Closing the Nutrition Gap for America’s Kids

Why are so many children undernourished in one of the richest countries on Earth?

Low-cost, high-calorie foods help kids avoid hunger. But they skimp on necessary nutrients.

Try tapping the word “rickets” into a smartphone and you may find that the autocorrect tool has other ideas. If you haven’t come across the word lately, it might be because the United States began to fortify foods with vitamins and minerals long before smartphones were invented, all in an attempt to eradicate conditions like rickets. However, deficiencies in some micronutrients, like iron and vitamin D, have persisted, even among children. That means for a significant number of American kids, malnutrition is still a reality.

[quote position="left" is_quote="true"]Conditions are different in the United States compared to the rest of the world in that people do get some food here, but it’s often empty in nutritional content.[/quote]

Many Americans think of child malnutrition as a problem that affects other countries—and it’s true that chronic micronutrient deficiencies are far more widespread in the developing world. But severe poverty and undernourishment exist in the United States, too. Nearly 20 percent of American children are living in poverty, and more than eight percent—over six million kids—are living in “deep poverty,” meaning their families earn less than half the federal poverty level (that’s less than $12,125 a year for a family of four).

“Malnutrition is a problem wherever poverty exists,” says Howard Schiffer, president and founder of Vitamin Angels, an international nonprofit that provides at-risk populations in 45 countries with access to vitamins and minerals. The organization operates domestically in 47 states, with plans to reach all 50 by next year. “Conditions are different in the United States compared to the rest of the world in that people do get some food here, as opposed to no food or very little food. But it’s often food that’s empty in nutritional content.”

Children under 18 account for 48 percent of recipients of the federal Supplemental Nutrition Assistance Program (SNAP), which exists, along with other government programs, to help prevent hunger and malnutrition. But the average SNAP benefit—which can only be spent on food, not vitamins—is less than $4.50 per day, per person.

“People with limited financial means [often don’t] buy fruits and vegetables because they are much more expensive than other sources of calories, like junk food,” explains Dr. Balz Frei, Ph.D., distinguished professor of biochemistry and biophysics, and director and endowed chair of the Linus Pauling Institute at Oregon State University. When people can avoid hunger by filling up on high-calorie foods, there’s little incentive for them to choose pricier options—even if there are more nutritious options. This is why, Dr. Frei says, “lower socioeconomic status is highly correlated with nutrient gaps.”

It’s not that families facing poverty don’t want to offer nutritious food, or don’t know better—it’s that getting any food at all on the table has to be the first priority. Which might be why poverty is so closely linked to childhood obesity—a condition that has made headlines lately for reaching “epidemic” levels. Approximately one third of all American kids are overweight or obese. Obesity and malnutrition can and do frequently coexist these days. For example, a study from the American Academy of Pediatrics found that obese children are actually more likely to be vitamin D-deficient than kids of average weight. It’s absolutely possible to be overfed on calories, but starved for micronutrients.

When nutrient-poor food is the only option, kids' physical and intellectual growth can become stunted.

Anyone eating a nutrient-poor diet could be at risk for malnutrition—but the problem is more serious for children because they need vitamins and minerals to support their growing bodies. Even when children have “inadequate” levels of a micronutrient—which means lower than the recommended daily allowance, but not low enough to be considered a deficiency—they may face health consequences. Dr. Frei points out that brain health and immune function can both be affected when a child has less-than-optimal levels of certain nutrients. Inadequacies in vitamin D, calcium, and magnesium can also lead to weak bone structure and put kids at higher risk for fractures.

“The normal development and growth of all of a child’s tissues is just critically dependent on vitamins and minerals,” Dr. Frei explains. “Starting from conception[...] Micronutrients are crucial to the trajectory of your health for the rest of your life.”

The potential for micronutrients to positively impact a child’s long-term future forms the foundation of Vitamin Angels’s work. Through a network of food banks and low-income clinics, the organization specifically tries to reach pregnant women, new moms, and children under five with the vitamins and minerals they need for good health.

“The reality today is that most children in the developing world, and even in poverty conditions in the United States, do not have a chance to lead a healthy and productive life from the day they are born,” says Schiffer. “They are limited from birth by the chronic, sometimes generational malnutrition of their mothers before they were even conceived.”

Some of the most serious nutrient deficiencies that occur in developing countries, like vitamin A deficiency, are rare in United States—but not all of them. The micronutrients that still present big challenges include:

Iron: The most common nutritional shortfall in the United States is iron deficiency, which can cause anemia. Very young children are one of the groups most at risk. Nearly 9 percent of children age 1 to 5—about 1.7 million kids—are iron deficient. A study in Pediatrics notes that iron deficiency can cause long-term problems for children’s neurodevelopment and behavior, some of which are irreversible.

Vitamin D: Experts have described the recent increase in vitamin D deficiency among children as “startling.” According to a 2014 study, roughly 2.5 million American kids are at risk. At its most severe, vitamin D deficiency can cause nutritional rickets, a condition that leads to soft, weak bones. Although still considered rare in the United States, a Mayo Clinic report found that the incidence of rickets has “dramatically increased” in the last 15 years. In theory, most children can get vitamin D through sunlight—but that approach hasn’t worked well historically. Before the fortification of foods with vitamin D, rickets was widespread.

Iodine: The American Academy of Pediatrics reports that roughly one-third of pregnant women in the United States are marginally deficient in iodine, a micronutrient that’s crucial for their children’s brain development. Severe deficiency can cause developmental delays, hypothyroidism, and other serious conditions.

Clearly, the consequences of micronutrient deficiencies can be devastating for children. But prevention is simple, effective, and relatively cheap. In fact, the Copenhagen Consensus—a think tank that asks prominent economists to determine the most effective ways to solve world problems—has given its top ranking to micronutrient interventions to fight hunger and improve education.

Through his work with Vitamin Angels, in the United States and abroad, Schiffer has seen firsthand the difference multivitamins can make to children living in poverty. In 2000, the organization provided supplements to 2 million children; this year, Schiffer expects to reach 40 million.

“[With the right nutrients], kids are sick less often, more attentive in school, and just healthier,” he explains. “There are a lot of important strategies for bringing people out of poverty, but nutrition has got to be among the first ones. Without nutrition, kids are too vulnerable and they can’t learn well.”

A little balance goes a long way.

In Schiffer’s view, that’s where the greatest potential lies: Ensuring every child has the nutrients they need to reach their full physical and intellectual capacity. “For the child, that’s where you really start to break the cycle of poverty because now they have a chance, not just to survive, but to thrive,” he says. “Kids start doing better in school, and all of a sudden, they have bigger opportunities.”

Photos by Flickr user (cc) Wendy Copley. Photo illustration at top by Addison Eaton.​

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