Objectives As an emerging middle-income country, Indonesia is grappling with the double burden of malnutrition across all age groups, including adolescents. Slow gains in reducing undernutrition are compounded by rapidly increasing overnutrition. This study aims to determine the patterns and determinants of this double burden, particularly stunting, thinness and overweight, among adolescent girls and boys aged 12–18 years in Indonesia. Methods A cross-sectional survey was conducted among 2,160 girls and boys in the districts of Klaten and Lombok Barat in 2017. Data were collected on adolescents’ nutritional status, sociodemographic characteristics, morbidity, dietary intake and physical activity and other relevant factors. Multivariable logistic regression models using generalized estimation equation were employed to determine risk factors for stunting, thinness and overweight. Results About a quarter of adolescent girls (25%) and boys (21%) were stunted. Approximately 5% of girls and 11% of boys were thin, whereas 11% girls and boys each were overweight. Living in a higher wealth household (OR = 0.67; 95% CI: 0.49–0.91), compared to a lower wealth household, and living in a district with higher socioeconomic status (OR = 0.63; 95% CI: 0.51–0.79) were associated with lower odds of being stunted. Adolescent education was also protective against stunting (OR = 0.52; 95% CI: 0.33–0.88). Older adolescents aged 15–18 years were more likely to be stunted (OR = 1.88; 95% CI: 1.42–2.46). Being a girl was associated with reduced odds of being thin (OR = 0.42; 95% CI: 0.30–0.58). Higher household wealth (OR = 1.93; 95% CI: 1.27–2.97) predicted being overweight, while maternal primary or some secondary education, compared to no or incomplete primary education, was protective against adolescent overweight (OR = 0.60; 95% CI: 0.40–0.90). Conclusion Indonesian adolescent girls and boys face both extreme spectrums of malnutrition. Addressing the dual burden of malnutrition requires a multi-pronged approach, and urgent shift is warranted in nutrition policy and programmes targeting adolescents to effectively address the associated underlying determinants.

One in eight people suffer from chronic hunger, leading to an insecure food situation. Chronic hunger mostly occurs in developing countries and includes adolescent girls. Our qualitative study, with data collected in December 2012, provided the results of an exploration of the experiences and strategies implemented by fifteen adolescent girls who tried to cope with their condition of living in food-insecure families. The age of the girls ranged from 10 to 19 years. Their coping strategies were grouped into self-initiated and parent-initiated strategies. Self-initiated coping strategies that were the girls' own initiatives included eating only rice without any vegetables or side dish, eating lessdesirable food, reducing portion size, skipping meals, saving pocket money and earning money to buy food. The parent-initiated coping strategies that were initiated by the parents and followed by the girls included selling their own field produce and livestock, asking for food, borrowing food and storing maize for 6 months up to 1 year. These results show that adolescent girls living in food-insecure areas implement several coping strategies in severe conditions, which parents may not be aware of, and such conditions may compromise their growth and health. The acknowledgement of such coping strategies and the girls' food insecurity condition can lead to a useful and suitable food insecurity alleviation programme for the girls and their families.

Background: Growing evidence highlights the linkage between body image, eating, and exercise behaviors among adolescents. Objective: This study aims to determine the association between body image perception, nutritional status, and dietary and physical activity behaviors among adolescents in Indonesia. Methods: A cross-sectional household survey was conducted among a representative sample (n = 2160) of adolescent girls and boys aged 12 to 18 years in Klaten and Lombok Barat districts. The association between adolescents’ body image, their diets, and physical activity patterns was determined using complex samples Cox’s regression analysis. Separate multivariate models were developed for adolescent girls and boys. Results: Physical appearance was considered important to nearly all adolescents. Approximately 11% of girls and 14% of boys were overweight or obese, the majority of whom (∼70%) correctly perceived themselves as overweight or obese. More of overweight or obese adolescents felt unhappy about their perceived weight than their thin counterparts. With respect to the overweight/obese girls, the adolescents’ perceptions of being overweight or obese was associated with a 63% reduction in the prevalence of overweight/obese girls consuming fatty snacks, such as deep-fried crackers (adjusted prevalence ratio (PR): 0.37, 95% confidence interval (CI): 0.19-0.71) and a 40% reduction in the prevalence of overweight/obese girls engaging in moderate-intensity physical activity (adjusted PR: 0.60, 95% CI: 0.38-0.94), after adjusting for potential confounders. No association between body image and eating and physical activity behaviors was observed among adolescent boys. Conclusions: Body image may be one of the most important determinants of dietary and physical activity behaviors, and thus future efforts to foster healthy eating and physical activity behaviors among Indonesian adolescents need to address body image concerns.

