Understanding the Double Burden: What is a key nutritional issue in low middle-income countries?

October 27, 2025 •

3 min read

Nearly half of all low- and middle-income countries face the double burden of malnutrition, a critical challenge where undernutrition coexists with overweight or obesity. Understanding what is a key nutritional issue in low middle-income countries is vital for addressing this complex global health crisis and its devastating intergenerational effects.

Quick Summary

The dual problem of undernutrition and overnutrition, known as the double burden of malnutrition, is a primary nutritional issue facing low and middle-income countries, with major health and economic impacts.

Key Points

Double Burden of Malnutrition: Many LMICs face the dual crisis of both undernutrition (stunting, wasting) and overnutrition (obesity) simultaneously.
Micronutrient Deficiencies: 'Hidden hunger,' or deficiencies in vitamins and minerals like iron, vitamin A, and iodine, remains a critical problem, especially in South Asia and sub-Saharan Africa.
Undernutrition's Long-Term Impact: Chronic undernutrition, like stunting, can cause irreversible damage to a child's cognitive development and leads to reduced adult productivity.
Rising Overnutrition: Increased access to processed, high-calorie foods due to urbanization and changing food systems is driving rising rates of overweight and obesity in LMICs.
Intergenerational Cycle: Malnutrition can be passed from mother to child and can increase the risk of NCDs later in life, exacerbating health issues across generations.
Multifaceted Solutions: Effective strategies require comprehensive, multi-sectoral approaches combining nutrition education, food fortification, female empowerment, and improved access to health services.

The Double Burden of Malnutrition: A Modern Crisis

The most significant nutritional challenge facing low- and middle-income countries (LMICs) today is the double burden of malnutrition (DBM). This phenomenon is defined by the coexistence of both undernutrition and overnutrition within the same country, community, household, and even within the same individual across their lifetime. While undernutrition in its various forms (stunting, wasting, micronutrient deficiencies) has long plagued LMICs, the rapid rise of overweight and obesity presents a new, compounding threat to public health.

The dual nature of this crisis means that populations must battle nutritional deficiencies and diseases of overconsumption simultaneously. A child might be stunted due to poor nutrition in early life, predisposing them to obesity and non-communicable diseases (NCDs) later in adulthood, especially as they move into urbanized environments with access to energy-dense but nutrient-poor foods. This dynamic creates a complex and challenging landscape for policymakers and healthcare professionals.

The Lingering Threat of Undernutrition

Despite global progress, undernutrition remains a devastating and widespread problem in many LMICs, particularly affecting women and young children. Forms of undernutrition include:

Stunting: Chronic undernutrition affecting long-term growth and cognitive development. In 2022, 149 million children under 5 were stunted globally.
Wasting: Acute weight loss from food shortage or illness, increasing death risk. 45 million children under 5 suffered from wasting in 2022.
Micronutrient Deficiencies: Lack of essential vitamins and minerals ("hidden hunger") affecting billions, impairing immune function and development.

The Rise of Overnutrition and Associated Diseases

Simultaneously, LMICs are seeing a rapid increase in overweight and obesity, driven by factors linked to economic development and globalization. As incomes rise and urbanization accelerates, diets shift towards those high in meat, oils, sugars, and ultra-processed foods. This dietary change contributes to rising rates of non-communicable diseases (NCDs) like diabetes and cardiovascular disease.

Driving Factors Behind the Double Burden

Multiple interconnected factors contribute to DBM, including poverty, changing food systems with increased availability of processed foods, inadequate sanitation, lack of education, and disruptions from climate change and conflict.

The Vicious Cycle and its Consequences

The DBM creates a cycle of health problems and hinders development. Childhood undernutrition leads to productivity losses, and treating NCDs linked to overnutrition burdens healthcare systems. Poor nutrition in women impacts maternal and infant health.

Comparison: Undernutrition vs. Overnutrition in LMICs


Aspect	Undernutrition (e.g., Stunting, Wasting)	Overnutrition (Overweight, Obesity)
Primary Cause	Inadequate food intake, poor sanitation, infectious diseases.	Excessive intake of energy-dense, nutrient-poor foods; reduced physical activity.
Common Prevalence	Highest in impoverished rural and conflict-affected areas.	Accelerating rapidly in urban areas, linked to rising incomes.
Population Affected	Primarily children under 5, and women of reproductive age.	Increasing among women, children, and adults across all age groups.
Long-Term Health Effects	Impaired cognitive development, reduced productivity, weakened immune system.	Increased risk of NCDs like diabetes, heart disease, and some cancers.
Economic Impact	Billions in lost economic productivity from cognitive and physical impairments.	Significant healthcare costs from treating NCDs.

Strategic Interventions for Change

Addressing DBM requires integrated, dual-purpose actions including improved nutrition education, food fortification, empowering women, sustainable food systems, behavioral change, social safety nets, and strengthening health systems. More strategies are available, such as those outlined by {Link: World Food Programme https://www.wfpusa.org/news/how-to-end-world-hunger-6-zero-hunger-solutions/}.

Conclusion

The double burden of malnutrition is a defining nutritional issue in low middle-income countries. A comprehensive approach addressing both under- and overnutrition is vital for improving global health and development. Tackling root causes and implementing integrated interventions is necessary for a healthier future.

Frequently Asked Questions

The primary nutritional problem is the double burden of malnutrition, where undernutrition (e.g., stunting, wasting, micronutrient deficiencies) coexists with overnutrition (overweight and obesity).

Micronutrient deficiencies persist due to poor-quality, monotonous diets that lack essential vitamins and minerals, inadequate sanitation leading to illness, and a lack of proper healthcare access.

Childhood undernutrition can lead to impaired physical and cognitive development, and increases the risk of obesity and diet-related non-communicable diseases (NCDs) in adulthood.

The increase is driven by factors like rising incomes, urbanization, and a shift towards more affordable but less nutritious, energy-dense processed and packaged foods.

Effective interventions include multi-sectoral programs focusing on nutrition education, food fortification, improving water and sanitation, empowering women, and implementing sustainable agricultural practices.

Poverty is a significant driver, limiting access to healthy, nutritious foods and pushing families towards cheaper, energy-dense options while also increasing vulnerability to undernutrition.

Women and children are disproportionately affected due to physiological needs, social inequities, limited access to resources, and poor maternal health which affects outcomes for both mother and child.