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Large parts of the American population are diagnosed as overfed but malnourished, according to the Centers for Disease Control and Prevention (CDC). It’s called the obesity paradox. While we have easy access to calorie-dense, highly processed foods, a balanced, nutritious diet is much harder to come by.

“The mistake is to think that if you eat an abundance of calories, your diet automatically delivers all the nutrients your body needs,” says Dr. Mark Hyman, author of “The Blood Sugar Solution” (Little, Brown & Co., 2012). “The problem is that the Standard American Diet (SAD) is energy dense (too many calories) but nutrient poor (not enough vitamins and minerals).” As a result, “Americans are suffering from massive nutritional deficiencies,” Hyman adds.

For years and years consumers were told by the food industry that it really doesn’t matter where calories come from. “A calorie is a calorie” is an often-heard mantra. Not so, says Dr. David Ludwig of Boston’s Children Hospital. In his studies, he found that from a metabolic perspective, all calories are not alike. Wholesome, nutrient-rich foods offer innumerous health benefits their high-fat, high-sugar, high-salt, highly processed and refined counterparts cannot match.

New research suggests that the adverse consequences of malnutrition due to calorie-dense but nutrient-poor diets become even more evident as we age. One study from Sweden concluded that the “consumption of fat laden foods can have huge implications for the risk of malnourishment in older age.” Participants in the study who had the highest fat intake during middle age showed the greatest risk of malnutrition as seniors.

Many of the symptoms of malnutrition worsen when people reach an age where they become more frail and vulnerable to diseases. These are not isolated instances. Surveys have found that about 25 percent of Americans age 65 and older suffer from some degree of malnutrition. Common results are unhealthy weight loss and diminishing muscle strength, weakening of the immune system as well as declining mental health.

Malnutrition also becomes of greater concern with age because of changes in body composition, according to studies by the National Institutes of Health (NIH). As muscle mass decreases, the percentage of body fat often rises, therefore elevating the risk of stroke, diabetes, heart disease and hypertension.

Involuntary loss of weight caused by dietary deficiencies may lead to negative energy balances. Low energy may be compounded by loss of appetite or inability to maintain a healthy diet regimen.

Other risk contributors can be a diminishing sense of smell and taste, gastrointestinal disorders (e.g. malabsorption), interactions with medications, physical disability and other inhibiting factors. Psychological components like suffering from social isolation, depression, bereavement and anxiety can make things worse. Lifestyle issues such as lack of knowledge about food, cooking and nutrition facts, reduced mobility and financial constraints may also play a role.

The key to prevention or treatment of malnutrition is early diagnosis and appropriate countermeasures, including adherence to sound dietary guidelines and regular physical exercise for muscle strength and enhancement of metabolic health. Implementing these cannot start too soon but is also never too late.

If you enjoyed this article, you may also be interested in “How Malnutrition Causes Obesity.”

Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.”, and at amazon.com. You can follow Timi on Twitter and on Facebook.

Most diet programs for weight loss are mainly focused on managing calories. Of course, there is good reason for that. A surplus of calorie intake versus expenditure eventually leads to weight gain. Only about 500 additional calories a day can result in an extra pound of body weight per week – and, of course, the opposite applies just as much. However, it is also important to know where those calories come from, a fact that is not always communicated as well.

According to the laws of physics, calories are all the same. Thus, in theory, it shouldn’t matter whether you drink sugary sodas or eat apples as long as both have the same calorie count. So, the kind of diet you choose – e.g. high-protein/low-carb, high-carb/low-fat, or anything in between – shouldn’t matter either, provided more calories are burned off than consumed. Still the discussion over the effectiveness of different weight loss approaches continues. But is this even the right conversation to have?

Obesity is undoubtedly one of the most pressing health problems of our time. But so is – paradoxically – malnutrition. “Americans are overfed and undernourished,” says Dr. Mark Hyman, author of the “Blood Sugar Solution – The UltraHealthy Program for Losing Weight, Preventing Disease, and Feeling Great Now!” (Little, Brown, 2012). In fact, he says, “most obese children and adults in the country are also the most nutritionally deficient.”

The so-called “Standard American Diet” (SAD) is notoriously caloric but too often nutrient poor, lacking many essential vitamins and minerals. People who eat large amounts of highly processed foods and ingest lots of sugar, refined grains and hydrogenated fats (trans-fats) may gain weight but remain hungry because their nutritional needs are not met. But instead of altering their food choices, they simply keep munching on more of the same.

When they eventually decide to go on a diet, they may starve themselves, but all they often do is deprive their body further by cutting back on (empty) calories without replacing them with more and better nutrients, which is what a healthy diet (for weight loss or otherwise) should be all about.

