Double Burden of Malnutrition

The double burden of malnutrition is the coexistence of undernutrition with overweight, obesity or diet-related non-communicable diseases. These contrasting forms of malnutrition may occur within the same individual, household, community or population, either simultaneously or across the life course.

Forms and levels of coexistence

The concept does not mean that every person suffers from both extremes. It describes their coexistence at several levels:

• At the individual level, a person may be overweight while also having a micronutrient deficiency, or may move from childhood undernutrition to adult obesity.
• At the household level, an undernourished child may live with an overweight or obese adult.
• At the population level, stunting, wasting and micronutrient deficiencies may remain prevalent while overweight and diet-related diseases increase.

Why the burden develops

The double burden reflects an interaction between persistent deprivation and a changing food and activity environment.

• Poverty, inadequate maternal and child nutrition, infections, unsafe water and poor sanitation sustain undernutrition.
• Greater availability of energy-dense, nutrient-poor foods and reduced physical activity contribute to overweight and obesity.
• Rapid urbanisation, unequal access to diverse diets and weak preventive healthcare can expose the same population to both sets of risks.

Public health significance and response

The double burden requires double-duty actions that address undernutrition without increasing obesity risk, and prevent obesity without reducing access to adequate nutrition.

• Maternal nutrition, breastfeeding, appropriate complementary feeding and dietary diversity support healthy growth.
• Food fortification, sanitation, immunisation and primary healthcare help address micronutrient deficiencies and infection-related undernutrition.
• Healthy food environments, nutrition labelling, physical activity and screening for non-communicable diseases address emerging overnutrition risks.

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