Affecting many low and middle-income countries, the double burden of malnutrition describes the prevalence of both under nutrition and over nutrition in the same place at the same time. It can have a devastating impact on individuals and economies. Obesity is on the rise in Indonesia, revealed one of the largest studies of the double burden of malnutrition in children.
The existence of this growing health problem in Indonesia is confirmed by researchers led by a PhD candidate from the University of Sydney in a paper published in PLOS ONE. Their study is the first of its kind in Asia and has global implications.
Researchers drew on a sample of children from the Indonesian Family Life Survey to examine risk factors for stunting (a sign of chronic under nutrition, which affects height and brain development), being underweight and obesity.
Stunted or underweight children tended to have a lower birth weight, an underweight or short parent, and a mother who never received formal education. The likelihood of being stunted was also higher among children in rural areas.
Meanwhile, children were more likely to be overweight or obese if they were in the youngest age group studied (two to 2.9 years), were male, had overweight or obese parents, and had fathers with high formal education.
In a paper published in Public Health Nutrition in April 2016, the authors looked at the children who were both stunted and overweight. Stunted children were significantly more likely to be overweight than children of a healthy height.
The research revealed inconsistent trends in the prevalence of being stunted and overweight, but associated risk factors were being young, being weaned after the age of six months, having short mothers or living in rural areas.
Lead author Cut Novianti Rachmi, an Indonesian physician and a PhD candidate in the Discipline of Child and Adolescent Health at The Children's Hospital at Westmead Clinical School, said, "The double burden of malnutrition is complex and wide reaching.
"It can occur in the same country, city or household - and also within the same individual, either at the same time, or during different stages of a person's life," she explained. "It's concerning that stunted children are also most at risk of being overweight or obese. There are serious potential consequences for their future health - as well as the broader financial and societal costs of managing the predicted associated rise in non-communicable diseases."
"While a variety of factors could account for the rising levels of obesity in Indonesia - including increased national wealth and availability of processed foods - more research is required to understand the causes," Dr Rachmi said.
Other co-authors, Professor Louise Baur, Professor Mu Li and Dr Kingsley Agho, called for an overhaul of policy related to these areas. "There are major, global policy implications for our findings - and an urgent need to modify current interventions and strategies to fit this condition," they said. "We won't adequately tackle the double burden of malnutrition unless under and over nutrition are dealt with as part of the same problem."