Double burden of malnutrition PDF

Running head: DUAL BURDEN OF MALNUTRITION
DUAL BURDEN OF MALNUTRITION
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DUAL BURDEN OF MALNUTRITION
The double burden of malnutrition can be explained as the coexistence of under-
nutrition conditions in addition to overweight, obesity and even other diet related non-
communicable disorders. This might prevail within individuals as well as households and
populations through the entire life-span. Researchers are of the opinion that under-nutrition in
both acute and chronic forms include wasting and stunting and are found to be strongly
inversely correlated with the wealth of the nations (Tzioumis et al., 2015). Many of the low
as well as the middle income countries have become successful in achieving economic
advancement and passed the nutrition transition phase and so their rates of under-nutrition
had declines to some extent (Tzioumis et al., 2015). However, this transition had resulted in
new problems of increasing number of obese and overweight people in the nations. This
assignment would first discuss the epidemiology and aetiology of the double burden of
malnutrition and how it had impacted the Asian country of India. It would also discuss the
interventions that could be taken to help India and similar nations to overcome the crisis
period successfully.
The double burden of malnutrition has affected nearly the entire world emerging out
as the global burden on the planet and it is important to understand the statistics and
epidemiology. About 1.9 billion adults all over the planet comprising of 18 years and above
are found to be overweight. About greater than 600 million people are found to suffer from
obesity with 41 million children under the age of 5 years are overweight or obesity. Again, on
the other hand about 462 million people in the world mainly adults are found to be
underweight (Vaezghasemi et al., 2014). Analysis of the statistical report has shown that
about 52 million people in the world are found to be wasted meaning that they are too thin in
comparison to their weight. About 155 million people are found to be stunted meaning that
they are too short for the age. It has been also found that about 264 million women of the
reproductive age are affected by iron-amenable anaemia. Therefore, from the statistical

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analysis, it can be clearly depicted that both obesity and under-nutrition go hand in hand
creating a double burden of disorders in every affected nation of the world.
The issue of the double burden of disorder mainly occurs at three important levels.
Therefore, in order to develop effective strategies for the mitigation of the issues, it is very
important to understand the aetiology of the global burden of double burden of malnutrition.
Firstly, the double burden of malnutrition can occur at the individual level. Researchers have
found out that this can occur due to the simultaneous form of development of any of the two
or more various of the types of malnutrition. They have found examples where individuals
have been seen to exhibit obesity symptoms along with nutritional anaemia or any nutritional
insufficiencies of deficiencies. Studies are also of the opinion that it can occur through
different phases of the life-span and can undergo temporary separation. This might occur due
to the contrasting nutrition environments (Tzioumis & Adair., 2014). It might result from the
shifting of the economic as well as the other circumstances like being overweight as an adult
when the individual was previously stunted due to chronic disorders across the various phases
of the time of childhood.
Secondly, the double burden of malnutrition can also develop at the household level.
Studies have been conducted where professionals had witnessed several examples of the issue
taking place at household level. It has been seen that a mother who suffers from nutritional
anaemia might have a grandparent or a child who was obese and suffered from diabetes type
2 issues. Statistical reports have revealed that dual-burden household are indeed one of the
common features in the middle income countries that are undergoing rapid forms of nutrition
transitions (El-Kassas & Ziade, 2017).
Third, burden of double burden of malnutrition is also seen to occur at the population
level. This includes under-nutrition as well as overweight, obesity as well as non-

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communicable disorders within the same community, region as well as in the regions and
even the nations. These components have affected many countries and are seen to co-exist
together. Researchers are also seen to affect women in many countries along with rapid
increase in overweight and other different types of NCDs (Thow et al., 2017).
In order to develop effective interventions and strategies for the mitigation of the
double burden of malnutrition, it is significant to know about the causes of the issue.
Epigenetics suggest that alteration of expression of different types of genes and not just the
genes themselves have the ability of influencing the risk of obesity, overweight, own birth
weight, and other NCDS. A number of factors can result in alteration of expression of genes
in the babies. This includes maternal under-nutrition (Tzioumis & Adair., 2014). This can be
seen to lead to alteration of the procedures by which the body of the infant regulates energy.
This can be passed on from generation to generation. Another important cause is the early-
life nutrition. Researchers are of the opinion that the in-utero as well as the early-life
nutrition environments can have huge impacts on the development of child. Researchers are
of the opinion that quality as well as quantity of the nutrition during the development of the
foetus as well as on the infancy can impact the immune system of the body and affect the
cognitive development as well as effective form of regulation of energy storage and even that
of the expenditure. Poor maternal nutrition before pregnancy and during it can result in
preterm birth and low infant birth weight (Dong et al., 2018). This can result in higher risks
of the metabolic disorders and even abdominal adiposity in the different phases of later.
Females who are again seen to be obese or have gained weight during pregnancy remain at
greater risk for giving birth to babies with larger birth weight. This puts the infants at a much
higher risk for developing obesity later in adulthood and faster pace of weight gain in earlier
part of life.

