The double burden of malnutrition

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March 31, 2014 by cfmsc

 by Lucía Félix

During the last two decades, countries like Brazil, Chile and Mexico have experienced a series of epidemiological, demographical and nutritional changes. The epidemiological transition is characterized by a shift from a high prevalence of infectious water-borne diseases such as diarrhea and cholera; to the preponderance of non-communicable chronic diseases like hypertension and type II diabetes. The demographic transition is observed in shifts from high to low fertility and mortality, as well as in population aging. Finally, the nutrition transition implies a shift in national diets, physical activity and body composition patterns.

Dietary patterns have shifted from low availability of traditional foods to a highly available “Western” diet, based on high calorie dense fat and sugar-processed foods. Simultaneously, the amount of physical activity has diminished. Among other variables, the latter have led to an increase in overweight and obesity rates. This has been associated to economic changes, which have led to high urbanization rates and an increase in the country’s Gross Domestic Product (GDP), which have however, negatively affected the population’s habits and health outcomes. For example, urbanized localities tend to have jobs of a more sedentary nature and industrialized foods offer, hence, the population tends toward overweight and obesity, and the resulting health consequences such as non-communicable transmitted diseases.

There is a growing body of evidence that shows that the most vulnerable populations—often targets of nutrition and health policies—are the ones who present the highest under nutrition and overweight rates and hence the double burden of malnutrition. Is it possible to consider that policies targeting under nutrition might be increasing the probability of overweight development within the same household?

Traditionally, under nutrition and overweight have been considered opposite conditions, as if on one side of the plateau lied under nutrition and across the divide lied overweight (over nutrition). However, a growing body of literature, which began in the 90’s with Barry Popkin,[i] has established that overweight and under nutrition, to some extent, share the same causal pathway. The coexistence of under nutrition and over nutrition has been denominated as the double burden of malnutrition. This condition is most likely to be observed in low and middle income countries undergoing the nutrition transition; countries which are now facing the growing health problems of developed countries such as diabetes and hypertension, while continuing to deal with the nutrition and health profiles of non-developed countries such as under nutrition and its consequences.

The double burden of malnutrition can be observed and has been studied in different geographical units, such as countries, regions or continents. It is important to note that under nutrition can be measured in different ways; low birth weight, wasting and stunting but also as a zinc, vitamin A, or Vitamin D deficiency. Overweight is most frequently measured using a Body Mass Index (BMI), which corresponds to weight/height2. .Lately, the double burden has also been a matter of study within the same household. The overweight mother-undernourished child dyad within the same household has become a frequent unit of analysis. This condition is particularly relevant in Mexico. Over the last two decades[ii], nutrition rates have significantly diminished; nonetheless this is still a health policy priority. As of now, 1.5 million children under the age of 5 present stunting, which can be prevented with adequate interventions.


On the other hand, 7 out of every 10 Mexican adults is either overweight or obese. The health consequences deriving from this conditions, such as type II diabetes and hypertension, led the past and current governments to consider it a health policy priority.



Under nutrition and overweight cannot longer be considered ends of a continuum, we must study them to find those shared causal pathways which serve as evidence to design proper and complete policies to attend the situation. It is a common misconception that an individual’s nutritional status can be explained by macroeconomic variables such as income and education; there is a more complex nature behind it, one that involves preferences, empowerment, and decisions among other factors. The double burden of malnutrition is just an example of how our reality is not black and white but a rather a grey skein which we must seek to disentangle.

Food is a fundamental component of Mexican culture and identity. However, changes we’ve experienced over the last few decades such as the type of lifestyle we have and the sort of foods introduced to the country, may no longer be compatible with our traditions. Do we really need to deep-fry everything; chicharrones, gorditas, quesadillas? I might be torturing a cliché, but have you ever though that your body, like the Mexican State, might not be able to afford the consequences?


[i]Popkin, B. M. 1994. “The nutrition transition in low-income countries: an emerging crisis.” Nutrition reviews no. 52 (9):285-98.

[ii]Rivera-Dommarco, J. A., González de Cossío T, Teresa Shamah-Levy, and Cuevas-Nasu L. 2012. Desnutrición en México: intervenciones hacia su erradicación. In Encuesta Nacional de Salud y Nutrición 2012. Evidencia para la política pública en salud. Cuernavaca, México: Instituto Nacional de Salud Pública.


Lucía Félix holds a BA in Psychology. She has worked for the Mexican Federal Government,  Oxfam Mexico and is currently a Msc student in Public Policy and Administration at the Centro de Investigación y Docencia Económicas (CIDE) in Mexico City.


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