Dealing with the "Double-Burden" in Developing Nations

The research that I and my colleagues have been doing in Accra, the capital city of Ghana, in West Africa, has clearly demonstrated there the existence of the “double burden” facing many developing nations, which are continuing to experience high (but generally declining) death rates among children from communicable disease even while seeing a rise in death rates among adults from degenerative diseases such as hypertension and other aspects of cardiovascular disease. This is illustrated most poignantly by the nutritional paradox, in which households include children who are underweight while the adults are obese. The Economist has picked up on this theme as it applies in particular to Arab societies.

TYRE is a small province on Lebanon’s border with Israel, a place of poor tobacco farmers and tin-roofed shacks. Only about half the population has enough to eat. Many say that, in the past six months, somebody in the household has spent a day without food or gone hungry to bed. But there is something odd about the burden of malnutrition. While in hungry households just over a quarter of children under five are too short for their age—a classic symptom of malnutrition—a third are overweight, malnourished in the opposite sense. Tyre is suffering malnutrition and obesity simultaneously.
This “dual burden” is growing everywhere, but nowhere as quickly as in the Arab world. Between 15% and 25% of Arab children under five are too short for their age and between 5% and 15% are underweight. Almost half of pregnant Egyptian women are anaemic, reflecting an iron deficiency often caused by poor diets. Yet a survey in 2006 reckoned that 30% of Egyptian adults were obese. Obesity estimates for Jordan, Kuwait, Saudi Arabia and the United Arab Emirates were even higher: between 35% and 45%.

This is all part of the nutrition transition, first identified many years ago by Barry Popkin and his colleagues at UNC, Chapel Hill, and now unfolding throughout the world.

In Egypt, Peru and Mexico, about half the women with anaemia are overweight or obese. They are simultaneously over- and underfed: too many calories, not enough micronutrients.