A major factor that people use to determine health status is weight or outward appearance. However, weight and appearance actually play a small role in determining health status. One example is a story by CNN that discusses the detrimental health consequences of malnutrition from a seemingly “healthy-looking” teenage boy. This article describes the health consequences of a poor diet that is low in appropriate macronutrients, vitamins, and minerals. In this article, a teenage boy, otherwise deemed “healthy”, based on body mass index (BMI) and unidentified visible signs of malnutrition, became hearing impaired and blind. This young man reported consuming a diet consistent with pringles, white bread, french fries, ham, and sausage. This young man also identified that he struggled with eating certain foods due to texture. In the eating disorder world, this is often identified as avoidant restrictive food intake disorder (ARFID), an eating disorder characterized by restrictive food intake based on appearance, texture, smell, brand, or past negative experiences with food resulting in malnutrition and other health concerns. Based on the lack of evidence or knowledge of this particular situation, one cannot possibly state that this boy is suffering from ARFID; however, based on dietary recall and texture avoidance it does show a correlation to this specific disorder. This boy was reported to be deficient in B12, low blood levels of copper and selenium, high blood levels of zinc, and low vitamin D, likely due to a lack of nutrients and food variety. 
Symptoms of Malnourishment
B12 deficiency can cause fatigue, a symptom the boy identified at the doctor, and disturbed vision, likely contributing to the boy’s blindness. Foods containing B12 include most animal foods such as meat, dairy, fish, poultry, and some fortified grains. Low levels of copper and selenium also contribute to fatigue, among other symptoms such as inhibited memory and learning. If you are looking to add some good sources of copper in your diet then look to add oysters, shellfish, whole grains, beans, nuts, and organ meats (liver, kidney). Selenium is also important in your diet so adding walnuts, freshwater fish, beef, and poultry can help with making sure you get enough selenium. Low levels of vitamin D is associated with low bone density, another symptom exhibited in this case. Foods containing vitamin D are fatty fish, fortified products such as orange juice, beef liver, cheese, and egg yolks. High Zinc levels in the blood can have strong side effects such as nausea, flu-like symptoms, and most importantly in this boy’s case, changes in taste and copper deficiency. Zinc can most often be found in meat, shellfish, legumes, dairy, and nuts. As you can see, it is extremely important to have a variety of foods in your diet in order to achieve adequate nutrition. When choosing foods to eat, many different colors and types of food are important because every food and color of food provides a different nutrient. If you want to learn more on what foods are high in certain nutrients, then check out one of our previous blogs “Eat the Rainbow”. This blog will teach you the importance of eating all kinds of colors of food in order to achieve nutritional adequacy!People in larger bodies are often overlooked, which is one reason atypical anorexia is so frequently missed.
Cardiac strain can occur even without visible weight loss; learn about the cardiovascular risks of anorexia.
Recognizing Malnutrition Beyond the Scale
This same pattern shows up in more than just restrictive eating. Someone with a limited list of “safe” foods due to fear or texture sensitivities can end up with the same kind of nutrient gaps as this teenager, even at a completely typical weight. It also shows up in less obvious ways, like insulin restriction in someone with type 1 diabetes, where the body is starved of usable energy even though food intake itself may look normal. The common thread is that a body’s outward appearance simply isn’t a reliable stand-in for what’s actually happening nutritionally on the inside.
