Changes needed to alleviate the ‘double burden’ of malnutrition

A report on malnutrition finds that a new approach is needed to help reduce undernutrition and obesity at the same time, as the issues become increasingly connected due to rapid changes in countries’ food systems. This is especially important in low- and middle-income countries, according to the four-paper report published in The Lancet. More than a third of such countries had overlapping forms of malnutrition (45 of 123 countries in the 1990s, and 48 of 126 countries in the 2010s), particularly in sub-Saharan Africa, South and East Asia, and the Pacific.

“We are facing a new nutrition reality,” said lead author of the report Francesco Branca, director of the Department of Nutrition for Health and Development, World Health Organization. “We can no longer characterize countries as low-income and undernourished, or high-income and only concerned with obesity. All forms of malnutrition have a common denominator—food systems that fail to provide all people with healthy, safe, affordable, and sustainable diets. Changing this will require action across food systems—from production and processing, through trade and distribution, pricing, marketing, and labeling, to consumption and waste.”

Globally, estimates suggest that 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. The new report explores 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 used survey data from low- and middle-income countries in the 1990s and 2010s to estimate which countries faced a double burden of malnutrition (i.e., in the population, more than 15% of people had wasting, more than 30% were stunted, more than 20% of women had thinness, and more than 20% of people were overweight).

In the 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. According to the authors, this reflects the increasing prevalence of being overweight in the poorest countries, where populations still face stunting, wasting, and thinness.

The report identifies a set of “double-duty actions” that simultaneously prevent or reduce the risk of nutritional deficiencies leading to underweight, wasting, stunting, or micronutrient deficiencies, and obesity or noncommunicable diseases, with the same intervention, program, or policy. These range from improved antenatal care and breastfeeding practices, to social welfare, and to new agricultural and food system policies with healthy diets as their primary goal.

To create the systemic changes needed to end malnutrition in all its forms, the authors call on governments, the United Nations, civil society, academics, the media, donors, the private sector, and economic platforms to address the double burden of malnutrition and bring in new actors, such as grass-roots organizations, farmers and their unions, faith-based leaders, advocates for planetary health, innovators and investors who are financing fair and green companies, city mayors, and consumer associations.

Report