Weight just a minute!

14 January 2022

Dr Harnish Patel is Consultant Physician in Medicine for Older People and Chair of the BGS Nutrition and GI Special Interest Group (SIG). He Tweets at @HPPatel_soton.

I relish this opportunity to write about my steaked claim in this specialty interest in nutrition. It was grate to meat many of you at the trainees weekend, online in this case. I hopefully gave you a tasters and stimulated you to develop an interest in all things nutritional during your training. All our AYMES should be to have sound knowledge in nutrition, ‘cause we’re not Thick and Easy.


One in ten older people are malnourished or at risk of being malnourished in the UK. The cost of malnutrition was estimated to be £19.6 billion in the UK in the years 2011-12, approximately 15% of the total expenditure of health and social care. With ageing, the cost of malnutrition will increase year on year unless we are proactive about detecting and managing it both in the community and in hospital. We all know the causes of malnutrition span physical, cognitive and psychosocial domains. For example, poor dentition, disease and presence of long-term conditions, musculoskeletal problems, poor gastrointestinal health and dementia. Psychological causes include living alone, lack of social networks and other mental stressors such as bereavement.

In some cases, the stress of caring for an individual can lead to the carer themselves becoming malnourished and increasing their risk of ill health. Malnutrition increases the risk of developing and progression of frailty as well as consequent morbidity and this relationship is bi-directional putting unnecessary burden on health and social care systems. Malnutrition is also strongly associated with sarcopenia, the loss of muscle function and muscle mass, which is a risk factor for falls. Malnutrition can independently impact on every system of the body. For older people, malnutrition can lead to weight loss, increased frequency of infections, poor wound healing, decreased mobility, delay in recovery from illness, increased hospital admissions and length of stay and an increased risk of heart failure and mortality. These factors pose significant threats to older people who may already have co-existing morbidities. Therefore, malnutrition has a considerable impact on older people’s health and social care needs with a wider impact on independence and quality of life.

How do organ systems derive their energy? How does ATP get synthesised? How do cells function?

Ahh, so you see how vital adequate macro- and micronutrients are. Services have been PEGged back for a long time. So, not to commission services or take an interest in better nutritional care for older people is like putting SLT in the wound. It’s not just about BMI (Big Molars and Incisors) or prescribing ONS (Ooh, Not half Sweet, dear), TPN (Tasteless Pot Noodles) or seafood and eating it. What is missing is a co-ordinated systematic approach to tackling malnutrition with development of appetising menus, provision of frequent SNAQs and an army of volunteer feeders, some with straws, some with beakers, at least in hospital. But, nothing that can’t be solved with some fat dough from those with deep pockets and a firm shake. We can’t barium the problem under the carpet and need to Build-Up Soup-er stars to carry the batten-berg, championing for better nutritional care. Let’s SCOFF a meal, turn a green leaf and fill this quiche, er, niche. It is a MUST. You get the whiff.

Hopefully you won’t have foundue this blog too cheesy. Join the SIG, we’re quite flexible I would say.

Confit of interests: none declared. All pun(nets) intended.


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