A Double Burden on our Emerging Economies

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Malnutrition, in all its forms, including undernutrition (wasting, stunting, underweight), micronutrient deficiencies, overweight, obesity, and resulting diet-related noncommunicable diseases, is the leading cause of poor health globally[i]. The double burden of malnutrition is characterized by the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases within individuals, households, and populations and across the life course.

Cause for concern

The obesity epidemic has received much attention in recent decades, particularly in high-income countries, and with good reason. According to the World Health Organization, 39% of the world’s adult population is overweight, with 650 million of these adults being obese. An estimated 38.2 million children under the age of 5 were overweight or obese in 2019[ii]. Obesity brings with it a myriad of health challenges such as the increased risk for type 2 diabetes, coronary heart disease, stroke, and certain types of cancer,[iii] and increased risk of severe illness from the virus that causes COVID-19[iv]. This puts tremendous pressure on individuals and health systems.

A parallel epidemic plaguing large swaths of the globe has been undernutrition. While we have seen some positive changes with a relative reduction in undernutrition of 19% from 1991 to 2017 and the prevalence of hunger fallen from 14.8 percent in 2000 to 10.8 percent in 2018, progress remains slow. Eight hundred and twenty million people are undernourished, and 9% of the world’s population are food insecure[v].

Unfairly, these two epidemics have collided in low- and middle-income countries, giving rise to a problem known as the Double Burden of Malnutrition. These two forms of malnutrition – over and under – can coexist within countries and communities (for example, where there is a prevalence of both undernutrition and overweight in the same community), within households (when a mother may be overweight or anemic and a child or grandparent is underweight), and even within the same person over their lifetime (obesity with deficiency of one or various vitamins and minerals, or an overweight adult who was stunted during childhood). Sadly, this has become the new norm in many parts of the world that have had to continue tackling undernutrition while finding themselves increasingly challenged to fight growing rates of obesity.

These countries cannot afford to ignore the potential of unhealthy diets. A food system that is efficient in delivering healthy food to all at an affordable price, in all situations, is required. High-income countries have seen the cost and consequences of not recognizing this sooner. Current estimates suggest that malnutrition costs the global economy US$3.5 trillion a year – 11% of the world’s GDP.[vi]

Although the double burden remains a largely untapped area for integrated policy action, there are opportunities to act. It presents a unique opportunity for mutual learning and collaboration between the Global North and Global South, as every country in the world is affected by one or more forms of malnutrition.

A way forward

This sparked an idea within the Sight and Life team – The Food Systems Innovation Hub, a place poised to deliver just such a point of collaboration. Designed to accelerate technology transfer and targeted investment in emerging economies such as Nigeria, Rwanda, and Bangladesh, they will provide a mechanism for sharing techniques and knowledge to tackle this double burden. This may take the form of social marketing campaigns to generate demand for more nutritious foods or of even more ambitious measures like aggregating the output of a local crop (teff in Ethiopia, for example) to make it more affordable and nutritious by fortifying it with vitamins and minerals.

We have a long way to go to achieve the Sustainable Development Goals outlined by the UN, but I am confident that these Innovation Hubs will be a step in the right direction. Sight and Life invites you to join us in this new, bold initiative and learn how you can become involved. 

Read more on the Food Systems Innovation Hubs HERE and watch the Foods Systems Innovation Hub webinar to find out more. Learn more about the Double Burden of Malnutrition in the 2018 issue of Sight and Life Magazine.


[i] https://www.who.int/news-room/fact-sheets/detail/malnutrition (accessed 7 January 2021).
[ii]https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:~:text=Some%20recent%20WHO%20global%20estimates,%25%20of%20women)%20were%20overweight (accessed 7 January 2021).
[iii]https://www.ncbi.nlm.nih.gov/books/NBK44656/#:~:text=The%20prevalence%20of%20obesity%20changed,children%20during%20the%20same%20period. (accessed 7 January 2021).
[iv] https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html (accessed 7 January 2021).
[v] https://ourworldindata.org/hunger-and-undernourishment (accessed 7 January 2021).
[vi] www.nutraingredients.com/Article/2014/11/14/Malnutrition-costs-11-of-world-sGDPGlobal-Nutrition-Report (accessed 29 October 2018).

Can the Food and Beverage Sector Contribute to a Healthier Society?

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Despite the progress made over the past few decades, malnutrition remains a leading global challenge and a major obstacle to achieving the Sustainable Development Goals. 88 percent of all countries face a serious burden of at least two of the three forms of malnutrition – undernutrition, micronutrient deficiencies, and overweight/obesity1. Worldwide, stunting still affects 155 million children, and 52 million children are wasted. 2 billion people are micronutrient-deficient, while another 2 billion adults and 41 million children are overweight or obese. The global community is off-course to meet the agreed-upon global nutrition targets.