ObjectiveThe present study aimed to take stock of nutrition interventions that warrant consideration as a minimum package of interventions in Indonesia to improve four key nutrition indicators for adolescents: stunting, thinness, overweight and anaemia.DesignWe conducted a review of the peer-reviewed literature published between 1995 and 2017 on nutrition-specific and nutrition-sensitive interventions that target adolescents in Indonesia. The search to identify studies was conducted in PubMed, Google Scholar and EMBASE, using key search terms. We also explored programmatic and policy documents from the grey literature as they related to adolescents and/or Indonesia. Our search yielded thirty-five peer-reviewed articles and programmatic documents.SettingIndonesia.SubjectsAdolescent girls and boys.ResultsThere is very limited evidence on the impact of interventions specifically among adolescents in Indonesia. Nevertheless, findings from our review suggest the minimum package of interventions in Indonesia could include the following nutrition-specifc interventions: (i) iron–folic acid supplements, paired with antihelminths delivered at scale via school-based platforms and through health centres; and (ii) diet counselling and nutrition education provided through school-based platforms, adolescent youth centres/peer education and technology-based platforms. The minimum package could also include the following nutrition-sensitive interventions: (i) improving access to reproductive health services; and (ii) increasing the coverage of interventions designed to increase school attendance.ConclusionsProgrammes and policies targeting adolescent nutrition are relatively new and coverage is low. To improve the nutritional status of this vulnerable population, additional evaluations of adolescent programming and surveillance data on adolescents are needed.

Few policies and programs exist to support adolescent nutrition in Indonesia. Coordinated efforts across relevant sectors and levels of government should be made to mainstream adolescent nutrition into relevant policies.

The double-burden problem of malnutrition in many developing countries is occurring against a backdrop of complex changes in the socio-economic and cultural environment. One such change is the increasing rate of female employment, a change that has attracted researchers to explore the possible relationships between maternal employment and child nutritional status. The present study employs a qualitative approach to explore the socio-economic and cultural environments that may influence child-care practices in families of working and non-working mothers with children of different nutritional status and types of domestic caregiver. It was conducted in Depok, a satellite city of Jakarta, Indonesia, and was designed as a case study involving 26 middle class families. The children were categorized as underweight, normal weight and obese, and caregivers were grouped as family and domestic paid caregivers. Twenty-six mothers and 18 caregivers were interviewed. Data were analysed by the constant comparative approach. The study identified five emerging themes, consisting of reason for working and not working, support for mother and caregivers, decision maker on child food, maternal self-confidence and access to resources. It confirmed that mothers and caregivers need support and adequate resources to perform child-care practices regardless of the child nutritional and maternal working status. Further research is required into how Indonesian mothers across a range of socio-economic strata can have increased options for quality child-care arrangements and support with child feeding. Additionally, this paper discussed the importance of enhanced dissemination of health information addressing both child underweight and obesity problems.

Background: Despite the rising double burden of malnutrition, adolescent nutrition has received little attention in Indonesia. Eating and physical activity behaviors established in adolescence are known to track into adulthood and may contribute to chronic diseases in later life. This study aimed to explore the eating behaviors and physical activity of Indonesian adolescents, and their influencing factors. Methods: The study, designed as a qualitative study, was conducted in 2 selected districts in Indonesia: Klaten and Lombok Barat. Data were collected through immersion, open and informal discussions, and participant observations with 302 adolescent girls and boys. Results: The eating and physical activity behaviors of adolescent boys and girls are influenced by contextual changes in their family lifestyles and environment. The adolescents in this study only conflate physical activity with participation in sport. Even when a wider view of physical activity is cast, their level of physical activity remains low, especially for adolescent girls. Adolescents and their families generally eat 3 meals a day, with schools an important source of food for adolescents. Adolescents skip breakfast at home, and breakfast and lunch are usually purchased and eaten at school. Fewer families cook and families rarely eat together due to increasingly busy lives, increased mobility, and digital connectivity. Conclusions: The rapid contextual shifts taking place in Indonesia influence the home, school, and peer environment to shape eating behaviors and physical activity among adolescent boys and girls. Gender-responsive multicomponent school-based interventions have the potential to serve as an important entry point for influencing adolescent nutrition.

Exclusive breastfeeding practice is generally low because of multifaceted factors internally within mothers themselves and also the surroundings. In addition, studies have consistently found that maternal employment outside the home is related to shorter duration of exclusive breastfeeding. With all these challenges, it is interesting that there are some mothers who manage to exclusively breastfeed their infants. Therefore, this report aims at exploring the characteristics of working mothers who are able to practice exclusive breastfeeding. The original study population was non-working and working mothers who have infants around 1 to 6 months old. The study design is an observational study with a mixed methods approach using a quantitative study (survey) and qualitative methods (in-depth interview) in sequential order. In addition, in-depth interviews with family members, midwives, supervisors at work, and community health workers were also included to accomplish a holistic picture of the situation. The study concludes that self-efficacy and confidence of the breastfeeding mothers characterize the practice of exclusive breastfeeding. Good knowledge that was acquired way before the mothers got pregnant suggests a predisposing factor to the current state of confidence. Home support from the father enhances the decision to sustain breastfeeding.