Overfed but Undernourished: The Clinical Relevance of Micronutrient Deficiencies in Obesity

Overfed but Undernourished: The Clinical Relevance of Micronutrient Deficiencies in Obesity

Bariatric surgeryWritten by Ingrid Kruizinga

Medical Affairs Specialist

Vegetarian Bariatric Patients

Obesity is often perceived as a result of excess. Yet research shows that people with obesity are not just taking in too much energy—they are often receiving too few essential nutrients. In their important 2018 review, Astrup & Bügel examine this paradox, urging clinicians to recognize the widespread problem of micronutrient deficiencies in individuals with overweight or obesity. 

Micronutrient Gaps in the Context of Obesity

The review emphasizes that obesity is associated with poor dietary quality, not just excessive quantity. Even when total calorie intake is high, intake of vitamins and minerals is often insufficient. According to the authors, commonly affected nutrients include: 

  • Vitamins A, D, E, C, B1, B12, and folate 
  • Minerals such as iron, calcium, magnesium, chromium, zinc, copper 

These deficiencies may arise from monotonous eating patterns, energy-dense but nutrient-poor foods, or changes in metabolism and absorption associated with obesity. 

Why These Deficiencies Matter 

Micronutrients are essential for nearly every biological function. Astrup & Bügel explain that even marginal deficiencies can affect long-term health. According to the triage theory discussed in the paper, when micronutrient availability is limited, the body will prioritize short-term survival functions over processes needed for long-term maintenance, such as DNA repair or immune resilience. 

Clinical implications mentioned in the review include: 

  • Impaired cognitive function 
  • Increased risk of insulin resistance and type 2 diabetes 
  • Heightened inflammation, potentially contributing to the development of non-communicable diseases 
  • Possible interactions with gut microbiota, further influencing metabolism and weight regulation 

Why compliance is difficult for patients

Bariatric surgery often entails significant lifestyle changes, including diet, eating behavior, exercise, and mental processes. These changes can be overwhelming, making it challenging for some patients to incorporate new routines, including taking vitamin supplements. Consistently taking supplements daily requires discipline and commitment.

Special Considerations for Bariatric Patients and Pharmacotherapy Users 

One of the review’s most important messages is the need for clinical vigilance in patients undergoing bariatric surgery or receiving long-term pharmacological weight loss treatment. These interventions can significantly affect nutrient absorption, increasing the risk of clinically relevant deficiencies. 

“Clinicians need to be aware of these gaps, particularly in those individuals with obesity who are undergoing bariatric surgery or taking pharmaceutical products long term to facilitate weight loss.”


— Astrup & Bügel, 2018 

Moving Toward Nutritional Quality in Obesity Management 

Astrup & Bügel call for a shift in the clinical approach: from managing obesity purely through calorie control, to including micronutrient assessment and supplementation as part of standard care. This is particularly relevant in preventive care, postoperative management, and long-term pharmacological treatment. 

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Source:

  • Astrup, A., Bügel, S. Overfed but undernourished: recognizing nutritional inadequacies/deficiencies in patients with overweight or obesity. Int J Obes 43, 219–232 (2019). https://doi.org/10.1038/s41366-018-0143-9

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