Low-income Countries Carry the 'Double Burden' of Malnutrition
Fri, December 9, 2022

Low-income Countries Carry the 'Double Burden' of Malnutrition

The world is facing a new reality in nutrition as low- to middle-income countries face the burden of both undernutrition and obesity that may lead to effects rippling through generations / Photo by: Riccardo Lennart Niels Mayer via 123RF


The world is facing a new reality in nutrition as low- to middle-income countries face the burden of both undernutrition and obesity that may lead to effects rippling through generations.

"We can no longer characterize countries as low-income and undernourished, or high-income and only concerned with obesity," Francesco Branca, Director of the Department of Nutrition for Health and Development at the World Health Organization (WHO), said in a press release.

A new approach would be needed to reduce both of these extremes of malnutrition, according to new reports on The Lancet, as it becomes an increasingly connected issue driven by rapid changes in the world's food systems.

The Double Burden of Malnutrition

Global estimates show nearly 2.3 billion people are overweight—both children and adults—while more than 150 million children are malnourished. The world dealt with these issues separately before, but they now come to a point in which they overlap in low- and middle-income countries.

Known as the double burden of malnutrition, researchers investigated the trends behind this intersection along with the changes in the society and food system that attribute to it. They also looked into the burden's explanation, effects, and policy measures that may address all forms of malnutrition.

Using survey data from low- and middle-income countries in the 1990s and 2010s, the authors determined the nations facing the intersection of malnutrition. They found that over 15% of people had wasting (unintended loss of weight due to a disease), more than 30% were undernourished, above 20% of women experienced thinness, and more than 20% were overweight.

Results also showed that over a third of low- and middle-income countries experienced the double burden of malnutrition; 45 of 123 countries in the 1990s and 48 of 126 countries in the 2010s. The WHO says this overlap is specifically evident in sub-Saharan Africa, South Asia, and East Asia and the Pacific.

The UN agency adds that fewer low- and middle-income countries with the highest incomes were affected in the 1990s—reflecting the rising prevalence of obesity in the poorest countries, even though they still face malnourishment, wasting, and thinness.

The New Nutrition Reality

Barry Popkin, the lead author of one of the reports, said the double burden of malnutrition is the outcome of a "new nutrition reality" in which changes in the major food changes led to the rise of both obesity and malnutrition in the poorest countries.

In their research, they found that all low-income countries account for the overweight and obesity levels of at least 20% among adults. The modern food system drives this reality, Popkin said, noting that the system's global reach is preventing low- and middle-income countries from "consuming safe, affordable and healthy diets [sustainably].”

"Emerging malnutrition issues are a stark indicator of the people who are not protected from the factors that drive poor diets. The poorest low- and middle-income countries are seeing a rapid transformation in the way people eat, drink and move at work, home, in transport and leisure," explained the lead author, who is also a W.R. Kenan Jr. Distinguished Professor of nutrition at the UNC-Chapel Hill Gillings School of Global Public Health.

The changes in the global food system include the increased availability of ultra-processed foods associated with weight gain. However, these foods also have adverse effects on the diets of infants and preschoolers' diets.

Other changes also led to the disappearance of fresh food markets while supermarkets increase in number. These supermarkets then took control of the food chain, alongside global food, catering, and agriculture companies in many countries, Popkin said in a press release.

Restricting the Double Burden

One of the reports on The Lancet also recommends high-quality diets in addressing undernutrition and obesity. These diets include optimal breastfeeding in the first two years; fruits and vegetables, grains and seeds; less meat; and lower consumption of high levels of sugar, saturated fat, trans fat, and salt.

However, this measure may be difficult to act on given the adverse changes in the food systems, specifically the increased availability of ultra-processed foods.

Addressing these changes will require action across the entire system—from production and processing, through trade and distribution, up to pricing, marketing, labeling, consumption, and waste. Doing so calls for a thorough re-examination of all relevant policies and investments.

Actions should also include taking into account key factors of malnutrition, including early-life nutrition, diet quality, socioeconomic factors, and food environments.

Previous measures failed to do so, and may even have unintentionally increased the risk for obesity and diet-related diseases in countries where food environments are changing rapidly, the UN said in a press release.

"Examples of actions that can deal with undernutrition and obesity range from improved antenatal care and breastfeeding practices, to social welfare, and to new agricultural and food system policies which have healthy diets as their primary goal," the global agency added.

The researchers also call on governments, international organizations, and the private sector to make ties with new areas of society (e.g. grass-roots organizations, farmers and innovators) in addressing the double burden of malnutrition.

"Without a profound food system transformation, the economic, social, and environmental costs of inaction will hinder the growth and development of individuals and societies for decades to come," Branca said.

One of the reports on The Lancet also recommends high-quality diets in addressing undernutrition and obesity / Photo by: Katarzyna Białasiewicz via 123RF