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The quality as well as the quantity of the foods along with the systems that produce
them is seen to have profound influence on the nutritional status of the population. It has been
found that in the later part of the century, the size of the packaged foods that are low in
nutrients and high on calories have increased and their price had decreased. On addition, the
cost of fresh foods had increased that had made the poorer sections of society in developing
countries to seek for packaged foods (Haddad et al., 2014). However, in the areas which have
been been hit by disasters, instability and conflicts, foods had become unaffordable,
unavailable or inaccessible, and people suffer from inadequate amount of food consumption
and get amounts of food which fail to meet their nutritional as well as energy requirements of
the growing children. This is seen to contribute towards nutrition as well as predisposing
towards infection, wasting and even stunting.
Malnutrition is intimately associated with poverty as well as disorders, researchers
have noticed that low socioeconomic status reduces the ability of individuals to afford
nutrient rich foods and this increases the chance of malnutrition. They tend to go for cheap
packaged foods that increase chance of obesity. Therefore, correlation has been found among
poverty, food insecurity, and obesity. Socio-economic gradient for obesity and overweight
prevalence are found in middle as well as in high-income countries. Urbanisation is yet
another contributor (Abdullah, 2015). Researchers are of the opinion that urban environments
without proper sanitation and inadequate water supply cause water borne disorders and this
result in under-nutrition. Again with financial development, it is seen that urban
environments discourage active travel and physical activities with lower reliance of home
prepared foods and greater reliance on take-away foods.
Malnutrition in the nation of India had always been found to be associated with
under-nutrition. However, the present data shows that National Family Health Survey
(NFHS) had conducted a survey and had found that obesity in the adults in the nation had

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also become a big problem in the country like that of the under-nutrition. It also shows that
under nutrition had still continued to be high in the poorer parts of the country where obesity
had reached endemic levels in some of the richer parts of the country. This had been found
after the agency had conducted survey of about 6 lakhs household in 2015-2016 (Desai &
Nambiar, 2015).
Statistical analysis shows that the previous round of NFHS that was conducted in
2005-2006, the proportion of underweight women and men in the country was found to be
thrice the proportion of the obese men and women. However, recent data has shown that the
number of the overweight or obese women in the nation is at 20.7% and this is only 2% lower
than the proportion of the underweight women (Goswami et al., 2016). The trend is quite
common in the men with nearly one in 5 men in India being overweight.
An interesting study found on thrifty genotype hypothesis, had shed more light on
the twin problem of high malnutrition and growing obesity in the nation of India. Under
nutrition in the pre-natal stage programmes the tissues of foetus in ways by which it becomes
difficult for the low birth weight babies in dealing with the abundance of food in the later life
(Bharati et al., 2018). The double malnutrition trap can be seen be particularly dangerous in
the Asian countries like that of India where urban population is rising and where people
increasingly face a sedentary lifestyles.
Close analysis of the district map shows that most of the high-obesity districts are
seen to be clustered largely mainly in the two ends of the country. These regions include
extreme north as well as extreme south. On the other hand, the undernourished districts are
mainly found in the centralised portions of the nation. A strong correlation is found by the
researchers in their studies regarding affluence, lifestyle disorders and obesity in the nation of
India (Gupta et al., 2014). The districts which have been seen to harbour a higher proportion

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of the rich households like those having televisions, computer, phones as well as motorised
two wheeler or four wheelers as per the data collected by census 2011 are seen to have higher
numbers of obese people as well as lower proportion of the underweight people.
A study showed the nutritional profiles of three states of the nation. It was seen that
none of the households in Andhra Pradesh was adequately nourished in nine nutrients of
proteins, calories, and micronutrients like carotene, thiamine, calcium, iron, riboflavin,
Vitamin C and niacin. Mean consumption of all nutrients except iron was found to be below
respective cut-off point for nutritional adequacy. The nutritional profile of another state was
better with 1.3% of households being adequately nourished. In Andhra Pradesh, minimum
calorie norm had been seen to reach only by the top 5% of all the different households for
calorie consumption (Gupta et al., 2014). In Rajasthan, only 0.5% of households were seen to
be properly nourished in all nine nutrients. Rate of calorie consumption was seen to be higher
in the urban areas than the rural areas in all three states.
A very strong relation had been also found between malnutrition as well as
sanitation in the nation. It has been found that areas and districts which have lower levels of
sanitation arrangement and toilet access have higher levels of under-nutrition and lower
levels of obesity. The results are absolutely converse for the districts which have high levels
of access to toilets (Dong et al., 2018).
Currently, the nation has been experiencing a rapid socio-economic, demographic,
and nutritional and health transition. Although, the nation had not been able to overcome the
problems of under-nutrition, poverty as well as communicable disorders, it is facing
additional challenged related to the affluence and outcome of industrialization, urbanization
and economic betterment. The last two decades had seen the emergence of obesity and over
nutrition that had in turn increased the prevalence of chronic disorders like diabetes and

