It seems impossible that malnutrition could be a problem in a modern Western country, particularly when obesity has been identified as the major public health challenge of the twenty-first century. Despite this, hospital malnutrition remains a major problem in the UK’s National Health Service, and there have been repeated calls for this to be addressed as a matter of urgency. In this article Dr Alastair McKinlay provides a detailed analysis of the problem of hospital malnutrition and how it should be tackled.