The double burden of malnutrition
This four paper series of the Lancet explores how the coexistence of overnutrition (overweight and obesity) and undernutrition (stunting and wasting) is affecting low- and middle-income countries (LMIC). Malnutrition in its many forms has previously been understood and approached as a separate public health issue, but the new emergent reality is that undernutrition and overnutrition are interconnected, referred to as double burden of malnutrition (DBM). Therefore, double-duty actions that simultaneously address more than one dimension must be implemented for policy solutions to be effective.The first paper shows that the DBM has increased in the poorest LMICs, mainly due to overweight and obesity increases, because of of very rapid changes in the food system, particularly the availability of cheap ultra-processed food and beverages in LMICs, and major reductions in physical activity. The second paper discusses the aetiological pathways and health consequences of the DMB, including the fact that life-course exposure to early undernutrition followed by later overweight increases the risk of non-communicable disease, by imposing a high metabolic load on a depleted capacity for homoeostasis, and in women increases the risk of childbirth complications. The third paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and diet-related non-communicable diseases (DR-NCD). The paper finds that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. The fourth paper discussed the translation of health effects of DBM into economic costs for individuals and economies in the form of lost wages and productivity, as well as higher medical expenses. Double-duty interventions, including stunting and overweigt, could save money and be more efficient than single-duty interventions.