Burden of Malnutrition in UK Essay Answer

Subject Name : Medical Science

Introduction

The double burden of malnutrition is a common health concern in many countries. It is defined as the coexistence of overnutrition and undernutrition. It is characterized by the coexistence of undernutrition along with other issues such as overweight, obesity and diet-related non-communicable diseases (NCDs). The double burden of malnutrition can manifest at the individual (presence of malnutrition issues over a lifetime), population (prevalence of both undernutrition and overweight in the same country or region) and household level (multiple family members affected) (World Health Organization, 2022). This essay aims to explore the burden of malnutrition in the UK and evaluate the determinants and consequences of malnutrition in the region. In addition, the essay will discuss the use of vertical and horizontal approaches to address undernutrition and overnutrition respectively. The essay will provide insight into the effectiveness of the approach and the methods to evaluate the success of the intervention.

The Health Burden of Malnutrition

Many government reports have revealed the burden of malnutrition in the UK. The dual burden implies the burden of undernutrition as well as overnutrition. According to a study by UK Parliament (2022), malnutrition affects more than one in every 20 people in the UK. In people aged 65 years and above, one in 10 people suffer from diabetes. In addition, malnutrition is disproportionately prevalent in a low-income households. Undernutrition is more common in children from low socioeconomic status. The statistics on malnutrition in England suggest that over 1.3 million people over 65 years experience malnutrition. Around 32% of this age group is at risk of malnutrition on admission to the hospital. Despite the such burden, inconsistencies have been found in nutritional screenings in care homes in the UK. In response to the identification of food insecurity issues, the meal on wheel services was introduced for elderly people in the UK. Recently, the meal on-wheel services have decreased to 50% in 2019 compared to 66% in 2016 (Malnutrition Task Force, 2019). Hence, more services need to be planned based on an understanding of the drivers and determinants of malnutrition in the country.

The burden of malnutrition is understood from the cost to the health care system. According to UK Parliament (2022), the cost of malnutrition was found to be around £23.5 billion. Lack of a proper system for screening of malnutrition can further increase the cost as treatment of malnourished people can be two-three times more harmful compared to non-malnourished patients. The treatment of the malnourished patient was estimated to be around £7,408 compared to £2,155 for non-malnourished patients. Considering the ways by which malnutrition is affecting the nation, the World Health Organization and the United Nations have called for policy action in the following six areas: developing resilient food systems for a healthy diet, promoting social protection for all, aligning health systems to nutrition needs, promoting universal coverage of dietary interventions, building a supportive environment for nutrition and promoting nutritional governance and accountability.

Determinants of Malnutrition

There are many determinants of malnutrition at the population level. Some drivers of the double burden of malnutrition include a combination of biological, environmental, social and behavioural factors. The biological factors include early life experiences such as early life nutrition environment, maternal nutrition and obesity during pregnancy (WHO, 2022). The study by Godfrey et al. (2017) confirms that obesity in pregnancy can have adverse health effects for both mother and the baby. Maternal weight gain during pregnancy and excessive gestation weight gain can increase the risk of obesity in offspring during childhood. In the context of social factors, malnutrition is linked to poverty and socioeconomic disadvantage. Various research studies have linked malnutrition with socioeconomic factors such as poverty. According to Ahmad et al. (2020), children from the low socioeconomic background are 2.5 times more vulnerable to malnutrition compared to those from middle or upper socioeconomic status. Such families are vulnerable to food insecurity issues as they cannot afford nutritious food. Similarly, urbanization and the built environment contribute to malnutrition. The build environment factors refer to the man-made aspects of the environment such as urban design, land use and transportation systems. Such an environment can sustain or support eating (Dixon et al., 2021. For instance, the availability of fast food options may influence eating behaviours and issues such as obesity.

Lifestyle is one of the important determinants of malnutrition. According to WHO (2022), an unhealthy lifestyle may lead to greater energy consumption and this behaviour lead to long-term weight or challenges in losing weight. In addition, evidence shows that both healthy as well as unhealthy dietary patterns may vary according to age, socioeconomic status, ethnicity and culture of people. Diet is recognized as one of the lifestyle factors that can prevent the risk of chronic disease. In addition, lifestyle pattern is the study of dynamic interactions between different individual factors (Gherasim et al., 2020). Thus, to address malnutrition issues in any region or population, having an understanding of the dietary and lifestyle patterns of the group is important.

Consequences of Malnutrition

The statistics on malnutrition suggest the extent to which is affecting the people in the UK. Taking steps to address the public health concern is important as there are many adverse consequences of malnutrition. It can lead to poor recovery, increased rate of infection, high rate of hospitalization and increased health care cost (). The report by Elia (2015) gives insight into the cost of malnutrition in the UK. The cost was estimated to be around e £19.6 billion per year or 15% of the total health expenditure. The primary reason for the cost linked to malnutrition is an increase in hospitalization, GP visits, prescriptions and rate of hospital readmission following discharge. However, the data is for the year 2011-2012 More recent reports suggest that malnutrition contributes to around 15% of the total healthcare budget of the UK. In the year 2022, the cost of malnutrition was estimated to be around £23.5 billion (UK Parliament, 2022).

