By Laetitia Satam, General Member
Malnutrition. When most people hear the word malnutrition, they think of undereating, having nutritional deficiencies, and picture someone looking weak. What if I told you malnutrition includes all those and the exact opposite? Malnutrition, as defined by the World Health Organization (WHO), is a deficiency or excess of nutrient intake, an imbalance of essential nutrients, or impaired nutrition utilization (2022). As the Western world grapples with an obesity epidemic, it is crucial to understand that on both sides of the spectrum, being underweight or overweight is malnutrition. As we see grocery store shelves stocked with ultra-processed foods, a diet declining in fresh fruits and vegetables, and parts of the world experiencing extreme food insecurity, it is no surprise that nutrition is declining worldwide.
Interestingly, countries, especially those currently undergoing rapid economic growth and development, can see a “double burden.”. The double burden in nutrition is when both undernutrition and obesity or cases of being overweight are prevalent. This double burden can be seen on an individual, a household, or a more significant population level. For example, a child who experienced stunting due to undernutrition who becomes obese later in life, in a home where parents and a mother suffer from anemia (low iron) but her children are overweight, or seeing both underweight and obese individuals in a country’s population (World Health Organization, 2020). This is a challenge for countries that are rapidly developing and are undergoing a nutrition translation. As incomes increase, so do levels of food security. However, when there is an increase in wealth in a nation and a more remarkable ability to secure food, that does not mean nutrition education is adequately provided, leading to people not only consuming more than they were previously but also consuming foods that are not optimized for health or ultra-processed foods commonly consumed in the West. Studies have found that industrializing countries like India also face significant wealth disparities, leading those in poverty to undernutrition. In contrast, those with more outstanding affluence face issues with overnutrition, widening the difference between populations (Nguyen et al., 2021). Interestingly, the prevalence of overweight/obesity is still increasing in low socioeconomic communities, although not at the rapid rates of urban centers (Nguyen et al., 2021). There is also a fear that these countries will adopt a more Western diet, which is full of ultra-processed foods and high in sugar and sodium. However, this can have even more detrimental health effects, as these countries may not have adequate health resources and systems to support an increase in the chronic diseases often seen in the West (such as heart disease, stroke, kidney disease, etc.). The double burden can strain healthcare systems dealing with extreme ends of malnutrition, an issue not typically seen in industrialized countries with solid healthcare systems.
Now, how can the double burden be addressed? This is where global health plays a role. While many of the WHO’s Sustainable Development Goals (SDGs) have been stalled by polycrises, this does change the fact that world hunger has worsened since 2015, with current levels not being observed since 2005. Sub-Saharan Africa is disproportionately affected by hunger, while the double burden grows in industrializing countries. Many SDGs can play a role in addressing the double duty. SDG 1, Zero Poverty and SDG 10, Reduced Inequalities, address critical determinants of malnutrition. By addressing these social determinants, initiatives can simultaneously contribute to SDG 1 and SDG 10, creating a more inclusive and equitable environment where all individuals can access sufficient nutritious food. Poverty is one of the most significant factors for facing food insecurity, and for some living in poverty, it means only ultra-processed foods are available. An interesting parallel has been drawn when discussing poverty in industrialized vs industrialized countries; a person in poverty in a country like Canada can most likely afford calories with a low nutritional value, whereas a person in a country with low socioeconomic conditions is unlikely to afford any calories. This further adds to the complexity of addressing poverty and malnutrition globally, highlighting the importance of different, localized initiatives.
Zero Hunger (SDG 2) aims to end hunger, achieve food security, and improve nutrition. Addressing the double burden of malnutrition aligns with the comprehensive approach needed to fulfill the aspirations of SDG 2. Initiatives promoting sustainable agriculture, equitable access to nutritious food, and improved food systems contribute to dismantling the double burden. Many efforts are being made to end hunger, from community gardens to changing distribution systems, supporting local and micro farmers, and ensuring the climate and soil are healthy enough to further agricultural development.
SDG3, Good Health and Well-being focuses on ensuring healthy lives and promoting well-being. Tackling the double burden of malnutrition aligns with SDG 3 by addressing undernutrition-related health issues (such as stunted growth and micronutrient deficiencies) and overnutrition-related concerns (including obesity and non-communicable diseases). An optimal diet is the foundation for good health and begins right from conception. Even giving birth continues to be dangerous in areas of the world, and we are facing high rates of food insecurity. Sub-Saharan Africa sees high cases of preeclampsia, which can lead to death in mothers during childbirth. In response, many soon-to-be moms choose to undereat pregnancy in hopes of keeping their babies small for birth. However, global health experts know that an adequate set of healthy weights leads to better outcomes for both the mother and the baby, highlighting the dangers of misinformation in vulnerable populations and the multifaceted role global health plays in addressing these inequalities.
Quality Education SDG 4: Education plays a pivotal role in addressing malnutrition. Promoting awareness about balanced nutrition, healthy lifestyles, and the importance of adequate healthcare contributes to achieving SDG 4. Educated communities are more likely to adopt positive health behaviours and make informed dietary choices. As people experience greater upward social mobility and have greater purchasing power for food, they must be educated on how to make healthy options on what to buy. Furthermore, with the expansion of global fast food chains and ultra-processed foods, individuals need to be educated on making wise choices when incorporating these options into their diets. Global health experts often advocate for educational initiatives because prevention is better than cure. Educating populations to make better nutritional decisions can alleviate the healthcare system's stress and allow future generations to prosper.
Partnerships for the Goals (SDG 17): Collaboration across sectors, nations, and organizations is crucial for effectively addressing the double burden of malnutrition. SDG 17 emphasizes the importance of partnerships, making it a cornerstone for the global health community to work together and pool resources to tackle complex challenges like malnutrition comprehensively. These collaborations must work with all levels of organizations to tackle the double burden occurring on multiple levels while ensuring individual needs are met.
While the double burden may be new, various global health sectors must pool together to address it. Strides can be made towards addressing the double duty by achieving the World Health Organization's Sustainable Development Goals. As more parts of the world continue to industrialize, the goal should be to provide everyone with the adequate nutrition they need in their worlds, regardless of their socioeconomic status.