The double burden of malnutrition can be explained as the coexistence of under-nutrition conditions in addition to overweight, obesity and even other diet related non-communicable disorders. This might prevail within individuals as well as households and populations through the entire life-span. Researchers are of the opinion that under-nutrition in both acute and chronic forms include wasting and stunting and are found to be strongly inversely correlated with the wealth of the nations (Tzioumis et al., 2015). Many of the low as well as the middle income countries have become successful in achieving economic advancement and passed the nutrition transition phase and so their rates of under-nutrition had declines to some extent (Tzioumis et al., 2015). However, this transition had resulted in new problems of increasing number of obese and overweight people in the nations. This assignment would first discuss the epidemiology and aetiology of the double burden of malnutrition and how it had impacted the Asian country of India. It would also discuss the interventions that could be taken to help India and similar nations to overcome the crisis period successfully.
The double burden of malnutrition has affected nearly the entire world emerging out as the global burden on the planet and it is important to understand the statistics and epidemiology. About 1.9 billion adults all over the planet comprising of 18 years and above are found to be overweight. About greater than 600 million people are found to suffer from obesity with 41 million children under the age of 5 years are overweight or obesity. Again, on the other hand about 462 million people in the world mainly adults are found to be underweight (Vaezghasemi et al., 2014). Analysis of the statistical report has shown that about 52 million people in the world are found to be wasted meaning that they are too thin in comparison to their weight. About 155 million people are found to be stunted meaning that they are too short for the age. It has been also found that about 264 million women of the reproductive age are affected by iron-amenable anaemia. Therefore, from the statistical analysis, it can be clearly depicted that both obesity and under-nutrition go hand in hand creating a double burden of disorders in every affected nation of the world.
The issue of the double burden of disorder mainly occurs at three important levels. Therefore, in order to develop effective strategies for the mitigation of the issues, it is very important to understand the aetiology of the global burden of double burden of malnutrition. Firstly, the double burden of malnutrition can occur at the individual level. Researchers have found out that this can occur due to the simultaneous form of development of any of the two or more various of the types of malnutrition. They have found examples where individuals have been seen to exhibit obesity symptoms along with nutritional anaemia or any nutritional insufficiencies of deficiencies. Studies are also of the opinion that it can occur through different phases of the life-span and can undergo temporary separation. This might occur due to the contrasting nutrition environments (Tzioumis & Adair., 2014). It might result from the shifting of the economic as well as the other circumstances like being overweight as an adult when the individual was previously stunted due to chronic disorders across the various phases of the time of childhood.
Secondly, the double burden of malnutrition can also develop at the household level. Studies have been conducted where professionals had witnessed several examples of the issue taking place at household level. It has been seen that a mother who suffers from nutritional anaemia might have a grandparent or a child who was obese and suffered from diabetes type 2 issues. Statistical reports have revealed that dual-burden household are indeed one of the common features in the middle income countries that are undergoing rapid forms of nutrition transitions (El-Kassas & Ziade, 2017).
Third, burden of double burden of malnutrition is also seen to occur at the population level. This includes under-nutrition as well as overweight, obesity as well as non-communicable disorders within the same community, region as well as in the regions and even the nations. These components have affected many countries and are seen to co-exist together. Researchers are also seen to affect women in many countries along with rapid increase in overweight and other different types of NCDs (Thow et al., 2017).
In order to develop effective interventions and strategies for the mitigation of the double burden of malnutrition, it is significant to know about the causes of the issue. Epigenetics suggest that alteration of expression of different types of genes and not just the genes themselves have the ability of influencing the risk of obesity, overweight, own birth weight, and other NCDS. A number of factors can result in alteration of expression of genes in the babies. This includes maternal under-nutrition (Tzioumis & Adair., 2014). This can be seen to lead to alteration of the procedures by which the body of the infant regulates energy. This can be passed on from generation to generation. Another important cause is the early-life nutrition. Researchers are of the opinion that the in-utero as well as the early-life nutrition environments can have huge impacts on the development of child. Researchers are of the opinion that quality as well as quantity of the nutrition during the development of the foetus as well as on the infancy can impact the immune system of the body and affect the cognitive development as well as effective form of regulation of energy storage and even that of the expenditure. Poor maternal nutrition before pregnancy and during it can result in preterm birth and low infant birth weight (Dong et al., 2018). This can result in higher risks of the metabolic disorders and even abdominal adiposity in the different phases of later. Females who are again seen to be obese or have gained weight during pregnancy remain at greater risk for giving birth to babies with larger birth weight. This puts the infants at a much higher risk for developing obesity later in adulthood and faster pace of weight gain in earlier part of life.
