Chapter 37 - The Underweight/Overweight Paradox in Developing Societies: Causes and Policy Implications

Abstract

In nearly half of all developing countries, underweight and overweight are equally relevant public health problems. For many years, underweight and overweight (which here refers to overweight and obesity) have coexisted in developing countries, reflecting the social and economic disparity in the population. Today, the underweight/overweight paradox goes beyond this: it concerns the growing number of developing countries where underweight and overweight have become common in low socio-economic status (SES) groups. In many countries where underweight and overweight coexist, the prevalence of overweight is in fact higher in low SES groups than in high SES groups, at least among women. In the remaining developing countries (mainly low-income economies), underweight is still the risk factor that contributes most to the total burden of disease; overweight ranks only seventeenth. Yet even in many of these countries, overweight is still more prevalent in higher SES groups than in lower ones. Since economic growth in developing countries is positively associated with both the overall prevalence of overweight and the shifting of overweight onto the poor, the situation in these countries may change in the near future. In this context, this chapter addresses two key issues: (1) the reasons underlying the underweight/overweight “paradox” among low SES groups, and (2) the public policies needed to confront this new phenomenon.