Under-Recognizing Malnutrition in Hospitalized Obese Populations: The Real Paradox

Obesity and malnutrition are frequently encountered in the hospitalized population. Although malnutrition associated with low or normal body mass index (BMI) is easily identified, malnutrition in obese patients goes frequently unrecognized as their fat mass masks underlying muscle mass deterioration. The purpose of this review is to explore if malnutrition has been studied in the obese hospitalized population and if that may be one of the reasons for the variable results in the obesity outcome data.

Various studies have shown a conflicting association between obesity and outcomes in hospitalized patient population. Most prior studies used BMI alone as an indicator of obesity and although some recent studies have included body fat percentage, muscle mass, and functional status, they still showed variable outcomes. Unfortunately, there are not many studies that looked into nutrition status specifically in obese patients to study the outcomes. Studies evaluating clinical outcomes in obese patients showed a wide range of outcomes; some showed a protective effect while others were neutral. We explored recent data about obesity, malnutrition, and outcomes, where researchers more precisely defined malnutrition and obesity to determine health outcomes.