Those of us who live in first-world countries rarely think of malnutrition as a condition that affects us. Yet you might be surprised to learn that it is rampant in hospitals, with between 20 and 50 percent of patients being malnourished upon admission. And for those patients who do enter hospitals well-fed, a third become malnourished during their stay due to mealtime interruptions, unpalatable food, or fasting for medical procedures.
Even in the broader US population, malnutrition is becoming a growing concern. According to one study, over 20 percent of Americans are projected to be malnourished by 2030. The study also found a steep rise in deaths due to malnutrition over the past two-and-a-half decades.
However, malnutrition remains an under-the-radar phenomenon in the US—and not just in hospitals. According to Dr. Liz Lipski, it is frequently overlooked in outpatient settings too. Practitioners, she says, often focus on disease patterns rather than underlying nutritional statuses that may lead to disease.
As functional medicine practitioners, we must be aware of this mounting problem in our culture—and thus our practices. For our patients’ sake, we need to be informed of and on the lookout for potential malnutrition among those under our care. Otherwise, we could be missing the key to restoring their health.
Most clinicians are trained to diagnose disease: ordering labs, interpreting biomarkers, and managing conditions. What most aren’t taught is how to read the body’s nutritional story directly.
In “What Your Patients’ Bodies Are Telling You Without Words,” Dr. Liz Lipski has turned decades of clinical nutrition expertise into a practical physical assessment you can perform in minutes. You’ll learn:
- What hair texture, color loss, and easy breakage reveal about protein and zinc
- How eyes, lips, and tongue signal deficiencies before labs catch them
- What skin, nails, and sensory changes indicate about essential fatty acids, B vitamins, and minerals
- How to use existing lab values as nutritional data you’re already collecting
These are evidence-based clinical skills that sharpen your pattern recognition and reduce unnecessary testing—and are immediately applicable in every patient encounter.
The Two Faces of Malnutrition
Part of the problem of identifying malnutrition is that not all cases are created equal. Dr. Lipski distinguishes between two primary presentations of the condition: underfed and overfed and undernourished.
Underfed malnutrition
Underfed malnutrition encompasses traditional cases—what most people think of when they envision a malnourished person in a third-world country. This type is characterized by obvious wasting, visible bones, and a lack of muscle mass, and it is easy to spot and diagnose.
Overfed and undernourished malnutrition
Overfed and undernourished malnutrition, on the other hand, presents very differently. It may not be easy to discern at all for someone without a trained eye. This patient may very well blend in among the crowd, looking normal from the outside. In fact, even overweight and obese people can fall into this category if their diet lacks micronutrient density.
Unfortunately, this is often what happens in our 21st-century American culture. We are starting to see an overfed, undernourished populace because so many people primarily consume cheap, ultra-processed foods that are stripped of nutrients. And because of Big Agriculture farming practices, even those who eat healthy diets still struggle to get all essential nutrients from food alone.
Subtle Symptoms of Malnutrition
So how do you identify a patient under your care who may present “normally” but in reality has a diet chronically short on nutrients? Dr. Lipski shares some symptoms of overfed and undernourished malnutrition:
- High levels of subcutaneous fat but visible muscle wasting (such as hollowing at the temples or a loss of hand-grip strength)
- Depression, anxiety, lethargy, and fatigue (often among the first signs of nutrient depletion)
- Slow wound healing
- Frequent illness
- Edema
Of course, each of these could be symptoms of other causes, too, which is why Dr. Lipski encourages any of these observations to be validated with further testing. But they can serve as useful starting points to pinpoint a cause like malnutrition that often goes unnoticed in medical care today.
Malnutrition and Triage Theory
As we mentioned in our last post, much of Dr. Lipski’s approach to nutrition-focused care is based on triage theory.
Triage theory posits that when nutrients are scarce, the body prioritizes survival by directing them to vital organs like the brain, heart, and lungs first. As a result, nonessential organs—for example, the skin, hair, and nails—are neglected and starved of nutrients. Consequently, they provide the earliest visible clues of malnutrition.
