Malnutrition is the leading cause of death and illness worldwide making it a major concern in global health today. Malnutrition can include both undernutrition and overnutrition, with a dual burden imposed on most countries. This dual burden makes it difficult to find effective interventions that target both conditions.
The central cause of malnutrition can be attributed to food insecurity, which is the lack of reliable and sufficient access to nutritional food. Access to food is influenced by multiple political and economic factors and is directly dependent on the capability of production, distribution, and consumption within a community. Though the causes of food insecurity are controlled by the market and sociopolitical influences, it has severe downstream medical effects which affect generations of at-risk communities and feed into an insurmountable loop of poverty and disease. Alongside these pathophysiological manifestations of food insecurity, there is also a detrimental effect on the mental health of the at-risk populations.
In low-to-middle income countries like India, there is a dual burden of malnutrition stratified by socioeconomic status. Both undernutrition and overnutrition amplify the effects of malnutrition in India, especially in communities living under the poverty threshold. According to the 2020 Food and Agriculture Organization report, 189.2 million people in India are malnourished. Children, especially below the age of 5, are heavily affected by this gap in resources during critical growth periods which ultimately exacerbates future chronic illnesses and infection. Undernutrition is caused by the inadequate intake and quality of food, which results in stunted growth and wasting, which is severe weight loss and weakness. Wasting and stunting can lead to a higher risk of infection and disease, both at a young age and later in life. This in turn lowers the quality of life and entrenches people who live in poverty, creating a vicious cycle that is difficult to break.
On the other hand, overnutrition deals with energy imbalance and overconsumption of high caloric food. Though there is an adequate intake of calories, this dietary routine may lack the necessary nutrition. A high caloric intake predisposes the population to chronic non-communicable conditions such as obesity, diabetes, and cardiovascular illnesses. These chronic illnesses cause long-term strain on livelihood due to associated medical costs and secondary limitations in upkeeping standard of living. Similar to undernutrition, overnutrition also increases the risk of infection and disease as well due to the deficiency of vital nutrients.
The immediate causes of this dual burden are an inadequate diet and subsequent risk of diseases. While these factors are intuitively apparent, alleviating this health challenge requires addressing structural factors. Food insecurity, poverty, and inadequate health services perpetuate malnutrition. For example, a family living under the poverty line has limited access to food and cannot afford enough food to meet the nutritional needs of each individual thus resulting in undernutrition. While a low socioeconomic status results in undernutrition, overnutrition can also occur for people in low-middle income families. Nutritious food is often less available and affordable than the lowest-cost food options which are full of added fats, sugar, and highly processed. Street food, for example, is a very affordable option to feed an entire family — but at the expense of nutritional value. There is a great divide between the resources available at different levels of socioeconomic statuses and a policy level change is required to curb this dual burden.
The importance of addressing this dual burden has been greatly highlighted by the ongoing pandemic. COVID-19 has disproportionately impacted communities that were already facing this dual burden. Individuals with lowered immunity due to undernutrition are at higher risk of contracting COVID-19, while those with chronic illnesses like obesity due to overnutrition are at higher risk of facing worse health outcomes after being infected with COVID-19.
Finding a solution for malnutrition is a difficult task due to the coexistence of both undernutrition and overnutrition. Understanding the demographic distribution of this dual burden at local and regional levels is necessary to develop more effective interventions. Public health programs are spearheading interventions that include educating at-risk populations and addressing policies that dismantle barriers related to food access. For example, programs that promote the importance of breastfeeding and improving women’s nutritional status at the reproductive age target both undernutrition in these populations and also reduce the obesity burden by preserving the infant’s health during critical periods of development. Governments and non-governmental organizations (NGO’s) also need to play an active role in making policy-level changes that increase accessibility to nutritional foods and monitor food markets. While there is no one size fits all approach to this nutrition paradox, educating yourself about these disparities and demanding necessary changes may help in paving the way for a world where food security is attainable.
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