Patients with a positive undernutrition screening score stay in hospital 1.4 days longer, with more associated complications and costs. A paper elsewhere in this journal describes the implementation of a novel in-hospital meal service resulting in improved protein and energy intake. Patient satisfaction was maintained and to some extent improved. However, the paper shows the difficulty of improving food intake in hospitalized patients. This may be due to factors such as illness-induced anorexia, poor nurse and physician nutritional awareness, and lack of a clear financial incentive. Despite substantial improvement, only 24% of patients had an adequate protein intake. Optimal nutrition should be inextricably associated with care, education and research. Moreover, achieving optimal nutrition needs continuous involvement from nutritional assistants, dieticians, nurses and physicians as well as an optimal in-hospital meal service. The road to optimal nutrition in underfed patients is still long in a world where overfeeding lies at the base of many healthcare problems.