of loneliness or even forgetting to eat or shop can have a huge effect, especially after illness,” she says.

Elderly people are particularly vulnerable to malnutrition with around 10,000 local people over 65 being underweight and up to 50% of patients going into care homes being at risk of malnutrition.

Last year 83-year-old Dennis Mahoney a former buildings site clerk of works from Rotherhithe found himself in this position. In July, he visited Guy’s Hospital to discuss treatment for an abnormal heart rhythm but was shocked to discover that he had pneumonia and was admitted to hospital immediately.

Whilst in hospital his dietitian discovered that he was also severely under-nourished. Despite being 6ft tall, Dennis weighed just 9 stone.

Dennis says: “I had lost my appetite completely and started to miss meals. I found myself getting weaker, to the extent that I couldn’t even walk across the room and I had to crawl up the stairs on all fours.

“The dietitian at Guy’s Hospital was marvellous. She said that I had to eat something and because of the ‘red tray’ project – which means that patients with problems eating and drinking are given extra help – I could decide exactly what I wanted to eat. For me, it was great to be able to enjoy a cooked breakfast at last.”

With the support of the hospital's dietitians and nurses, Dennis began to eat again, starting simply by re-introducing three meals a day at set times. Now, only a few months after being discharged from hospital, Dennis’ weight is a much healthier 12.5 stone.

He says: “I’m now back to full health and I cannot thank the team at Guy’s Hospital enough.”

Over the coming months the project team will be asking local GPs, healthcare professionals, community groups working with older people, and patients living with malnutrition or their carers, to share their knowledge and experiences.

Dr Weekes says: “As health and social care professionals we need to talk to patients about the reasons why they are thin or losing weight and work together to address the underlying issues people face.

“By tackling these problems we can help local people to live more healthily, help them reduce the amount of time they take to recover after an illness and ultimately avoid unnecessary stays in hospital.”

Malnourished patients in hospitals and care homes cost the UK in excess of £7.3 billion each year in terms of treatment.