Addressing the double burden of malnutrition in Bangladesh: Evidence from National Policy Documents and gaps in policy integration.

BackgroundThe Caribbean faces a growing nutrition crisis marked by the double burden of malnutrition — the simultaneous presence of childhood undernutrition and rising obesity. Despite policy progress, malnutrition persists across socioeconomic lines, threatening long-term public health and development outcomes.ObjectiveThis narrative review explores the epidemiological trends, biochemical consequences, social determinants, and policy responses to childhood malnutrition in the Caribbean. It highlights barriers and opportunities for public health action, with a focus on equity and sustainability.MethodsThis narrative review was informed by a structured bibliographic search conducted between January and June 2025. Sources were identified through PubMed, Scopus, Web of Science, and Google Scholar using combinations of terms such as 'childhood malnutrition', 'double burden’, ‘nutrition policy', 'obesity', 'stunting', 'food security', and 'micronutrient deficiencies', each linked to 'Caribbean'. Grey literature was obtained from Food and Agriculture Organization of the United Nations (FAO), the Pan American Health Organization (PAHO), the Caribbean Public Health Agency (CARPHA), the Healthy Caribbean Coalition (HCC), and the Caribbean Food and Nutrition Institute (CFNI).ResultsUndernutrition remains significant in low-income populations, with stunting and micronutrient deficiencies such as anaemia persisting across several countries. Simultaneously, childhood overweight and obesity are increasing rapidly, especially in urban settings. Biochemical evidence reveals an early onset of metabolic dysfunction and hidden hunger (micronutrient deficiencies), both of which contribute to a higher burden of non-communicable diseases (NCDs). Structural drivers include poverty, food insecurity, and ultra-processed diets. Weak health systems exacerbate disparities. While national policies such as sugar-sweetened beverage (SSB) taxes, food fortification, and school-based nutrition programmes show promise, their implementation is often fragmented and under-resourced.ConclusionsAddressing the double burden of childhood malnutrition in the Caribbean will require multisectoral convergence, stronger data systems, targeted fiscal policies, and equity-driven interventions. Regional collaboration and investment in locally led research will be critical to designing sustainable solutions. The urgency of this crisis demands bold, coordinated action to protect the nutritional well-being of the Caribbean’s next generation.

At a Crossroads: Ada and Public Policy

Prevalence and Correlates of Double and Triple Burden of Malnutrition Among Children and Adolescents in India: The Comprehensive National Nutrition Survey

Food is one of the determinants and conditions of health and an inherent right of all people. The consequences of food and nutrition insecurity in the population, such as obesity, malnutrition and specific nutritional deficiencies, impact the health sector and have historically meant that it has assumed the responsibility for food and nutrition programs and policies in Brazil. However, ensuring food and nutrition security requires a combination of public policies, among which the National Food and Nutrition Policy of the Unified Health System (SUS) plays a fundamental role. This paper seeks to contribute to the debate on intersectoriality and health promotion based on presenting the National Food and Nutrition Policy and discussing its role as interface between the SUS and the National Food and Nutrition Security Policy and System. This perspective strongly suggests the combination of efforts to promote health and food and nutrition security in order to optimize initiatives developed in different sectors and accompanied by different policy councils that are not interrelated, enabling enhanced government and civil society action on the determinants of health and nutrition.

Understanding the process of establishing a food and nutrition policy: the case of Slovenia

Key Stakeholder Perceptions of Impact and Feasibility of National, State, and Local Nutrition Policies for Cancer Prevention in the United States (P22-019-19)

Background/objectivesLittle is known about the separate or combined effects of state and national nutrition policies regulating food and beverages in schools on child overweight/obesity (OV/OB) and related racial/ethnic disparities. We investigated the influence of school nutrition policies enacted in California, independently and in combination with the United States’ national policy “Healthy Hunger Free Kids Act” (HHFKA) on childhood OV/OB and racial/ethnic disparities.Subjects/methodsAn interrupted time series design was used with data from 12,363,089 child-level records on 5th- and 7th-graders in California public schools to estimate sex- and racial/ethnic-specific time trends in OV/OB prevalence during three periods: before the California nutrition policies (2002–2004); when only California policies were in effect (2005–2012); and when they were in effect simultaneously with HHFKA (2013–2016).ResultsBefore the state’s policies, OV/OB prevalence increased annually among children in most subgroups. Improvements in OV/OB trends were observed for almost all groups after the California policies were in effect, with further improvements after the addition of HFFKA. The total change in annual log-odds of OV/OB, comparing the periods with both state and federal policies versus no policies, ranged from −0.08 to −0.01 and varied by grade, sex, and race/ethnicity. Within each sex and grade, the greatest changes were among African-American (−0.08 to −0.02, all p < 0.05) followed by Latino children (−0.06 to −0.01, all p < 0.05). Although disparities narrowed among these groups versus White children after the dual policy period, disparities remained large.ConclusionsState and national nutrition policies for schools may have contributed to containing the upward trend in childhood OV/OB and racial/ethnic OV/OB disparities within California. However, sizable OV/OB prevalence and disparities persist. To end the epidemic, promote healthy weight and increase health equity, future efforts should strengthen state and national policies to improve food quality in schools, particularly those serving populations with the highest OV/OB prevalence.

