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Grappling with dilemma of under nutrition and obesity

Concern over double burden of obesity and under nutrition

Over a third of low and middle income countries have overlapping forms of malnutrition

Low and middle-income countries need a new approach to reduce under nutrition and obesity.

According to a report published in the Lancet, this is due to the rapid changes in countries’ food system.

More than a third of such countries have overlapping forms of malnutrition, particularly in sub-Sahara Africa, South Asia and the Pacific.

To change this trend, the study said, the need to radically take action across the food systems — from production and processing, through trade and distribution, pricing, marketing and labelling, to consumption and waste. “We are facing a new nutrition reality,” said the report’s lead author Dr Francesco Branca, director of the Department of Nutrition for Health and Development at the World Health Organisation.

“We can no longer characterise countries as low-income and undernourished, or high-income and only concerned with obesity.”

Globally, it’s estimated almost 2.3 billion children and adults are overweight and more than 150 million children are stunted. However, in low- and middle-income countries these emerging issues overlap in individuals, families, communities and countries.

This new report explored the trends behind this intersection — known as the double burden of malnutrition — as well as the societal and food system changes that may be causing it, its biological explanation and effects and policy measures that may help address malnutrition in all its forms.


The authors surveyed data from low- and middle-income countries in the 1990s and 2010s to estimate which countries faced a double burden of malnutrition like if in the population, more than 15 per cent of people had wasting, more than 30 per cent were stunted, more than 20 per cent of women had thinness and more than 20 per cent of people were overweight.

According to the report in 2010s, 14 countries with some of the lowest incomes in the world had newly developed a double burden of malnutrition, compared with the 1990s. However, fewer low- and middle-income countries with the highest incomes were affected than in the 1990s.

The authors said this reflected the increasing prevalence of being overweight in the poorest countries, where populations still faced stunting, wasting and thinness.

Exposure to undernutrition early in life followed by becoming overweight from childhood onwards increases the risk of a range of non-communicable diseases, making the double burden of malnutrition a key factor driving the emerging global epidemic of type 2 diabetes, high blood pressure, stroke and cardiovascular disease.

Negative effects can also pass across generations. For example, the effect of maternal obesity on the likelihood of the child having obesity may be exacerbated if the mother was undernourished in early life, said the report.

Despite physiological links, actions to address all forms of malnutrition have historically not taken account of these or other key factors, including early-life nutrition, diet quality, socioeconomic factors, and food environments. In addition, there is some evidence that programmes addressing undernutrition have unintentionally increased risks for obesity and diet-related NCDs in low- and middle-income countries where food environments are changing rapidly.

While it is critical to maintain these programmes for undernutrition, they need to be redesigned to do no harm, said the report. The authors said the existing undernutrition programmes presented opportunities to address obesity and diet-related NCDs.