Actions Targeting the Double Burden of Malnutrition: A Scoping Review

Abstract

Background: In many developing countries, nutritional and epidemiological transitions are contributing to continuous undernutrition and escalating overnutrition, resulting in coexisting forms of malnutrition often referred as the “double burden of malnutrition” (DBM). This complex phenomenon constitutes an unprecedented challenge to global public health and has been prioritized by international health organizations, prompting governments to swift action. Specifically, five years ago the World Health Organization (WHO) proposed a roadmap to tackle the DBM though so-called “double-duty actions”. The objective of this review was to synthesize the literature on interventions which address the DBM. Methods: We developed a scoping review to identify interventions addressing the DBM. We searched PUBMED for papers reporting interventions until December 2019. Articles examining interventions, government policies, or tools at the individual, household, or community level to address the DBM were included. Results: Seven articles met the inclusion criteria. Three were from sub-Saharan Africa, one was from Southeast Asia, and one was from Central America. Two were modelling studies, with one covering 24 low-income countries and the other focusing on Ghana. Conclusion: Notwithstanding the pressing issue of the DBM, there is a paucity of studies examining double-duty actions despite the attention that it has garnered within the global nutrition community. Whilst nutrient deficiencies may be curbed by poverty reduction measures, for obesity prevention nutrition, education and promotion of physical activity, along with the encouragement of local food production, may be instrumental.

Prevalence and correlates of overweight and obesity among primary school children in Kilimanjaro, Tanzania

“…These findings indicate the existence of the two forms of malnutrition (under nutrition and over nutrition) in Tanzanian primary school children and highlight the importance of considering both forms of malnutrition in future studies. The prevalence of thinness and overweight/obesity observed, were similar to what has been reported recently in a scoping review [26].…”

Social Stratification, Diet Diversity and Malnutrition among Preschoolers: A Survey of Addis Ababa, Ethiopia

“…There are country-specific thresholds signifying the number of years of schooling needed for a significant reduction in child malnutrition [66]; accordingly, Ethiopia also needs to develop a contextual threshold level because primary education alone may not be enough to make the needed nutritional impact. Behavioral interventions and health promotion initiatives tailored to the mother's level of understanding could be one opportunity, however, there is limited evidence on its implementation and success in tackling under-and over-nutrition simultaneously [67].…”

A Simulator to Determine the Evolution of Disparities in Food Consumption between Socio-Economic Groups: A Brazilian Case Study

“…However, five years after the failed attempt to relaunch the FNS, not only is it necessary to deal with the food access by the most vulnerable due to the latest economic declines [1] but also to deal with excess consumption, the so-called "double burden of malnutrition", where undernutrition and obesity co-exist [6,23]. The "double burden" brings serious macro effects on health [36,60,63], the economy [24,86], and the environment [87][88][89]. Therefore, beside the measures existing in the FNS, it is also important to tackle other contextual inequalities shown that this study has shown has a direct influence on food security, including gender disparities, income inequality, education, and regional differences.…”