The term "double burden of malnutrition" refers to the coexistence of malnutrition and obesity within populations, households, or even individuals. This phenomenon is increasingly prevalent in many countries worldwide, presenting complex challenges for public health systems and policymakers.

Malnutrition

Malnutrition encompasses various forms of undernutrition, including stunting (low height for age), wasting (low weight for height), and micronutrient deficiencies. It often results from inadequate intake of essential nutrients, such as protein, vitamins, and minerals, due to factors such as poverty, food insecurity, and limited access to nutritious foods. Undernutrition can have devastating consequences, particularly for children, impairing physical and cognitive development and increasing susceptibility to infectious diseases.

Obesity

In contrast, obesity refers to excessive intake of calories, often accompanied by an imbalance of nutrients, leading to overweight, obesity, and related non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and certain cancers. Overnutrition is driven by factors such as excessive consumption of energy-dense, nutrient-poor foods, sedentary lifestyles, and urbanisation. It poses significant health risks and contributes to the global burden of chronic diseases, particularly in low- and middle-income countries undergoing rapid nutrition transitions.

The double burden

The double burden of malnutrition occurs when individuals or populations experience both undernutrition and overnutrition simultaneously, often within the same household or community. According to WHO, “Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant, and young child nutrition. At the same time, these children are exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns, in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.”

Challenges of the double burden

The double burden of malnutrition poses significant challenges for public health systems, as it requires addressing both ends of the malnutrition spectrum simultaneously. Strategies aimed at reducing undernutrition, such as promoting breastfeeding, improving access to nutritious foods, and implementing micronutrient supplementation programs, must be integrated with efforts to prevent and manage overnutrition, including promoting healthy eating habits, increasing physical activity, and regulating the food environment.