“A new nutrition reality”: WHO report proposes new approach for malnutrition double burden

17 Dec 2019 --- Rapid changes in low- and middle-income countries’ food systems are exacerbating the double burden of malnutrition. This twin presence of obesity and undernutrition is highlighted in a new four-paper report from the World Health Organization (WHO) and published in The Lancet. The experts are now calling for a new approach, with proposed actions ranging from improved antenatal care and breastfeeding practices to social welfare, and new agricultural and food system policies with healthy diets as their primary goal.

“We are facing a new nutrition reality. We can no longer characterize countries as low-income and undernourished, or high-income and only concerned with obesity. All forms of malnutrition have a common denominator – food systems that fail to provide all people with healthy, safe, affordable, and sustainable diets,” says Dr. Francesco Branca, lead author of the report and Director of the Department of Nutrition for Health and Development at WHO.

The report identifies a set of “double-duty actions” that simultaneously prevent or reduce the risk of nutritional deficiencies leading to underweight, wasting, stunting or micronutrient deficiencies, as well as obesity or other noncommunicable diseases (NCDs). These can all be addressed with the same intervention, program, or policy, as is the case with breastfeeding, social welfare and new policies prioritizing healthy diets.

“Both industry and policymakers have a role to play in creating and solving these issues. Policymakers have to set evidence-based policies that are free from conflict of interest to ensure access to healthy and sustainable diets for the population. Industry has a role in implementing these policies. We expect the food and beverage industry to reduce fat, sugar and salt in products, particularly the ones directed to children. In addition, industry can provide data, knowledge and other resources where appropriate,” Branca tells NutritionInsight.

Both industry and policymakers have a role to play in creating and solving these issues.A radical re-examining
Branca continues that changing the status quo will require action across food systems – from production and processing, through trade and distribution, pricing, marketing, and labeling, to consumption and waste. “All relevant policies and investments must be radically re-examined.”

Last week, Branca told NutritionInsight that a food system overhaul could also curb climbing rates of deadly noncommunicable diseases (NCDs), including hypertension, heart issues and many types of cancer.

WHO notes that there is some evidence that programs addressing undernutrition have unintentionally increased risks for obesity and diet-related NCDs in low-income and middle-income countries where food environments are changing rapidly. Therefore, these programs should be redesigned to do no harm. Existing undernutrition programs delivered through health services, social safety nets, educational settings, and agriculture and food systems present opportunities to address obesity and diet-related NCDs. 

To create the systemic changes needed to end malnutrition in all its forms, the authors call on governments, the UN, civil society, academics, the media, donors, the private sector and economic platforms to address the double burden of malnutrition and bring in new actors. These could include grass-roots organizations, farmers and their unions, faith-based leaders, advocates for planetary health, innovators and investors who are financing fair and green companies, city mayors and consumer associations.

“We have sent a communication package on this series to inform every WHO Representative of our 150 country offices. Our WHO representatives are our ‘feet on the ground’ helping our Member States to translate WHO’s guidance into country action and impact. We are also actively sharing the findings on social media. Regarding our normative and standard-setting work and tool development, we are ensuring that nutrition is addressed holistically,” explains Branca. 

A pervasive problem
Globally, estimates suggest that almost 2.3 billion children and adults are overweight and more than 150 million children are stunted. In low- and middle-income countries, however, these emerging issues overlap in individuals, families and communities. The researchers used survey data from these regions in the 1990s and 2010s to estimate which countries faced a double burden of malnutrition. This is defined as a population having more than 15 percent wasting, more than 30 percent stunting, over 20 percent of women having thinness and over 20 percent of people being overweight.The nutritional needs of populations are specific to each country and depends on various environments.

It was found that more than a third of low- and middle-income countries had overlapping forms of malnutrition, at a frequency of 45 of 123 countries in the 1990s and 48 of 126 countries in the 2010s. The problem was particularly common in sub-Saharan Africa, South Asia, and East Asia and the Pacific, where 29, seven and nine countries were affected, respectively. 

Additionally, 14 of the lowest income countries newly developed a malnutrition double burden between the 1990s and the 2010s. However, fewer low- and middle-income countries with the highest incomes, relative to others in that category, were affected. The authors say this reflects the increasing prevalence of people being overweight in the poorest countries, even as segments of the population still face stunting, wasting and thinness.

Branca explains that the nutritional needs of populations are specific to each country and depend on meteorological, geographical, economic and social environments. The type of food system delivering food is also a determinant. 

“Therefore, a situation analysis and nutrition-needs assessment have to be done in every country to ensure that an effective response can be delivered. This implies that a nutrition-needs assessment should be done for different population groups and socio-economic strata, as well as different population groups, including vulnerable populations, such as indigenous peoples,” he concludes. 

By Katherine Durrell