Nutrition and health are closely related and adequate nutrition are fundamental to the development of each child’s full human potential. Malnutrition is not just deprivation of food. It is a complicated interaction of nutrient needs and health influenced by the physiological state, metabolic processes and possibly infection. If nutrient needs are not met to a very large extent, survival itself may be questionable. However, when there is mild to moderate inadequacy over a fairly wide range of nutrient intakes, the organism adapts with some compromise.
Dual Malnutrition consists of not only undernutrition but also obesity or overweight when someone’s diet contains excess or imbalance of macro and/ or micronutrient foods which can lead to obesity. Around 33 percent of the world’s population is obese or overweight. This might lead to the development of chronic diseases in developing countries. Both undernutrition and over-nutrition can have a devastating effect on the nation’s overall health and productivity. This condition is commonly known as the dual burden of malnutrition. According to WHO, double burden of malnutrition is characterized by the coexistence of undernutrition along with overweight, obesity, or diet-related NCDs within individuals, households, and populations, and throughout life. However, combating the malnutrition deficiency diseases problem requires funding, innovation along with an understanding of the link of micronutrient malnutrition to undernutrition and obesity and malnutrition.
There is a direct link between obesity and malnutrition diseases. If you are overweight, you are more susceptible to an array of chronic illnesses including cardiovascular diseases, type 2 diabetes and also some type of cancer. You might be having micronutrient deficiency diseases as well. Obesity is said to have an effect on individuals’ productivity as they move slowly and are sick of working due to the presence of complications of diabetes and many other non-communicable diseases.
Therefore, how to prevent micronutrient deficiency and the issue of obesity and overweight in developing countries? Increase in the economic development and urbanization have led to changes in the lifestyle of people all around the world, this also includes people with sedentary lifestyle and people having more of processed foods or meals that are cooked outside the home. The malnutrition diet of people consuming more processed and packaged foods, calorie dense and nutrition-deficient being high in fat, salt, and sugar. It is recognized that overweight and obese people have lower serum concentrations of micronutrients compared to their counterparts. Micronutrient deficiencies in developing countries have been associated with poor health outcomes as increased maternal mortality, poor fetal development, increased infections, and reduced growth and development among children.
World Health Organization (WHO) has stated that “Dual malnutrition is reflected in epidemiology and supported by the evidence, undernutrition early in life and even in utero may predispose to overweight and non-communicable diseases (NCDs) such as diabetes and heart disease later in life”. The main reason attributed to this condition is that undernutrition actually has an effect on individuals’ physiology in ways that might increase the likelihood of becoming overweight or obese later in life.
The drivers of the dual burden of malnutrition are:
- Biological Factors:
- Early life experience
- Environmental Factors:
- Food supply and systems
- Food Access, portion sizes, and cost
- Cultural and social aspects
- Urbanization, urban design, and built environment
- Trade and its policy
- Social and Demographic Factors
- Socioeconomic disadvantage, inequality, and poverty
- Food insecurity
- Behavioral Factors
- Lifestyle and habits
- Psychological factors
Malnutrition prevention and treatment need innovation in nutrition, wherein more creativity is needed in developing how food systems can provide higher quality products. It is important to address the dual burden of malnutrition which offers an opportunity for alignment and coordination between those charged with addressing undernutrition, early nutrition, overweight, and obesity, infectious diseases, maternal and child illness, and NCDs.
The United Nations Decade of Action on Nutrition has provided a framework for addressing the double burden of malnutrition which outlines the six key areas for policy actions. These include:
- Food systems for healthy, sustainable diets: This includes national policies and investments and integration of nutrition objectives into food and agriculture policy, strengthening local food production and processing, and establishing and strengthening institutions, policies, programmes, and services in order to enhance the resilience of food supply in crisis prone areas, including areas affected by climate change.
- Social protection and nutrition-related education: Implementation of the nutrition education and information interventions that are based on national dietary guidelines and coherent policies related to food and diets, incorporation of nutrition objectives into social protection programmes and use of cash and food transfers that also includes school feeding programme and other forms of social protection for vulnerable populations
- Aligned health systems providing universal coverage of essential nutrition actions: This includes health care strengthening and universal health coverage, health system strengthening to integrate nutrition actions effectively. The universal access to all the direct nutrition actions and relevant health actions impacting nutrition through health programmes should be promoted.
- Trade and investment for improved nutrition: Identification of opportunities to achieve global food and nutrition targets through trade and investment policies and improvement in availability and accessibility of food supply through appropriate trade agreements and policies.
- Safe and supportive environments for nutrition at all ages: This action area reflects the importance of environmental determinants of malnutrition outcomes. The policy action addresses issues of social and environmental determinants of malnutrition including in school, workplace, and city contexts as well as integrating actions on water, hygiene, and sanitation along with promotion, protection, and support of optimal breastfeeding practices.
- Strengthen and promote nutrition governance and accountability: This action focuses on policies, plans, and frameworks of Member States governance. This includes measures for reviewing, updating, and strengthening national strategies.
Thus, it is essential to identify, promote, and implement double duty actions that will simultaneously and synergistically act on both undernutrition as well as overweight, obesity, and diet-related non-communicable diseases across six policy action areas discussed above.
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