Nutrition Conversations · The Canadian Nutrition Society

Addressing Malnutrition - Stronger Together with Professor Heather Keller

·34 min·3 clips

Heather Keller discovered malnutrition was rampant in hospitals after seeing patients arrive malnourished from the community.

This episode of the Canadian Nutrition Society's Nutrition Conversations podcast is hosted by Rupinder Dhaliwal, program manager of the Canadian Malnutrition Task Force, who interviews Professor Heather Keller for Canadian Malnutrition Awareness Week. Keller explains that her focus on malnutrition began in her first clinical role in the 1990s at a chronic care and rehabilitation facility, where she observed patients arriving already malnourished from the community and deteriorating further in hospital. She notes that malnutrition is widely misunderstood by the public, who associate it primarily with extreme deprivation, when in fact it commonly occurs alongside disease, surgery, cancer treatment, and normal aging. One in four pediatric patients arrives at hospital in a malnourished state, and the figure is significant for adults too. Keller identifies three high-risk settings: acute care (where medications, NPO orders, and illness suppress food intake), long-term care (where cognitive impairment and functional dependence create feeding barriers), and the community (where older adults losing independence face transport and physical barriers to accessing food). She addresses the stigma around the word malnutrition, acknowledging that it provokes denial and parental guilt, and suggests that healthcare providers use language like nutrition problems with patients while continuing to use the clinical term malnutrition among professionals to maintain awareness. The CMTF's research arc is described: a national study across eight provinces and 18 hospitals to establish Canadian prevalence data, followed by a modified Delphi consensus process to develop the Integrated Nutrition Pathway for Acute Care, then implementation studies in five and later ten hospitals that demonstrated the pathway was feasible without full research-level resourcing. The Stronger Together theme of Malnutrition Awareness Week is explained through concrete examples, such as physios incorporating patient weighing into their daily walking routines, and community homecare workers flagging food access problems to care teams. Keller recommends the SCREEN tool (Seniors in the Community: Risk Evaluation for Eating and Nutrition), which she created over 20 years ago, as a self-administered risk identifier for older adults and their families. She urges families to treat nutrition like exercise — vital to maintaining independence at home — and to intervene early when warning signs appear.

As heard by us

A careful, clinical look at a fixable problem too many systems still miss.

Addressing malnutrition through a Canadian public-health lens, the piece treats an overlooked problem as something clinicians, patients, and health systems can confront directly.

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Why you'd press play

You want a clear, humane explanation of malnutrition in Canada.

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