Impact: Twin threats of obesity and undernutrition in low- and middle-income countries

A major report co-authored by Professor Corinna Hawkes, Director of City’s Centre for Food Policy, calls on ‘double duty actions’ to address all forms of malnutrition.

The four-paper report argues that a new approach is needed simultaneously to reduce both undernutrition and obesity as the issues are becoming increasingly connected due to rapid changes in the world’s food systems.

Global estimates suggest that well over two billion children and adults are overweight, while more than 150 million children are stunted. This is especially the case in low- and middle-income countries: more than a third of them have overlapping forms of malnutrition (45 out of 123 countries in the 1990s and 48 out of 126 countries in the 2010s). In particular, sub-Saharan Africa, south Asia, east Asia and the Pacific are most affected.

Undernutrition and obesity can impact generations as both maternal undernutrition and obesity are associated with poor health in offspring. However, due to the speed with which food systems are changing, more people are exposed to both forms of malnutrition at different points in life, further increasing harmful health effects.

Time for action

Professor Corinna Hawkes says “continuing with business-as-usual is not appropriate in the new nutrition reality. The good news is that there are powerful opportunities to use the same platforms to address different forms of malnutrition.

“The time is now to seize these opportunities for ‘double duty action’ to get results”.

Lead author of the report, Dr Francesco Branca, Director of the Department of Nutrition for Health and Development, World Health Organization, says “we are facing a new nutrition reality. We can no longer characterise 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 labelling, to consumption and waste. All relevant policies and investments must be radically re-examined”.

In a Lancet editorial accompanying the report, Dr Richard Horton, Editor-in-Chief, says:

“[this] publication of the WHO Series on the Double Burden of Malnutrition comes after twelve months of Lancet articles exploring nutrition in all its forms.

“It has become clear that nutrition and malnutrition need to be approached from multiple perspectives and although findings have sometimes converged, there is still work to be done to understand malnutrition’s multiple manifestations.

“This [research] defines the future direction required to achieve the UN Decade of Action on Nutrition global goal of eradicating hunger and preventing malnutrition in all its forms”.

Trends and causes

The report explores the trends behind this intersection 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 of a country, more than 15 per cent of people had wasting, over 30 per cent were stunted, more than 20 per cent of women had thinness and over 20 per cent of people were overweight).

In the 2010s, 14 low-income countries newly developed a double burden of malnutrition when compared with the 1990s. However, fewer low- and middle-income countries were affected in the 2010s than in the 1990s. The authors suggest that this reflects the increasing prevalence of being overweight in the poorest countries where populations still face stunting, wasting and thinness.