BackgroundDouble burden of malnutrition is a global problem posing a serious public health challenge especially in low- and middle-income countries including Ethiopia, where a high prevalence of under-nutrition continues to exist and overweight is increasing at an alarming rate. Although both under-nutrition and over-nutrition are investigated extensively in Ethiopia, evidence about the double burden of malnutrition especially at the individual level is very limited.ObjectiveTo assess the prevalence of the co-existence of overweight/obesity and stunting and associated factors among under-five children in Addis Ababa, Ethiopia at an individual level.MethodsInstitution-based cross-sectional study was conducted from May to June 2021 among 422 mothers to child pairs in Addis Ababa. Twenty-nine (30%) of the health centers in Addis Ababa were selected to take part in the study using a simple random sampling technique. The total sample size was allocated proportionally to each of the selected health centers based on their performances within 6 months prior to the study. A systematic random sampling method was used to select the study participants. An interviewer-administered structured questionnaire was used to collect data. Descriptive statistics and a hierarchical logistic regression model were used to characterize the study population and to identify factors that are associated with the outcome variable respectively. Odds ratio along with 95% CI were estimated to measure the strength of the association. The level of statistical significance was declared at a p-value less than 0.05.ResultsThe prevalence of the co-existence of overweight/obesity and stunting was 5.1% with 95% CI (2.9–7.1%). The hierarchical logistic regression analysis revealed that child age (6–23 months) [(AOR = 2.86, 95% CI: (1.02–8.04)], maternal education status (non-educated) [(AOR = 4.98, 95% CI: (1.33–18.66)], maternal age during birth (≥ 28 years) [(AOR = 0.22, 95% CI: (0.06–0.79)] and childbirth order (3+) [(AOR = 6.38, 95% CI: (1.03–39.7)] were significantly associated with the co-existence of overweight /obesity and stunting. Conclusion and recommendations: The study revealed that the prevalence of the co-existence of overweight/obesity and stunting is low in Ethiopia. However, local and national nutrition policies and programs should be tailored and implemented to simultaneously address both under-nutrition and over-nutrition.

The Co-Occurrence of Overweight and Micronutrient Deficiencies or Anemia among Women of Reproductive Age in Malawi

Window of opportunity – positioning food and nutrition policy within a sustainability agenda

Extending the Value of Membership: ADA Foundation and Political Action Committee

Background: There is a high prevalence of the double burden of malnutrition (DBM) in children and adolescents in South Asia. This research aims to explore which sociodemographic factors are attributed to DBM in urban Bangladesh, a South Asian country. Methods: We conducted secondary analyses of data obtained from the national survey of childhood obesity among school-age children in Bangladesh (2012–2013). The sample includes 4140 children (aged 5–9 years) and adolescents (10–19 years) randomly recruited from the city corporation (urban) areas in all administrative divisions. At the population level, DBM was defined as the coexistence of underweight and overweight/obesity among children and adolescents. At the household level, DBM was defined as maternal underweight co-occurring with child overweight/obesity within the same mother-child dyad. A multivariable logistic regression model was fitted to estimate odds ratios and 95% confidence intervals. A rapid policy review was conducted to understand the implication of the results obtained from the analysis. Results: The prevalence of DBM at the population level was 45.2% (95% CI: 42.5–45.5%), ranging between 40.0% and 47.6% across seven divisions (p < 0.001). At the household level, DBM prevalence was 16.6% (95% CI: 14.7–18.7%), ranging between 14.0% and 19.0% across seven divisions (p = 0.015). At the population level, DBM odds were 56% higher among younger children (5–9 years) than adolescents (10–19 years) (OR: 1.56; 95% CI: 1.37–1.78), and this association was found in four divisions. At the household level (mother-child pairs), DBM odds were 64% higher in younger children than adolescents (OR: 1.64; 95% CI:1.38–1.95); and higher in children living at a lower-middle socioeconomic status (SES) and middle SES, than upper SES. The policy review revealed that Bangladesh has made substantial commitments to improve nutrition; however, reference to DBM is absent from policy documents. Conclusions: The prevalence of DBM is high among children in urban areas in Bangladesh, disproportionately affecting younger children and households with low SES. In the current policy space, Bangladesh should revise national nutrition frameworks to recognize DBM as a public health priority and implement region-sensitive strategies for preventing and reducing malnutrition among school-aged children.

