Double Burden: Stunted Kids More Likely to Be Obese

May 13, 2016

Research illustrating the "double burden" of malnutrition has been published, showing that stunted children are more likely to be at risk of overweight and obesity than children of normal height.

The work was conducted in Indonesia, a rapidly developing economy and the world's fourth most populous nation.

The results can also likely be extrapolated to many other countries in Asia and other parts of the world, researchers told Medscape Medical News when the findings were reported last year at the European Congress on Obesity.

At that meeting, Tim Lobstein, PhD, director of policy at the World Obesity Federation, London, United Kingdom, said: "This is probably the most important paper presented this week in terms of how many children are affected by the problems described. We sit in Europe and twiddle around with a few patients in clinics when you've got these millions and millions of children who are going to be doubly burdened and at very high risk of chronic disease in quite early adulthood."

Emerging Economies Face Explosion in Obesity

Many low- and middle-income emerging-economy countries are undergoing what is known as "nutrition transition." As these nations undergo rapid development and people get wealthier, they stop having to perform as many chores, they get cars, they sit more, and they have access to different kinds of food, including Western convenience foods.

All of this has led to an explosion in obesity in these countries, as evidenced just last week in a report on the extent of this problem in rural China.

One of the key messages from this research for healthcare personnel is that interventions to treat undernutrition in very young children must emphasize improvements in linear growth rather than gaining weight alone, experts have stressed.

So stunting (a sign of chronic undernutrition, which affects height and brain development) must be combated while controlling for excess body weight

Double Burden of Malnutrition "Complex and Far-Reaching"

In their newly published work, the researchers — led by Cut Novianti Rachmi, MD, an Indonesian general practitioner who led the research as part of her PhD thesis at the University of Sydney, Australia — drew on a sample of children from the Indonesian Family Life Survey to examine risk factors for stunting, being underweight, and obesity.

The research is published in PLoS One this week, along with another paper published in Public Health Nutrition last month, and is the first study of its kind in Asia.

The results indicate that the double burden of malnutrition occurs in Indonesia, albeit with some inconsistent trends in the prevalence of being stunted and overweight. Associated risk factors were being young, being weaned after the age of 6 months, having short mothers, or living in rural areas.

"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," Dr Rachmi explains in a University of Sydney press statement.

"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 noncommunicable diseases," she adds.

"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," she concludes.

The authors have declared no relevant financial relationships .

Follow Lisa Nainggolan on twitter: @lnainggolan1. For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

PLoS One. Published online May 11, 2016. Article
Public Health Nutr. Published online April 28, 2016. Abstract


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