Double burden of malnutrition

The double burden of malnutrition is characterised by the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases, within individuals, households and populations, and across the lifecourse.

In the context of a changing global nutrition landscape, influenced by economic and income growth, urbanization, demographic change and globalization, diet-related epidemiology has seen a significant shift in recent decades.

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WHO/NHD

Burden

In 2014, more than 1.9 billion adults worldwide, 18 years and older, were overweight while 462 million were underweight. More than 600 million were obese. In the same year, 41 million children under the age of five were overweight or obese but 159 million were affected by stunting (low height-for-age). While 50 million children were affected by wasting (low weight-for-height). In low- and middle-income countries, almost five million children continue to die of undernutrition-related causes every year yet simultaneously these same populations now witness a rise in childhood overweight and obesity – increasing at a rate 30% faster than in richer nations.

This double burden of malnutrition can exist at the individual level – for example obesity with deficiency of one or various vitamins and minerals, or overweight in an adult who was stunted during childhood – at the household level – when a mother may be overweight or anaemic and a child or grandparent is underweight – and at the population level – where there is a prevalence of both undernutrition and overweight in the same community, nation or region.

Moreover, the relationship between undernutrition and overweight and obesity is more than a coexistence. Reflected in the epidemiology and supported by evidence, undernutrition early in life – and even in utero – may predispose to overweight and noncommunicable diseases such as diabetes and heart disease later in life. Overweight in mothers is also associated with overweight and obesity in their offspring. Rapid weight gain early in life may predispose to long-term weight excess. These are just some of the examples of biological mechanisms, which along with environmental and social influences, are increasingly understood as important drivers in the global burden of malnutrition across the lifecourse.

Opportunity

This double burden of malnutrition offers a unique and important opportunity for integrated action on malnutrition in all its forms. Addressing the double burden of malnutrition will be key to achieving the Sustainable Development Goals (in particular Goal 2 and Target 3.4) and the Commitments of the Rome Declaration on Nutrition, within the UN Decade of Action on Nutrition.

FOOTNOTE: While we recognise the importance vitamin and mineral related overnutrition, it does not form part of this definition.