Insights: The Double (and Deadly) Burden of Malnutrition

Alyssa GovindanNews, Newsletter

The burden of non-communicable diseases (NCDs) has been increasing in recent years to the point that it now constitutes the leading cause of death worldwide. In response, the Secretary General of the United Nations will convene a third high-level meeting on NCDs at the United Nations General Assembly (UNGA) this September. The meeting will focus on prevention and control of NCDs such as lung and heart cancers, diabetes and diseases related to diet and exercise.

Among the issues on the agenda is the double burden of malnutrition – defined as the coexistence of undernutrition and diet-related diseases such as overweight, obesity and diabetes. This coexistence can occur at the individual level, within families and communities as well as at the population level within a nation or region.

Perhaps surprisingly, developing countries experience higher rates of NCDs than industrialized countries do. Despite headlines containing news of starvation and famine in the developing world, increased economic development has shifted the burden. Low- and middle-income countries are now experiencing higher mortality rates from NCDs along with an increased prevalence of overweight and obesity than they are from infectious disease.

Research reveals a nutrition transition is occurring, as rapidly growing economies face the expansion of faster and cheaper food. Improved access means people are eating more fat, more meat, more added sugars, and larger portion sizes all while exercising less. Over the last 30 years, these lifestyle and environmental factors are acting in synergy to fuel an obesity epidemic in the developing world. Without a push for supportive health, agricultural and food processing policies, these factors can prove detrimental to development.

Along with dietary changes, the world has seen a decrease in physical activity level (PAL) which accounts for 6% of deaths worldwide.  This decline is due to multiple factors, most notably fewer jobs in industries like farming and forestry and more sedentary jobs like office work.  Urban infrastructure also plays a role depending on the abundance or lack of playgrounds, parks and bike paths.

Although it has been studied and proven that developing countries are experiencing higher levels of obesity, overweight and related NCDs, Africa and Southeast Asia still have the lowest mean BMI compared to America and Europe. Severely underweight children are concentrated in Africa and South Asia. These regions are still tackling undernutrition, while increasingly trying to combat an epidemic of diseases related to over-nutrition in other population segments.

Simultaneous high morbidity and mortality from infectious and chronic diseases polarized by social class is referred to as the protracted-polarized model. It is a newer and more complex epidemiological trend that scientists and health experts are using to class stages of nutrition transition. While richer communities experience a higher risk of chronic illness, poor communities experience higher risk of infectious diseases and chronic illnesses at the same time. Urbanization, urban poverty and globalization are all key factors that determine the stage of a population’s nutrition transition.

The double burden offers an opportunity to tackle malnutrition in all its forms. Although addressing under and over nutrition require different approaches, the coexistence of both means that multiple sectors must get involved. The health, food, biotech and agriculture industries all have a role to play in promoting a healthy lifestyle through diet and exercise but also tackling sources of undernutrition such as food insecurity and severe climate disasters. The WHO says that integrated action on malnutrition in all its forms is key to achieving the sustainable development goals. We as a community must step up to address this complex fight.

Alyssa GovindanInsights: The Double (and Deadly) Burden of Malnutrition