In the developing countries of Africa, Asia and Latin America, it's relatively easy to spot the youngsters suffering from malnutrition. They're the ones with the glassy eyes, toothpick arms and legs, and rags for clothing.
But in Baltimore, hunger presents a different face: an overweight adolescent in T-shirt and jeans, or a sickly infant who turns up repeatedly in hospital emergency rooms.
City health officials are taking the problem of malnutrition seriously, as food and fuel prices soar and more families lose homes and jobs. In tough economic times, even people who are working can have trouble putting food on the table.
The need is reflected in a dire statistic: One in eight families who bring children to the University of Maryland Medical Center's emergency room are undernourished, according to a recent study. Young children are listless and distracted, while teens are bloated from filling up on fats and starches. Both are at risk for serious health problems that can affect later growth and development.
The city, quite sensibly, wants to encourage families to get help, and it's urging area doctors to screen young patients for signs of malnutrition and refer their families to local food pantries. That's a start - though more may be needed, when you consider that 11 percent of the families eligible for benefits in the UM study weren't receiving Food Stamps or enrolled in the Woman, Infants and Children program. Both can bring healthier foods within reach.
But many of the nonprofit groups that operate food pantries and soup kitchens say they're now also feeling the pinch.
The Maryland Food Bank, for instance, distributes products to food pantries around the state. But officials there say they have been swamped recently by people seeking assistance, whose numbers have risen as much as 50 percent over last year. Meanwhile, donations from suppliers have dropped sharply, a situation the city is trying to improve with cash and contributions from municipal workers.
The UM study of malnourished youngsters is a sign of trouble to come. As economic woes deepen, the need for nutrition programs will only grow. City officials are rightly concerned about getting the word out. But they need a plan that produces more than just advice for hungry people.