Nutrition experts have long known that one of the best ways to achieve and maintain a healthy weight range is to focus on nutritional quality first. Yes, portion sizes do matter, but they become less important as you switch from empty calories to nutrient-dense ones. An extra helping of fresh fruit or vegetables is harmless by comparison to a supersized cheeseburger, pizza slice or order of French fries. The same goes for snack foods. While potato chips, candy bars and cookies may give you some instant gratification, they will not satisfy you for long (that’s why you keep reaching for them). Healthy snacks, on the other hand, like apples, citrus fruits, bananas or berries, will do the job much better, and the health benefits are of course much greater.

The bottom line is that single strategies like counting calories won’t work if they don’t go hand in hand with a health-conscious change of eating habits and food choices. Part of that process is educating yourself about nutritionally superior foods and the many advantages they can provide, not just for managing body weight but, more importantly, for all-around good health.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

Pediatricians in almost every part of the country report seeing undernourished children in greater numbers than at any time in recent memory. More and more parents who have fallen on hard times due to the ongoing economic downturn are unable to afford enough food to give to their kids. Entire families subsist on junk food and go hungry for several days each month, according to a survey conducted by researchers at Boston Medical Center (BMC).

“Before the economy soured in 2007, 12 percent of youngsters age 3 and under whose families were randomly surveyed in the hospital’s emergency department were significantly underweight. In 2010, that percentage jumped to 18 percent, and the tide does not appear to be abating,” said Dr. Megan Sandel, professor of pediatrics and public health at BMC and investigator with Children’s Health Watch, a network of researchers who track children’s health in the U.S. “Food is costing more and dollars don’t stretch as far. It’s hard to maintain a diet that is healthy,” she added.

Doctors at hospitals in Baltimore, Little Rock, Minneapolis and Philadelphia also reported dramatic increases in the ranks of malnourished kids that show up in their emergency rooms with nutrition-related health problems.

Nearly 40 million people, including 14 million children, are currently facing hunger or the risk of hunger in America, according to the U.S. Department of Agriculture’s surveys on domestic food security. 3.5 percent of American households experience hunger on a regular basis, meaning that families are forced to skip meals and go without food for entire days. Three million children live under these severe conditions. Another eight percent of households are affected by chronic food insecurity, which means they are periodically at risk of hunger, eat low-quality diets and depend heavily on outside help, such as food stamps and food banks. 10.5 million children live currently in this kind of situation.

When children experience hunger, even temporarily, it is a much more serious problem than when adults suffer from shortages. A lot of irreversible damage can be done when growing kids are deprived of essential nutrients. A recently published study on the exposure to famine and under-nutrition during childhood and adolescence found that serious health problems persist throughout adulthood among those who were exposed to malnutrition early in life. The study, which was conducted by researchers from the University Medical Centre Utrecht and the University of Amsterdam in the Netherlands and published in the European Heart Journal, found “direct evidence that acute under-nutrition during childhood has an important impact on future health.”

For the study, the researchers investigated the medical history of almost 8,000 women who lived as children, teenagers or young adults during the so-called “Dutch famine” right at the end of World War II. “The Dutch famine of 1944 to 1945 is a ‘natural experiment’ in history, which gave us the unique possibility to study the long-term effects of acute under-nutrition during childhood,” wrote Dr. Annet van Abeelen from Utrecht, one of the lead authors of the study report. “Our findings suggest that a relatively short period of severe under-nutrition is associated with an increased risk of coronary heart disease in adult life, in a dose-dependent manner,” she added.

The women who were between 10 and 17 years old at the start of the famine, and who had been severely exposed to food shortages, were found to have a 38 percent higher risk of developing heart disease later in life, compared to others who were only moderately or not at all affected.

“The contemporary relevance of our findings is that famine and under-nutrition are still a major problem worldwide,” Dr. Abeelen wrote.

Depending on a child’s age, malnutrition can be extremely harmful both mentally and physically. Symptoms of nutritional deficiencies can include poor (stunted) growth of the brain and vital organs, mental retardation, muscle weakness, compromised immune system, fragile bone structure (rickets, osteoporosis), decaying teeth, delayed growth spurts and puberty, delayed menstrual cycle for young girls, and many chronic conditions, like asthma, anemia and pneumonia. A vast array of illnesses that develop later in life, like diabetes, heart disease and failure of key organs to function properly, can also be traced back to poor nutrition during childhood.

In other words, from a perspective of public health, the myriad effects of poverty and hunger on today’s children will stay with us for a very long time, possibly for a generation. Even proponents of austerity programs to reduce the national deficit acknowledge that cutting back on government spending on behalf of the most vulnerable members of society will make the current situation only worse. For the millions who already struggle to survive, shrinking the economy further is a recipe for disaster. In the end, we all will pay the price in terms of higher health care costs – just to keep a significant part of the population alive.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” ( http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter at http://twitter.com/TimiGustafsonRD