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. The new approach is especially important in low- and middle-income countries, according to a new 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 Asia, and East Asia and the Pacific.
Undernutrition and obesity can lead to effects across generations as both maternal undernutrition and obesity are associated with poor health in offspring. However, because of the speed of change in food systems, more people are being exposed to both forms of malnutrition at different points in their lifetimes. This phenomenon further increases harmful health effects.
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 nations. 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.
High-quality diets reduce the risk of malnutrition in all its forms by promoting healthy growth, development, and immunity, and preventing obesity and non-communicable diseases (NCDs) throughout life. The components of healthy diets are: optimal breastfeeding practices in the first two years; a diversity and abundance of fruits and vegetables, whole grains, fibre, nuts, and seeds; modest amounts of animal source foods; minimal amounts of processed meats, and minimum amounts of foods and beverages high in energy and added amounts of sugar, saturated fat, trans fat, and salt.
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 epidemics of type 2 diabetes, high blood pressure, stroke, and cardiovascular disease. Adverse effects can also pass across generations – for example, the impact of maternal obesity on the likelihood of the child having obesity may be exacerbated if the mother was undernourished in early life.
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-income and middle-income countries where food environments are changing rapidly.
While it is critical to maintaining these programmes for undernutrition, they need to be redesigned to do no harm. Existing undernutrition programmes delivered through health services, social safety nets, educational settings, and agriculture and food systems present opportunities to address obesity and diet-related NCDs.
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 NCDs, with the same intervention, programme, or policy. These range from improved antenatal care and breastfeeding practices, to social welfare, and 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 UN, 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 organisations, 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.