Both undernutrition and overnutrition can lead to adverse health consequences. Undernutrition can lead to adverse health effects such as the risk of recurring illness, and impaired physical and mental development. The study by Saleem et al. (2021) gives evidence of the risk of developmental delays in children with severe acute malnutrition. The study was done on children with severe acute malnutrition in rural areas of Pakistan. The children were screened for nutritional status and clinical complications. Out of 177 children, 69% of the children were found to have delayed global development. This shows that the majority of the participants revealed delayed or unstable development. This suggests the need to pay more emphasis to developmental delays in remote areas. However, one gap that affects the local application of the result is that the study was done in Pakistan and the results cannot be applied in the context of the UK. Hence, a more recent evaluation for the UK setting is needed.

Strategies to Address Undernutrition Using the Vertical and Horizontal Approach

To manage the health burden from malnutrition in a regional population of 5, 00, 000 people, there is a need to identify an ideal approach to address both undernutrition and overnutrition. To address undernutrition, it is planned to use the vertical approach. The vertical approach involves stand-alone disease management or disease control programmes through separate administration and budget. It is the approach to solving problems utilizing single-purpose machineries such as the eradication of disease using vaccination or other disease-specific campaigns. (Onwe et al., 2021). One vertical program that can be used to address malnutrition or undernutrition issue is the implementation of malnutrition screening and assessment programs at the population level followed by the implementation of nutritional intervention. The advantage of screening is that it can help to systematically detect and treat people at-risk and malnourished patients at the population level (Serón-Arbeloa et al., 2022). There are different validated tools available for systematic assessment such as the Malnutrition Universal Screening tool. Similar tools can be implemented in hospital and community settings of the region to identify people at risk of undernutrition. This approach can help to evaluate the burden of malnutrition in the region. It can facilitate the implementation of appropriate treatment such as dietary advice or nutritional supplementation intervention for the population (Harris et al., 2019).

In contrast, the horizontal approach is defined as an approach where health problem is solved by creating permanent institutions such as general health services. Vertical programs have short or medium-term objectives with centralized management. The advantage of such vertical programs is adaptability, the possibility of financial control and the implementation of innovative strategies to manage diseases. Its focus is on engaging the community in action to promote health. Compared to the vertical approach which uses a top-down approach, the horizontal approach focuses on the use of a comprehensive approach to treating all underlying issues in a population (). To address the issue of overnutrition or obesity, it is planned to implement community-based lifestyle interventions for the population. Such programs can address the complex set of factors leading to overnutrition. For instance, it is planned to implement a lifestyle modification program that targets both physical activity and a healthy diet. Comprehensive lifestyle modification programs can be implemented in local regions and they can include education on modifying eating habits and engaging in exercise. It can facilitate weight loss and address habits contributing to overweight or obesity (Wadden et al., 2020).

Evidence to Support the Effectiveness of Chosen Approach

The justification for choosing malnutrition screening for addressing undernutrition in the region is that it can facilitate identifying people at risk and implementing targeted actions for those groups. The study by Rowne, Geraghty and Corish (2022) argues that routine screening for malnutrition should be done on a weekly basis. Community-based malnutrition screening was encouraged as 25% of patients admitted to the hospital have been found to be at risk of malnutrition. Such community-based nutritional screening is essential to prevent malnutrition risk and implement early intervention and treatment. The study by Isanaka et al. (2019) gives evidence of the cost-effectiveness of community-based screening and treatment of acute malnutrition in Mali. A cluster randomized treatment was conducted in Mali and the cost-effectiveness of screening was assessed by taking data from care providers. The study revealed the cost-effectiveness of screening and malnutrition treatment initiatives. However, the study suggested the need to do better investments to increase the frequency of screening, reduce the cost associated with treatment and minimize the cost associated with the management of complicated cases.

The main justification for choosing a community-wide lifestyle modification program is that it can address all risk factors that can contribute to obesity. Lifestyle factors such as diet, physical activity and sedentary behaviour are associated with the risk of weight gain and obesity. Much evidence exists for the effectiveness of lifestyle intervention on body weight and obesity. The study by Koeder et al. (2022) explored the effect of a lifestyle intervention in a general population in Germany using a non-randomized controlled trial method. The one-year lifestyle program focused on four areas namely the emphasis on a plant-based diet, physical activity, stress management and community support. The comparison of outcomes in the intervention and control groups revealed significant differences in body weight, BMI, waist circumference, HbA1c level and resting heart rate in the intervention groups. Thus, similar measures can prove to be effective for a regional population of 500, 000 people.

Evaluation of Success

The success of the horizontal and vertical approach in addressing malnutrition in the area can be understood from collecting surveillance data on the number of malnourished and obese people before and after the implementation of the program. This step can be implemented six months after the implementation of the intervention. In addition, hospital records can be taken to evaluate the reduction in cost due to early treatment and management of the dual burden of malnutrition.

Conclusion

From the analysis of the burden of malnutrition in the UK, it can be concluded that it is a major public health concern in the country. The statistics on the burden of malnutrition show that both undernutrition and obesity risk is high in the country. The incidence of malnutrition has been associated with increased costs to the healthcare system and it has exposed the population to the risk of many chronic health issues. To address the issue in a regional population, the vertical approach of community-based malnutrition screening and the horizontal approach of lifestyle modification intervention was targeted. It is expected that regular screening can lead to early intervention and a reduction in the cost of treatment.

References

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