Malnutrition is presenting a “double burden” as nations struggle to address both undernourishment and obesity simultaneously, according to a report published in The Lancet on Dec. 15.

This double burden of malnutrition is most pronounced in lower- and middle-income countries, with up to a third of these nations struggling with this dual burden.

Data analysis revealed that, in the 1990s, the percentage of lower- and middle-income nations facing the double burden ranged from as high as 37% to as low as 12% (depending on the cutoff used for stunting, wasting and obesity).

In the 2010s, the range was largely unchanged at 38% to 8%.

A report published in mid-October by the U.N. Children’s Fund (UNICEF) revealed that one third of the world’s children suffer from some form of malnutrition: stunting (significantly below average height), wasting (significantly below average weight) and being overweight or obese (above the normal range on the body mass index).

The UNICEF report noted that a combination of “food deserts” (places without healthy food choices) and “food swamps” (locations with mostly unhealthy food options) are key factors driving what The Lancet report is calling the double burden of malnutrition.

Within the more than 120 lower- and middle-income countries analyzed for The Lancet report, there was an overall decrease in the severest expressions of the dual burden – mostly due to declines in stunting and wasting.

Notable disparities remain, however, as the wealthiest lower- and middle-income nations saw an overall decrease in the double burden, while the poorest saw an overall increase.

The patterns are not universal or clear-cut, though, as divergent trends across regions were found.

Certain areas, including Latin America and central Asia, have seen an increase in obesity among lower-income households, while in other areas, including sub-Saharan Africa and South Asia, the higher-income households have seen such increases.

Increased consumption of highly processed foods and lifestyle changes related to the influx of modern technology in both the workplace and the home were cited as key drivers of the increase in overweight and obese individuals, even as stunting and wasting declined.

“We can no longer characterize countries as low-income and undernourished, or high-income and only concerned with obesity,” said Francesco Branca, the World Health Organization’s director of the department of nutrition for health and development, in a press release announcing the report’s publication. “All forms of malnutrition have a common denominator – food systems that fail to provide all people with healthy, safe, affordable and sustainable diets.”

The full report is available here.

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