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Malnutrition and Obesity: Interrelationship, Causes, Effects and Initiatives


It is a universally acknowledged truth that a healthy life is equal to a happy life. This is exactly what the UN General Assembly has decided to achieve by taking an initiative in formulating and implementing its resolution that proclaims “A United Nations Decade of Action on Nutrition”. This resolution aims at improving the current quality of the living standards of people all over the world by eradicating all forms of health related problems in a time span of 10 years (as indicated by the term “decade”). Out of all, the most prevalent health issues are that of malnutrition and obesity which co-exist with each other at the same time and in the same areas, and lead to the problems of being underweight, overweight, obese and victims of other diet-related non- communicable diseases (NCDs).


This article talks about the “Double Burden of Malnutrition” which is the central aspect of this work. Malnutrition, in its pure sense, refers to the condition of being undernourished or malnourished. This condition arises when a person does not consume a healthy and a balanced diet and thereby falls victim to nutritional deficiency. The term “Double Burden” is indicative of the dual burden or the dual problem (which means two in number) arising out of one single health problem i.e., malnutrition. The very first problem associated with malnutrition is the problem of being underweight. People who have their Body Mass Index (BMI) below 18.5 kg/m2 fall in this category. These people suffer from many health problems such as stunted growth, wasting, nutritional deficiency, weakness, extremely thin and so on.

A malnourished child (underweight).

A malnourished child (underweight).

The second problem is that of being overweight and obese. People who have their Body Mass Index (BMI) above 25 kg/m2 fall in the category of overweight and people with BMI above 30 kg/m2 are considered as obese. People who are overweight and obese tend to pose a major threat for many diseases like Type 2 diabetes, respiratory difficulties, skin problems, infertility, certain types of cancers, musculoskeletal problems, metabolic effects on blood pressure, cholesterol and so on.

An obese woman (overweight).

An obese woman (overweight).


An important point to consider here is that how is obesity associated with malnutrition as both of them lead to contrasting body conditions. The answer to this is that if people in a country, for example, if 70% of a country’s population keeps on consuming food which is available without maintaining any healthy eating habits in terms of the quality and quantity of the food, then logically, the remaining 30% of the population will have no access to food resources as their share is consumed by the 70%. So, as a result, the 70% of population will develop into overweight and obese individuals while the remaining 30% will remain undernourished and underweight due to inaccessibility of food resources.


As given in the example above, malnutrition and obesity result from the eating habits of people. But the next question is how and why do these eating habits contribute to this dual burden of malnutrition. The answer to this is the income and the economic growth of people which leads to nutrition transition. This can be considered as the main cause for developing these health issues. This is so because when people start earning more, their lifestyle changes and they invest a good amount in technologies so that they can live a comfortable life without having to do any work. Their dependency on technologies leads in their low physical workout and more sitting at one place and eating. As far as their eating is concerned, it has been noted that people belonging to high income groups consume a lot of energy-dense foods which are high in saturated fats and sugars. Therefore, intake of such food items and the absence of physical activity lead to the problems of obesity and overweight in people. Taking this into consideration, it can be said that people belonging to low income groups do not usually have much money to invest in high quality food products. Though they do a lot of physical activity, but in order to balance their drained energy, they face problems in accessing food resources of their country mainly because they do not have much money and slightly because their share of food is always consumed by the higher income groups.

Another cause of double burden of malnutrition is the epidemiological transition which reflects a shift in this dual burden from getting influenced initially by infections or diseases related with undernutrition to high rates of NCDs. The last cause is the demographic transition which describes a shift in the population structure and the augmenting lifespans. This is related with a shift from high birth and death rates of population of younger people to the older people.


Having discussed about the causes, the next point to take note of is who all are affected and how are they affected with this particular health issue. According to a report by WHO, there are three levels where this problem can manifest. These are:

Policy Brief by WHO showing the three levels where the Double Burden of Malnutrition manifests.

Policy Brief by WHO showing the three levels where the Double Burden of Malnutrition manifests.

1. Individual Level

Firstly, this problem can manifest at the individual level. This is related with only one person and describes how a person, who in his early years can be malnourished, but in the later years can become obese as a result of increasing urbanization.this is particularly related with the income and economic status as already discussed.

2. Household Level

Secondly, this problem can manifest at the household level which means, on one hand, one member of a family can suffer from malnutrition while on the other hand, the other person of the same family can suffer from obesity. This can perhaps take place in middle- income families where more is invested in a child’s health leading him to be obese and less in the parents’ health leading to their malnourished body condition.

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3. Population Level

Thirdly and lastly, this problem can manifest at the population level of a country which means that people in a community, locality, region or country suffer from the dual burden of malnutrition among which the women are the most affected in comparison to the men. In yet another report, WHO gives an accurate data of people suffering from malnutrition and obesity across various stages of life. As far as the percentage of people falling victim to malnutrition is concerned, it is noted that in 2014, approximately 462 million adults globally were underweight while in 2016, nearly 155 million children below 5 years of age were found to be malnourished. As far as women are concerned, an approximate of 264 million of them are affected by iron- amenable anaemia. Another finding shows that nearly 1.9 billion adults are overweight out of which more than 600 million are obese and nearly 41 million children under the age of 5 years are overweight and obese. It has also been noted that the developing countries are more prone to this double burden as compared to the developed countries. This is so because these countries are in nutrition transition because of the involvement of all kinds of income status.


The above-mentioned estimates show that this problem is a very serious one and needs to be addressed carefully. For this purpose, the initiative taken by the UN General Assembly suggests some “double- duty actions” to combat this double burden which is a global issue. The double- duty actions include several interventions, programmes and policies that possess the potentiality to successfully deal with the dual issues of malnutrition and obesity in one approach. Among the policies, there are policies to ensure access to optimal maternal and antenatal nutrition and care, the protection, promotion and supporting of breastfeeding etc. Among the programmes are the ones that foster healthy diets in preschools, schools, public institutions and workplaces etc.

Apart from these, there are six major key areas of policy action namely:

1. Food system for healthy and sustainable diets

2. Aligned health systems for universal coverage of essential nutrition actions

3. Safe and supportive environment for nutrition at all ages

4. Social protection along with nutrition- related education

5. Trade and investment for improved nutrition

6. Strengthen and promote nutrition governance and accountability.

The Double-Duty Approach (WHO).

The Double-Duty Approach (WHO).

Therefore, to conclude, the double burden of malnutrition is a global problem which can be eradicated only by putting efforts at two different levels. The first level is the government level which ensures equal access to food resources in its country and takes all the measures as given in the previous paragraph. The second level is the individual level where a person can do a lot of physical workout and cut down on the intake of fatty and sugary foods in the diet without any other person’s intervention. Some other measures can be promoting healthy behaviours to encourage people to lose weight, changing the diet from energy-dense foods to unsaturated foods having low fats. If all these efforts are taken in the right way, then the Sustainable Development Goal 2 (SDG2) of ending all forms of malnutrition and Sustainable Development Goal 3 (SDG3) ensuring healthy lives and well- being for all at all ages will be successfully accomplished thereby making a healthy world.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2020 Kriti Khandelwal

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