When you suspect malnutrition in a patient, Dr. Lipski recommends conducting a nutrition-focused physical assessment (NFPA). This is a quick, head-to-toe physical exam used to identify patterns of nutritional deficiency through observing external body tissues. It often takes less than five minutes, making it an easy tool to add to your existing toolkit.
The nutrition-focused physical assessment—a systematic, head-to-toe evaluation of hair, eyes, skin, nails, mouth, and sensory function—has largely disappeared from clinical training. Yet it takes only minutes to perform and can reveal nutrient insufficiencies that labs often miss entirely.
Dr. Liz Lipski is on a mission to resurrect this critical clinical skill. In her KI Master Class, “What Your Patients’ Bodies Are Telling You Without Words,” she will teach you the tools you need, from pattern recognition to targeted nutritional intervention, to bring healing to some of your toughest patients.
The Malnutrition Continuum
According to Dr. Lipski, the progression of malnutrition is predictable. The good news is that once you know the pattern, you can keep it in mind as you examine and treat patients. The five stages of malnutrition include:
- Optimal tissue levels: This is the ideal state—the body is getting the full range and amount of nutrients it needs.
- Depletions: The body begins to compensate based on triage theory. It diverts more nutrients to vital organs, depriving other, nonessential organs.
- Physiological impairment: Metabolic changes and oxidative damage to DNA begin to occur.
- Energy and mood symptoms: Depression, anxiety, mood changes, and fatigue appear. As mentioned above, these are often the first visible signs of overfed and undernourished malnutrition.
- Functional defects: Prolonged malnutrition eventually leads to a diagnosis of a formal disease.
What Your Patients’ Bodies Are Telling You Without Words by Liz Lipski, PhD, CNS, FACN, IFMCP, BCHN, LDN
When a person starves their body of essential nutrients, there will be signs. While underfed malnutrition leads to obvious symptoms, overfed and undernourished malnutrition can be tougher to identify. Unfortunately, it is often the latter type that you will encounter in your practice, given the prevalence of over-processed, nutrient-stripped food in the 21st-century American diet.
Identifying the signs of overfed and undernourished malnutrition is a key topic Dr. Liz Lipski covers in her latest Kharrazian Institute Master Class, “What Your Patients’ Bodies Are Telling You Without Words.” This master class distills her decades of expertise into a systematic, learnable clinical skill that you can apply starting with your next patient: nutrition-focused physical assessments.
When you enroll in Dr. Lipski’s course, you will gain access to:
- 10 comprehensive recorded video modules
- Live demonstration footage of an NFPA
- Downloadable reference guides
- Members-only Facebook group
- And more
You can’t see what you haven’t been trained to look for. This course restores a powerful clinical skill that should have been taught from the start. Enroll today to start bringing health and healing to the overfed and undernourished patients in your care.
Dr. Lipski holds a PhD in Clinical Nutrition from the Union Institute and is a Fellow of the American College of Nutrition (FACN). She holds dual board certifications in clinical nutrition (CNS and BCHN), is certified in functional medicine (IFMCP), and is a Cochrane member.
Frequently Asked Questions
Why is malnutrition so often missed in a standard outpatient setting?
Most clinical training focuses on diagnosing specific diseases through lab work and biomarkers. Because of this, many practitioners overlook the “nutritional story” the body is telling. Additionally, overfed and undernourished patients often look healthy or are even overweight, which can lead to a false assumption that they are meeting their nutrient needs.
What are the most reliable early warning signs of nutrient depletion?
According to triage theory, the body sends scarce nutrients to vital organs like the heart and brain first. This means the earliest signs of deficiency appear in “nonessential” tissues like hair, skin, and nails. Additional energy and mood symptoms include depression, anxiety, and fatigue.
How can I fit nutrition-focused physical assessments (NFPAs) into a busy practice?
The NFPA is designed to be a highly efficient tool. It is a systematic, head-to-toe evaluation that typically takes less than five minutes to perform.
How can I master these physical assessment skills to better serve my patients?
In the latest KI Master Class, “What Your Patients’ Bodies Are Telling You Without Words” by Dr. Liz Lipski, you will learn how to turn physical observations into actionable clinical data. Enroll today to restore this vital skill to your practice and start identifying the hidden malnutrition in your patients.