Fueling the Dilemma

Central to the challenges of malnutrition in its three modalities, as well as to the approaches to address them, are food systems. Food systems – the set of processes of production, processing, marketing, distribution, purchasing, and consumption of food, together with the consumer practices, resources, and institutions in these processes – are major determinants of food quality and choices and consequently nutritional status and health. The private sector – from multinationals to smallholder farmers – is the engine that drives food systems, with the food and beverage (F&B) industry playing a unique and powerful role. The F&B sector has a disproportional impact on nutrition and health outcomes as the “nutrition transition” in low and middle-income countries (LMICs) has shown, with increased consumption of sugar, fats, refined grains, and highly processed foods2. In LMICs, F&B industry products represent a growing share of local diets, driven by urbanization, rising incomes, maturing supply chains, and increasing demand for processed foods due to their convenience and extended shelf life. Though taking place at a faster pace in cities, this transition is increasingly reaching rural areas.

Beverage Industry, energy drinks

The associated global obesity epidemic3, which has engulfed developed countries and LMICs alike, is costing the world an estimated US$ 2 trillion annually. Noncommunicable diseases (NCDs) now account for 68 percent of all deaths worldwide, with three of the four most prevalent ones – cardiovascular diseases, cancers, and diabetes – being associated with diets4. The global community may well have reached a tipping point with the accumulating evidence on the global and serious nature of overweight and obesity and their major contribution to the increasing burden of NCDs and premature death. Urgent, comprehensive, and systematic action is called for now to reverse this tide.

Unraveling the Issue

Together with consumer choices and lifestyles, the F&B sector’s influence on these trends and burden is undeniable. Moreover, the industry’s contribution to reducing undernutrition and micronutrient deficiencies has been insufficient, with numerous missed opportunities to help address these burdens across countries and markets.

Five key levers can be employed by society to improve the F&B sector’s contribution to improved nutrition and health: incentives, a favorable enabling environment, consumer education and demand, safety net procurement, and direct pressure and accountability from consumers, grassroots organizations, high-value employees, and investors. Incentives through various policies can be strong inducers of positive action by private sector actors. Tax policy, for example, can both incentivize increased availability of affordable nutritious foods and discourage production and consumption of poor quality foods. A favorable enabling environment, primarily instituted by the public sector, can reward F&B players which contribute to public health and discourage or penalize those that don’t. Consumer education and demand can pull the whole food value chain towards sustainable diets and compel companies to offer a nutritious, sustainable, and ethical product portfolio. The recent clean label movement in high-income countries5 illustrates the power of consumers to catalyze major industry shifts. As institutional buyers such as national governments and multilateral agencies step in to ensure the poorest of the poor are covered, they contribute to the viability and sustainability of nutrition-minded companies. Last but not least, the voice of society through various actors and channels can both inhibit the most egregious corporate actions in the short term and promote long-term steering and investment in a nutrition-positive direction. An auspiciously growing trend are right-minded nudges on firms from large individual and institutional investors, including asset managers and pension funds, as highlighted by the recent letter from the CEO of BlackRock, the world’s largest asset manager, to his fellow executives.

obaasima, food fortification, quality seal

A number of industry initiatives and public-private partnerships have made valuable contributions to improving nutrition outcomes through product reformulation, improved labeling standards, restrictions on marketing and distribution to vulnerable groups, and disincentives to consumption of poor nutritional value products of such as sugar-sweetened beverages through taxation. In LMICs, these efforts have concentrated on food safety or fortification of staple foods (flour, rice, oil), and condiments with micronutrients. Some of them, including the OBAASIMA program in Ghana, have applied a category branding approach, with the use of a “quality seal” logo to distinguish products meeting nutrient profile (sugar, salt, saturated fat) and fortification standards.

Evolving Over Time 

Today, LMICs grapple with the full spectrum of malnutrition challenges, with a persistent burden of undernutrition and micronutrient deficiencies combined with a rising tide of overweight and obesity. The aforementioned tipping point of awareness may well represent a leapfrogging opportunity for LMICs as their food systems develop and their F&B sectors mature and can better align their strategy and investments with societal needs, thus avoiding the enormous burden this misalignment has imposed elsewhere. Key to this alignment is a systemic approach that encompasses all three modalities of malnutrition, includes actions that both promote the consumption of nutritious foods and reduce that of poor quality products, and addresses the critical areas in which F&B companies can make the greatest difference to nutrition outcomes: product portfolio and labeling, marketing communications and practices, and availability and affordability for low-income consumers. 

Aligning the F&B sector with societal needs is a long, winding, and overdue journey, which will ultimately benefit all individuals in all countries, as consumers, suppliers, employees, or shareholders, as well as the planet. Let’s embark on this likely bumpy ride and step on the gas – a healthier, happier and more productive world awaits us and our descendants.


1Global Nutrition Report 2017.
2Hawkes, Corinna; Harris, Jody; and Gillespie, Stuart. 2017. Changing diets: Urbanization and the nutrition transition. In 2017 Global Food Policy Report. Chapter 4. Pp 34-41. Washington, DC: International Food Policy Research Institute (IFPRI). https://doi.org/10.2499/9780896292529_04.
3WHO, Controlling the global obesity epidemic. Available at http://www.who.int/nutrition/topics/obesity/en/.
4World Bank, An Overview of Links between Obesity and Food Systems; Implications for the Food and Agriculture Global Practice Agenda. June 2017.
5Kerry, Beyond the Label: The Clean Food Revolution. Available at https://go.kerrycleanlabel.com/cleanlabelwhitepaper/?.