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cardiovascular disease (CVD) mainly in the urban areas. Therefore, it is important the
international agencies as well as the governmental authorities of the nation to develop
strategies and interventions that successfully control and manage the situation (Haddad et al.,
2014).
It is important for the concerned authorities to develop a health policy framework that
would be based on the number of action areas that each of the concerned organisations and
departments need to take. The policy would be developed on the collaborative research
output on the stalwart healthcare managers of the nation as well as international areas. The
framework of the policy would be helpful in guiding each of the stakeholder agencies to
understand their roles and responsibilities in managing the dual burden of malnutrition and
mitigate the issues from the very roots (Khandelwal et al., 2017).
One of the most important parts of the policy development would be ensuring food
system and sustainable diets in the nation that align with the goal of mitigating the chances
of malnutrition and obesity together. National policies would be developed and investments
would be done along with the integration of nutrition objectives into food and agriculture
policy. This would also include strengthening of the local food production as well as
processing mainly by the smallholders and family farmers (Kosaka & Umezaki, 2017).
Moreover, focus should be also done on the strengthening and establishing of institutions,
services, program and policies that increase the resilience of the food supply in the crisis
prone areas affected by poverty and malnutrition.
The policy would also include effective healthcare strengthening as well as universal
health coverage systems for all classes of people. Initiatives for health system strengthening
needs to be done for integrating nutrition actions successfully along with the promotion of

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universal access to all direct nutrition actions and relevant health actions that impact nutrition
through health programmes arrangement (Khandelwal et al., 2017).
Another arena that needs to be included in the policy is development of safe and
supportive environments for ensuring effective nutrition for all ages. This action area should
mainly comprise of taking into consideration about the environmental determinants of
malnutrition. Commitment from allocated authorities is required for addressing the social
and environmental determinants of malnutrition. This should also include schools,
workplaces as well as city contexts and should even integrate different actions for water,
sanitation and even hygiene development. Researchers are also of the opinion that there is
need for promotion, protection as well as support of optimal breastfeeding practices and
hence programs for its development should also be included (Kamal et al., 2015).
Another important arena in the policy would be social protection as well as nutrition
related education. It is extremely important for the implementation of the nutrition education
as well as information interventions. These would be based on the national dietary guidelines
as well as the coherent policies which relate to food and different diets along with the
incorporation of the nutrition objectives (Rachmi et al., 2018). These objectives would be
included in the social protection programs along with different humanitarian assistance
safety-net programs. This might include the utilisation of cash as well as food transfers with
school feeding programs and other forms of social protection programs for vulnerable
populations.
The policy also needs to provide more importance to the trade as well as investment
for improvement of nutrition. The government should try to focus on appropriate
identification of the opportunities for achieving global food and nutrition targets mainly
through the procedures of trade and investment policies (Wells et al., 2018). This would also

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include investment policies as well as improvement in the availability and accessibility for
the food supply through appropriate trade agreement and policies.
Another important arena which holds utmost importance is the strengthening and
promoting nutrition governance as well as accountability. The actions that would be taken
should focus on the policies, plans and frameworks for the Member State’s governance. It
should be including proper measures of the reviewing, updating and even the strengthening of
the national strategies (Thow et al., 2016). This should also include establishing appropriate
“national cross government, inter-sectoral, multi-stakeholder mechanisms; improving the
availability, coverage, quality, quantity, and management of multi-sectoral information
systems” as stated by the World Health Organisation in 2016. The government should also
focus on the appropriate development as well as adoption and adaption of the international
guidelines on the healthy diets.
From the above direction, it can be found that double burden of malnutrition had
affected the life quality of people of huge number of nations. It had resulted in huge amount
of suffering affecting people of various socioeconomic classes in various manners. The
people suffering from poverty had shown conditions of malnutrition and these of affluent
levels are suffering from obesity. This had been resulting in huge economic impact on people
of the nation affecting their productivity and increased healthcare costs. India is one of the
Asian countries which are suffering from the issue of double burden of malnutrition.
Therefore national and international bodies need to develop policies that would cover all the
important action areas that would help in overcoming the barriers and mitigate the issue
successfully.

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