A report released last week shows that obesity is harming the health of millions of Americans, including children and teens. The report, "F as in Fat: How Obesity Policies are Failing in America 2009," from the Trust for America's Health, says that 28.8 percent of Maryland youths ages 10 to 17 are overweight or obese - and thus at increased risk of a long list of chronic health problems such as type 2 diabetes, hypertension, atherosclerosis and some cancers.
None of this comes as much of a shock. But here's something that most people probably would find surprising: Despite the fact that they generally eat more than enough food, overweight children also can suffer from malnutrition.
How can a fat teenager living in Baltimore experience malnutrition, a condition that brings to mind images of children with swollen bellies living in Africa, the Asia-Pacific region and other impoverished parts of the developing world?
Originally from Nigeria, I am a nutritional biochemist who studies the interactions among dietary habits, infections, inflammation and immunity. Today, global health research tells us that malnutrition is as much about what we eat as what we do not; it is either a lack of adequate food or an overabundance of nutritionally bankrupt foods.
Take a 14-year-old African-American boy living in Baltimore. Like many Americans, he eats too much junk food, while watching hours of television or playing video games.
He knows he is obese. What he doesn't know is that his body is starving for omega--3 fatty acids and other essential nutrients like vitamins and minerals required for good development and health.
Now take a 14-year-old boy from Nigeria. He has poor, uneducated parents and has to share a small bowl of rice and legumes with his three siblings every day. He walks several miles to school daily, often in intense heat. He is emaciated and frequently endures pangs of hunger. For Nigerian children like this, malnutrition usually starts before they are born due to poor prenatal care.
They are an ocean apart, yet both boys suffer from malnutrition, ranging from undernutrition with resulting short stature and below normal weight for the Nigerian to overconsumption of high-fat foods with little or no exercise leading to obesity for the American. Research tells us that both of these forms of malnutrition weaken a person's defenses against various infections and make one more prone to diseases, including measles, malaria, tuberculosis, respiratory and diarrheal diseases, HIV/AIDS and some cancers.
Baltimore is challenged by the full range of this malnutrition spectrum. According to the Baltimore Health Department, the prevalence of overweight students in the city is much higher than national figures.
And undernutrition also appears to be a problem: A July 2008 study showed that 13.5 percent of Baltimore families with young children suffered from what researchers call food insecurity, meaning they either routinely ran out of food or worried they wouldn't have enough to feed their families. Some of those families are at increased risk for malnutrition.
And we are starting to see cities in developing countries fight a similar battle. While undernutrition is widespread in many African countries, there are increasing pockets of obesity showing up in the urban groups: affluent teenagers who are physically inactive and have access to calorie-dense and fatty foods.
The United Nations' Food and Agriculture Organization reported last month that 1 billion people - about one-sixth of the world's population - suffer from hunger. Poor countries in sub-Saharan Africa and the Asia--Pacific region account for 91 percent of the world's undernourished, a situation that "poses a serious risk for world peace and security."
What is to be done? Plenty. And we know how to go about it.
The United States must fund programs that are proven to encourage kids to adopt a healthier diet - one that contains enough essential nutrients, including vitamins and minerals. At the same time, we, as a nation, must invest more in global health research targeted to nutritional/dietary factors and their roles in the prevention and management of various diseases. We can do both, and it can be done at all levels: federal, state and local.
Today, we know enough about nutrition and health to encourage kids in Baltimore to eat nutrient-rich foods and also engage in appropriate physical activities. And we also have proven strategies, like strengthening agricultural infrastructure, that can provide kids in Nigeria with adequate food.
However, we still lack adequate knowledge about how undernutrition influences the powerful punch of some infectious agents. The lack of similarity in rates of some cancer types in people who share genetic ancestry but live in different parts of the world suggests that dietary habits may be an important associated environmental factor. Such a study will require global collaboration between U.S.-based scientists and scientists in developing countries, among others.
But today, global health research targeted to elimination of malnutrition and its health consequences is an underappreciated and underfunded area. We simply must do more to find answers to the worldwide problems of hunger, obesity and malnutrition-related diseases. Children all over the world are counting on us.
Dr. Cyril O. Enwonwu is professor of biomedical sciences and director of International Research Initiatives at the University of Maryland School of Dentistry and adjunct professor of biochemistry and molecular biology at the UM School of Medicine. He is also a Research! America Ambassador in the Paul G. Rogers Society for Global Health Research. His e-mail is firstname.lastname@example.org.