Rafael Perez-Escamilla, professor of public health argues that future strategies to tackle stunting and micro nutrient deficiencies must consider the socioeconomic factors rooted in these diseases.
“These two double burden of malnutrition components (stunting and overweight) have common elements rooted in the social determinants of health (SDoH),” he explained.
“For example, household food insecurity, a condition related to poverty that limits access to a nutritious and safe diet, has been consistently associated with both undernutrition in children and overweight in women.
“The first 1000 days of life offer a window of opportunity to prevent both stunting and obesity, and are a worthwhile focus for strategies to tackle nutrition disparities.”
Nutrition science and politics
In the analysis piece published in the BMJ, professor Perez-Escamilla and his team present evidence that highlights common drivers of the food and nutritional components of the double burden of malnutrition (DBM), and the obesity epidemic in high-income countries.
These include environmental and socioeconomic influences such as the ability to access nutritious foods and adopt healthier nutrition habits and behaviours.
Other drivers include inter-generational transmission of both stunting and obesity from parents to their children is often observed in socially and economically disadvantaged households.
The team also identified a lack of shared multi-sectoral delivery platforms that can act as a catalyst for reducing health and social inequities within populations and raising educational attainment.
The researchers, which include those from Tufts and Drexel University in Philadelphia, reach conclusions that are in line with the “double duty actions” proposed by World Health Organisation (WHO).
These actions call for initiatives that reduce the risk or burden of under-nutrition and overweight through a number of recommended actions.
One action wanted to see interventions, policies, and programmes designed to tackle one form of malnutrition do not inadvertently increase the risk of another
Examples cited include sugar fortification with micro nutrients, or agricultural policies that foster the consumption of energy dense foods and sugar sweetened beverages.
Other actions include leveraging existing initiatives designed to tackle one type of malnutrition to simultaneously reduce other types, especially maternal-child nutrition programmes during the first 1000 days.
The research team also wanted to see the identification of shared upstream nutrition sensitive drivers between different forms of malnutrition (such as food systems).
UN’s Decade of Action
“Tackling the double burden of malnutrition through double duty equitable actions will be of critical importance in achieving both the ambitions of the UN’s Decade of Action on Nutrition and the Sustainable Development Goals,” the analysis commented.
“Implementation science research based on complex systems frameworks is needed for understanding how to scale up cost effective, multisectoral interventions that can simultaneously tackle stunting, overweight, and micronutrient deficiencies.”
Source: British Medical Journal (BMJ)
Published online ahead of print: doi.org/10.1136/bmj.k2252
“Nutrition disparities and the global burden of malnutrition.”
Authors: Perez-Escamilla et al.