Opportunities to advance malnutrition care and health equity

This year marks our nation’s 10th observance of Malnutrition Awareness Week. We are a member of Congress and the national coordinator of the Defeat Malnutrition Today coalition. This year we are collaborating on a resolution acknowledging the importance of this week, with a special focus on nutrition as a patient right.  

Malnutrition Awareness Week is enhanced this year by the Centers for Medicare and Medicaid Services’ (CMS) recent decision to add a malnutrition-related measure, the Global Malnutrition Composite Score, to its Inpatient Hospital Reporting Program for the first time in the history of Medicare. The significance of this move cannot be understated. One in every two older adults is either at risk of malnutrition or is malnourished. Malnutrition affects 20 to 50 percent of admitted hospital patients, but it is diagnosed in only about 8 percent of hospital stays. Malnutrition increases the frequency and length of hospital stays and leads to higher health care costs: in fact, disease-related malnutrition costs exceed an estimated $50 billion annually. A 2021 Agency for Healthcare Research and Quality systematic review reports patient malnutrition is an “underrecognized threat to patient safety.” 

Addressing malnutrition, especially in the inpatient hospital setting, is also a fundamental health equity issue. CMS has found that readmission rates are significantly higher for Black and Hispanic Americans, as well as for American Indian and Alaskan Natives. And, according to the United States Department of Agriculture, there is a higher prevalence of food insecurity among Black, Hispanic, low-income, and rural households, as well as among elderly people living alone. 

The next step in improving malnutrition care and health equity is for hospitals to link patients who are malnourished or at risk for malnutrition to community-based nutrition services and resources that are available post-discharge. This is where further congressional action is still needed. Medical nutrition therapy (MNT) provided by a registered dietitian or nutritionist in the outpatient setting can help improve health outcomes. Medicare, however, currently offers MNT coverage for very few conditions. Passing the Health Equity and Accountability Act, which includes the Medical Nutrition Therapy Act and other improvements to federal nutrition programs, will extend this coverage to malnutrition and chronic diseases that frequently result in malnutrition such as cancer, HIV, and diabetes. 

Congress must also bolster programs that are successfully addressing hunger. Nutrition programs are the largest component of the Older Americans Act (OAA), a law that funds both Meals on Wheels and meals served in congregate settings like senior centers. We successfully incorporated “reducing malnutrition” into the purpose of OAA nutrition programs during its most recent update in 2020 and added malnutrition screening for all meals participants. Meals provided through OAA help combat both malnutrition and isolation by also improving older adults’ connections with their communities. 

Despite their importance, OAA programs remain significantly underfunded. The need for additional resources is compounded by unprecedented demand, accelerated by the COVID-19 pandemic and exacerbated by the rising cost of food from inflation. Urgent congressional action is necessary to adequately provide much-needed nutrition for vulnerable older adults, which is why we are advocating for doubling the funding for OAA nutrition programs in FY 2023. 

Later this month, the White House will convene a White House Conference on Hunger, Nutrition and Health. It has been 53 years since the last one, and one of this conference’s key focuses is to improve nutrition quality by 2030. This achievement would mean lower rates of malnutrition, especially among older adults. Caring for the most vulnerable populations in our nation should be the goal of this Malnutrition Awareness Week and those that follow.  

We look forward to the President’s national strategy to improve nutritional health for all Americans from the upcoming conference. Let us all recognize this Malnutrition Awareness Week as a crucial opportunity to make progress toward ending hunger and disease-related illnesses. 

Suzanne Bonamici represents Oregon’s 1st District. Bob Blancato is the national coordinator of the Defeat Malnutrition Today coalition.