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More than 1 in 3 low- and middle-income countries face

both extremes of malnutrition
Being undernourished or overweight are no longer separate public health issues

Date: December 16, 2019

Source: University of North Carolina at Chapel Hill

Summary: Being undernourished or overweight are no longer separate public health issues. A new
article details how more than one in three low- and middle-income countries face both
extremes of malnutrition -- a reality driven by the modern food system.

FULL STORY

A new approach to food systems is needed to help low- and middle-income

countries reduce both obesity and undernutrition, two issues that have become
increasingly connected, according to the first paper in a four-paper report
published in The Lancet.

"We are facing a new nutrition reality where major food system changes have led the poorest countries
to have high levels of overweight and obesity along with undernutrition," says Barry M. Popkin, lead
author of the first paper and W.R. Kenan Jr. Distinguished Professor of Nutrition at the University of
North Carolina at Chapel Hill Gillings School of Global Public Health. "Our research shows that
overweight and obesity levels of at least 20% among adults are found in all low-income countries.
Furthermore, the double burden of high levels of both undernutrition and overweight occurs primarily in
the lowest-income countries -- a reality that is driven by the modern food system. This system has a
global reach and is preventing low- and even moderate-income countries and households from
consuming safe, affordable and healthy diets in a sustainable way."

Globally, estimates suggest that almost 2.3 billion children and adults are overweight, and more than
150 million children are stunted. In low- and middle-income countries, however, these emerging issues
overlap in individuals, families and communities. The first paper 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.

Popkin and his co-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, meaning that, 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.
Results showed that more than a third of low- and middle-income countries had overlapping forms of
malnutrition, 45 of 123 countries in the 1990s and 48 of 126 countries in the 2010s. The problem was
particularly common in sub-Saharan Africa, south Asia, and east Asia and the Pacific, where 29, seven
and nine countries were affected, respectively.

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, relative to others in that category, were affected. The authors say this reflects
the increasing prevalence of people being overweight in the poorest countries, even as segments of the
population still face stunting, wasting and thinness.

"Emerging malnutrition issues are a stark indicator of the people who are not protected from the factors
that drive poor diets," Popkin says. "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 in leisure. The
new nutrition reality is driven by changes to the food system, which have increased the global
availability of ultra-processed foods that are linked to weight gain while also adversely affecting infant
and preschooler diets. These changes include disappearing fresh food markets, increasing numbers of
supermarkets, and the control of the food chain by supermarkets and global food, catering and
agriculture companies in many countries."

The other three papers in The Lancet series build on Popkin and his team's work, exploring the
physiological impacts of the double burden of malnutrition and recommending "double-duty"
interventions that simultaneously reduce the risk of nutritional deficiencies while preventing obesity and
related diseases.

To create the systemic changes needed to end malnutrition in all its forms, the series' 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
grassroots organizations, farmers and their unions, faith-based leaders, advocates for planetary health,
innovators, political leaders, consumer associations, and investors who are financing fair and green
companies.

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Story Source:

Materials provided by University of North Carolina at Chapel Hill. Note: Content may be edited for
style and length.

Journal Reference:

1. Barry M Popkin, Camila Corvalan, Laurence M Grummer-Strawn. Dynamics of the double burden
of malnutrition and the changing nutrition reality. The Lancet, 2019; DOI: 10.1016/S0140-6736
(19)32497-3
Cite This Page:
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University of North Carolina at Chapel Hill. "More than 1 in 3 low- and middle-income countries face
both extremes of malnutrition: Being undernourished or overweight are no longer separate public health
issues." ScienceDaily. ScienceDaily, 16 December 2019.
<www.sciencedaily.com/releases/2019/12/191216203756.htm>.

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