Background: Ultraprocessed products (UPPs) have been associated with unfavorable health outcomes; however, until now, they have not been associated with the coexistence of undernutrition and overnutrition, known as the double burden of malnutrition (DBM) at the individual level. Methods: Cross-sectional analyses were performed on data collected from children and adolescents participating in the 2006 and 2016 Mexican National Health and Nutrition Surveys. The food and beverages reported in the food frequency questionnaire (SFFQ) were classified as UPPs as defined by the NOVA classification system. Associations of UPPs with anemia, excess weight, and the DBM were estimated with logistic regression models. A pseudo-panel was generated using the cohorts of children born from 1997 to 2001 to estimate the effect of the UPPs on anemia, excess weight, and the DBM. Results: The consumption of UPPs (% energy) was higher in 2016 (children 30.1% and adolescents 28.3%) than in 2006 (children 27.3% and adolescents 23.0%) in both age-groups. The higher contribution of UPPs was positively associated with excess weight and the DBM in children’s lower tertile of socioeconomic status (SES) and the DBM in higher tertile of SES in adolescents. The pseudo-panel analysis shows the positive association between UPPs and DBM in lower SES. Conclusions: These results provide evidence of the association between the consumption of UPPs and the DBM and excess weight in children and adolescents.

The evolution of nutrition patterns in Zambia has resulted in the coexistence of undernutrition and overnutrition in the same population, the double burden of malnutrition. While Zambia has strong policies addressing undernutrition and stunting, these do not adequately address food environment drivers of the double burden of malnutrition and the adolescent age group, hence the need for nutrition policy reforms. We conducted a theory-based qualitative prospective policy analysis involving in-depth interviews with nutrition policy stakeholders and policy documents review to examine the feasibility of introducing nutrition policy options that address the double burden of malnutrition among adolescents to identify barriers and facilitators to such policy reforms. Using the multiple streams theory, we categorized the barriers and facilitators to prospective policy reforms into those related to the problem, policy solutions, and politics stream. Using a life course approach in nutrition programming could facilitate policy reforms as adolescence is one of the critical invention points in a person's lifecycle. Another key facilitator of policy reform was the availability of institutional infrastructure that could be leveraged to deliver adolescent-focused policies. However, the lack of evidence on the burden and long-term impacts of adolescent nutrition problems, the food industry's strong influence over governments' policy agenda setting, and the lack of public awareness to demand better nutrition were perceived as critical barriers to policy reforms. In addition, the use of the individual responsibility framing for nutrition problems was dominant among stakeholders. As a result, stakeholders did not perceive legislative nutrition policy options that effectively address food environment drivers of the double burden of malnutrition to be feasible for the Zambian context. Policy entrepreneurs are required to broker policy reforms that will get legislative policy options on the government's agenda as they can help raise public support and re-engineer the framing of nutrition problems and their solutions in Zambia.

The double burden of malnutrition (DBM) is described as the co-existence of undernutrition and overweight or diet-related non-communicable diseases within a country, community or an individual (WHO). It is a major global issue, affecting approximately half of the worlds’ population. International organizations have published policy reports to function as guidelines for national implementation to tackle the double burden of malnutrition. The goal of this study is to analyze the advancement of the implementation of these recommendations in a number of middle-income countries.Reports and recommendations on policies against DBM from 10 leading international organizations are analyzed and compared on several aspects, such as proposed measures, stakeholder involvement and target population. These organizations are UN, FAO, WHO, EAT forum, GAIN, World Food Program, World Bank, UNICEF, IFPRI and Global Panel on Agriculture and food systems for Nutrition. The level of implementation of the described policies is studied for Nigeria, Zambia and Indonesia by means of desk research and stakeholder interviews. These (semi-structured) interviews are based on the encountered information gaps within the desk research. Stakeholders were selected from a variety of organizations, such as government, NGO's, consumer organizations, science and industry in order to be able to examine the subject from different angles.The study is still ongoing at the time of abstract submission. The (preliminary) results and conclusions will be presented and they are expected to describe per country which nutrition policies against DBM are initiated or implemented. Major learnings and best practices of these implementations will be reported and major differences and similarities between implementations in Nigeria, Zambia and Indonesia will be described and compared with the policy guidelines from the leading health organizations. These results may be used as learning when policies against DBM are newly implemented in other middle-income countries or to improve existing policies.