The quality as well as the quantity of the foods along with the systems that produce them is seen to have profound influence on the nutritional status of the population. It has been found that in the later part of the century, the size of the packaged foods that are low in nutrients and high on calories have increased and their price had decreased. On addition, the cost of fresh foods had increased that had made the poorer sections of society in developing countries to seek for packaged foods (Haddad et al., 2014). However, in the areas which have been been hit by disasters, instability and conflicts, foods had become unaffordable, unavailable or inaccessible, and people suffer from inadequate amount of food consumption and get amounts of food which fail to meet their nutritional as well as energy requirements of the growing children. This is seen to contribute towards nutrition as well as predisposing towards infection, wasting and even stunting.
Malnutrition is intimately associated with poverty as well as disorders, researchers have noticed that low socioeconomic status reduces the ability of individuals to afford nutrient rich foods and this increases the chance of malnutrition. They tend to go for cheap packaged foods that increase chance of obesity. Therefore, correlation has been found among poverty, food insecurity, and obesity. Socio-economic gradient for obesity and overweight prevalence are found in middle as well as in high-income countries. Urbanisation is yet another contributor (Abdullah, 2015). Researchers are of the opinion that urban environments without proper sanitation and inadequate water supply cause water borne disorders and this result in under-nutrition. Again with financial development, it is seen that urban environments discourage active travel and physical activities with lower reliance of home prepared foods and greater reliance on take-away foods.
Malnutrition in the nation of India had always been found to be associated with under-nutrition. However, the present data shows that National Family Health Survey (NFHS) had conducted a survey and had found that obesity in the adults in the nation had also become a big problem in the country like that of the under-nutrition. It also shows that under nutrition had still continued to be high in the poorer parts of the country where obesity had reached endemic levels in some of the richer parts of the country. This had been found after the agency had conducted survey of about 6 lakhs household in 2015-2016 (Desai & Nambiar, 2015).
Statistical analysis shows that the previous round of NFHS that was conducted in 2005-2006, the proportion of underweight women and men in the country was found to be thrice the proportion of the obese men and women. However, recent data has shown that the number of the overweight or obese women in the nation is at 20.7% and this is only 2% lower than the proportion of the underweight women (Goswami et al., 2016). The trend is quite common in the men with nearly one in 5 men in India being overweight.
An interesting study found on thrifty genotype hypothesis, had shed more light on the twin problem of high malnutrition and growing obesity in the nation of India. Under nutrition in the pre-natal stage programmes the tissues of foetus in ways by which it becomes difficult for the low birth weight babies in dealing with the abundance of food in the later life (Bharati et al., 2018). The double malnutrition trap can be seen be particularly dangerous in the Asian countries like that of India where urban population is rising and where people increasingly face a sedentary lifestyles.
Close analysis of the district map shows that most of the high-obesity districts are seen to be clustered largely mainly in the two ends of the country. These regions include extreme north as well as extreme south. On the other hand, the undernourished districts are mainly found in the centralised portions of the nation. A strong correlation is found by the researchers in their studies regarding affluence, lifestyle disorders and obesity in the nation of India (Gupta et al., 2014). The districts which have been seen to harbour a higher proportion of the rich households like those having televisions, computer, phones as well as motorised two wheeler or four wheelers as per the data collected by census 2011 are seen to have higher numbers of obese people as well as lower proportion of the underweight people.
A study showed the nutritional profiles of three states of the nation. It was seen that none of the households in Andhra Pradesh was adequately nourished in nine nutrients of proteins, calories, and micronutrients like carotene, thiamine, calcium, iron, riboflavin, Vitamin C and niacin. Mean consumption of all nutrients except iron was found to be below respective cut-off point for nutritional adequacy. The nutritional profile of another state was better with 1.3% of households being adequately nourished. In Andhra Pradesh, minimum calorie norm had been seen to reach only by the top 5% of all the different households for calorie consumption (Gupta et al., 2014). In Rajasthan, only 0.5% of households were seen to be properly nourished in all nine nutrients. Rate of calorie consumption was seen to be higher in the urban areas than the rural areas in all three states.
A very strong relation had been also found between malnutrition as well as sanitation in the nation. It has been found that areas and districts which have lower levels of sanitation arrangement and toilet access have higher levels of under-nutrition and lower levels of obesity. The results are absolutely converse for the districts which have high levels of access to toilets (Dong et al., 2018).
