The British Dietetic Association and UK Malnutrition Awareness and Prevention Network (MAPN) are calling on Ministers to take urgent action on a “perfect storm” of malnutrition risk for the UK’s older population caused by the COVID-19 pandemic.

Signed by over 100 dietitians, academics and other specialists working in the field of malnutrition, the letter sets out a range of key actions that are needed. Sadly, over a million older people, one in ten of over-65s, was at risk of malnutrition before the COVID-19 pandemic struck. This number will only have increased.

BDA Chair Caroline Bovey said: “Malnutrition, particularly amongst older people, is a huge problem, but one that is often missed or ignored. Dietitians see its impacts every day, from increased recovery times and frailty to higher infection risk. COVID-19 has brought this long-term issue into the public eye, especially as many people who have survived the disease return from hospital needing significant rehabilitation and support. Governments around the UK need to draw on the expertise of dietitians and other malnutrition experts to put in place measures so that we don’t face an even greater crisis of malnutrition in the near future.”

Full text of the letter below. 

Dear Ministers, 

It has been estimated that malnutrition affected over 3 million people in the UK, pre-COVID. Of this group about 1.3 million are over the age of 65, representing one in ten of that population. Since the beginning of the pandemic, it has been reported that nearly five million adults are experiencing food insecurity. COVID-19 has significantly impacted nutritional health and increased the risk of malnutrition among vulnerable communities in the UK, including many older adults and those from Black, Asian and Minority Ethnic backgrounds. We are calling on your departments, which have overall responsibility for health, care and food policy, to work with all arms of government to take urgent action to address these issues.

Whilst we have moved beyond the initial peak of the pandemic, subsequent rises in rates of infection alongside ongoing social distancing measures and shielding recommendations will continue to affect normal means of accessing food and significantly increase risk of malnutrition. These risks will be exacerbated as we move towards the ‘flu season this winter and are likely to increase at-risk groups’ vulnerability to both malnutrition and COVID-19, particularly as social isolation and loneliness can often be significant underlying social causes of malnutrition. The impact of the pandemic is creating a perfect storm for an increase in malnutrition in the UK.

Most people who are malnourished live at home, in their community, and raising awareness of the risk of malnutrition among these households and the people who care for them is vitally important now and in the coming months. Malnutrition and undernutrition impact on the immune systems of people affected and will increase their vulnerability to the effects of COVID-19 and other infectious diseases. Malnutrition impacts on frailty through muscle wasting and cognitive impairment, leading to an increased risk of falls and an inability to go about typical daily tasks such as buying or preparing food. A parallel risk of anxiety and depression is also a concern.

Organisations supporting older and more vulnerable people and helping with the emergency food response report that too many ‘new’ individuals have become vulnerable to malnutrition during the pandemic and urgently require ongoing assistance. Food banks, sadly, continue to play a significant and increasing role in filling the gap left by the failings of our welfare system, despite the government’s increases in the value of Universal Credit. Many people will be unable to cook healthy meals even if they can access food, due to a lack of equipment, facilities, capacity or fuel.

Individuals recovering from COVID-19 will have additional nutritional needs as a result of being ventilated or inactive for long periods.

Difficulties in detecting community cases of malnutrition are also now exacerbated by the move to health services operating remotely rather than through face to face appointments and visits. Community dietetic services, despite best efforts, are not running ‘business as usual’ because of redeployment to assist acute services, social distancing measures and inadequate access to technology and other resources. This means that individuals who urgently require dietetic support at home are considerably less likely to be referred or to fully access these services.

In the longer term, it is vitally important to prioritise upstream prevention and community capacity building to support eating for health, and to tackle food insecurity. Please take steps to eradicate food insecurity.

We, the undersigned, are calling for your government to:

Ensure that local authorities have ringfenced additional funding to continue with high quality food provision for people who may need to shield or self-isolate in future, with suitable advice from dietitians.
Ensure that local authorities have funding to establish long-term sustainable solutions to malnutrition amongst over 65s, including meals on wheels services.
Ensure that funding and support is made available for vital NHS dietetic services and third sector nutrition and food services, both during the COVID-19 pandemic and beyond it.
Fund a campaign to raise awareness of the importance of good nutrition for at risk groups and their carers.
Invest in proactive case-finding in order to locate and help individuals at risk and an upstream, prevention-based approach to prevent people becoming food insecure in the first place.
Prioritise nutrition as part of NHS rehab pathways and support community malnutrition services to return as quickly as possible, albeit exploiting new technological solutions as much as possible.
Urgently introduce a legally enshrined “Right to Food”, as laid out within the International Covenant on Economic, Social and Cultural Rights in the UK, to ensure that governments at both a national and local level take appropriate action.

This government has repeatedly stated it wishes to prioritise the prevention of ill health and to create a more resilient and dynamic UK economy. Taking action to ensure that all population groups receive the support they need to eat well should be priority actions so that the government delivers on these aims. We would welcome a response to our call for action.

Chief signatories:

– University of Hertfordshire: Professor Wendy Wills, Professor of Food and Public Health; Director, Centre for Research in Public Health and Community Care (CRIPACC) and NIHR ARC East of England Prevention & Early Detection in Health and Social Care theme lead; Dr Angela Dickinson, Senior Research Fellow in Older People’s Health; Jane McClinchy, Principal Lecturer in Nutrition and Dietetics
– British Dietetic Association: Caroline Bovey RD BEM, Chair; BDA Older People Specialist Group (BDA-OPSG): Alison Smith RD, Chair
– National Association of Care Caterers (NACC): Sue Cawthray, National Chair
– Sustain: Morven Oliver-Larkin, Meals on Wheels Campaign Coordinator
– Food Train/Eat Well Age Well Scotland (EWAW): Michelle Carruthers, MBE, Chief Executive, The Food Train, Laura Cairns, Project Manager, Tilly Robinson-Miles, Impact and Policy Officer, Danielle Redmond Grey, Digital Communications Officer, Eat Well Age Well
– Hertfordshire Independent Living Services (HILS): Sarah Wren, MBE, Chief Executive
– Age UK Salford: Emma Rose, Programme Director; Dave Hayes, Chief Executive Officer
– Bournemouth University (BU): Jane Murphy, Professor of Nutrition – – Nutrition Diet Resources UK (NDR-UK): Linda McPhillie, Chief Executive; Jenni Henderson, Development Officer (Malnutrition Lead)