Currently, the nation has been experiencing a rapid socio-economic, demographic, and nutritional and health transition. Although, the nation had not been able to overcome the problems of under-nutrition, poverty as well as communicable disorders, it is facing additional challenged related to the affluence and outcome of industrialization, urbanization and economic betterment. The last two decades had seen the emergence of obesity and over nutrition that had in turn increased the prevalence of chronic disorders like diabetes and cardiovascular disease (CVD) mainly in the urban areas. Therefore, it is important the international agencies as well as the governmental authorities of the nation to develop strategies and interventions that successfully control and manage the situation (Haddad et al., 2014).
It is important for the concerned authorities to develop a health policy framework that would be based on the number of action areas that each of the concerned organisations and departments need to take. The policy would be developed on the collaborative research output on the stalwart healthcare managers of the nation as well as international areas. The framework of the policy would be helpful in guiding each of the stakeholder agencies to understand their roles and responsibilities in managing the dual burden of malnutrition and mitigate the issues from the very roots (Khandelwal et al., 2017).
One of the most important parts of the policy development would be ensuring food system and sustainable diets in the nation that align with the goal of mitigating the chances of malnutrition and obesity together. National policies would be developed and investments would be done along with the integration of nutrition objectives into food and agriculture policy. This would also include strengthening of the local food production as well as processing mainly by the smallholders and family farmers (Kosaka & Umezaki, 2017). Moreover, focus should be also done on the strengthening and establishing of institutions, services, program and policies that increase the resilience of the food supply in the crisis prone areas affected by poverty and malnutrition.
The policy would also include effective healthcare strengthening as well as universal health coverage systems for all classes of people. Initiatives for health system strengthening needs to be done for integrating nutrition actions successfully along with the promotion of universal access to all direct nutrition actions and relevant health actions that impact nutrition through health programmes arrangement (Khandelwal et al., 2017).
Another arena that needs to be included in the policy is development of safe and supportive environments for ensuring effective nutrition for all ages. This action area should mainly comprise of taking into consideration about the environmental determinants of malnutrition. Commitment from allocated authorities is required for addressing the social and environmental determinants of malnutrition. This should also include schools, workplaces as well as city contexts and should even integrate different actions for water, sanitation and even hygiene development. Researchers are also of the opinion that there is need for promotion, protection as well as support of optimal breastfeeding practices and hence programs for its development should also be included (Kamal et al., 2015).
Another important arena in the policy would be social protection as well as nutrition related education. It is extremely important for the implementation of the nutrition education as well as information interventions. These would be based on the national dietary guidelines as well as the coherent policies which relate to food and different diets along with the incorporation of the nutrition objectives (Rachmi et al., 2018). These objectives would be included in the social protection programs along with different humanitarian assistance safety-net programs. This might include the utilisation of cash as well as food transfers with school feeding programs and other forms of social protection programs for vulnerable populations.
The policy also needs to provide more importance to the trade as well as investment for improvement of nutrition. The government should try to focus on appropriate identification of the opportunities for achieving global food and nutrition targets mainly through the procedures of trade and investment policies (Wells et al., 2018). This would also include investment policies as well as improvement in the availability and accessibility for the food supply through appropriate trade agreement and policies.
Another important arena which holds utmost importance is the strengthening and promoting nutrition governance as well as accountability. The actions that would be taken should focus on the policies, plans and frameworks for the Member State’s governance. It should be including proper measures of the reviewing, updating and even the strengthening of the national strategies (Thow et al., 2016). This should also include establishing appropriate “national cross government, inter-sectoral, multi-stakeholder mechanisms; improving the availability, coverage, quality, quantity, and management of multi-sectoral information systems” as stated by the World Health Organisation in 2016. The government should also focus on the appropriate development as well as adoption and adaption of the international guidelines on the healthy diets.
From the above direction, it can be found that double burden of malnutrition had affected the life quality of people of huge number of nations. It had resulted in huge amount of suffering affecting people of various socioeconomic classes in various manners. The people suffering from poverty had shown conditions of malnutrition and these of affluent levels are suffering from obesity. This had been resulting in huge economic impact on people of the nation affecting their productivity and increased healthcare costs. India is one of the Asian countries which are suffering from the issue of double burden of malnutrition. Therefore national and international bodies need to develop policies that would cover all the important action areas that would help in overcoming the barriers and mitigate the issue successfully.
References:
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Bharati, S., Pal, M., & Bharati, P. (2018). An Overview of Growth and Malnutrition Among 5–18-Year Children in India. In Advances in Growth Curve and Structural Equation Modeling (pp. 105-121). Springer, Singapore.
Desai, R. K., & Nambiar, V. S. (2015). Coordinated School Health Approach In Indian Schools May Prevent The Occurrence Of Dual Burden Of Malnutrition Among School Children. Journal of Community Nutrition & Health, 4(1), 26.
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