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Stunted growth and obesity: the double burden of poor nutrition on our doorstep

Soha, seven, is now taller than her 10-year-old sister Suhala whose growth has been stunted. Jo Currie/World Vision

Stunted growth and obesity: the double burden of poor nutrition on our doorstep

Soha, seven, is now taller than her 10-year-old sister Suhala whose growth has been stunted. Jo Currie/World Vision

Excess weight and obesity are growing problems that contribute to escalating rates of chronic conditions such as diabetes and cardiovascular disease. Globally, [around 37% of adults](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60460-8/abstract) were either overweight or obese in 2013. Of ten countries that have the highest rates of overweight and obese adults in the world, nine are in the Pacific region.

However, what is not widely known is that some of Australia’s less developed neighbours also have very high rates of child undernutrition. These countries have the “double burden” of overnutrition in adults and undernutrition in children.

Child undernutrition is defined by stunted linear growth: low height for a child’s age. By the age of two years, it is usually irreversible. Stunting leads to poor cognitive development, weak educational outcomes and reduced employment opportunities.

Improving nutrition is likely to have strong economic benefits for a developing country. Indeed, one study found that a child’s height-for-age index at two years of age was the best predictor of human capital.

Globally, an estimated [165 million children](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60937-X/abstract) under five years of age suffered from stunting in 2011. Undernutrition caused just over three million child deaths in the same year – approximately 45% of all deaths in children under five.

While the highest rates of stunting are in South Asia and sub-Saharan Africa, some countries in Southeast Asia and the Pacific have very high rates, including Timor-Leste (50%), Papua New Guinea (44%), Indonesia (39%), Solomon Islands (33%), and Kiribati (33%). While there have been steady reductions in the prevalence of undernutrition in most of Asia over the past two decades, there has been almost no change in the Pacific region since 1990.

Australia’s closest neighbours have some of the highest rates of malnutrition. Papua New Guinea, May 2014. Leo Samuel recovering from malnutrition/© UNICEF

The causes of undernutrition are complex and have been divided into two groups: immediate and underlying. In addition, basic factors such as income poverty, low educational status, and cultural beliefs (such as food taboos during pregnancy and after childbirth) contribute.

Immediate causes include inadequate food intake; infectious diseases; inappropriate caring practices, such as failure to exclusively breastfeed until six months of age (as recommended by the World Health Organisation) and to give infants nutritionally diverse complementary feeding after six months; and ineffective treatment of undernutrition.

Underlying causes include lack of access to clean water and latrines; inadequate access by families to food all year round; low agricultural productivity; and gender inequalities that lead to women consuming less nutritious food (such as red meat) than men within the same household.

There is broad global consensus on the types of interventions that most effectively address child undernutrition. The influential medical journal The Lancet has published two series on maternal and child undernutrition (in 2008 and 2013) which have been a catalyst for greater attention to the issue. The scholarly articles in these series have provided the body of evidence for the “first 1,000 days” approach, which targets interventions in the period from early pregnancy to a child’s second birthday.

A major goal of this approach is to break the inter-generational nature of undernutrition whereby an undernourished woman gives birth to a low-birthweight baby who is then at high risk of stunted linear growth and – if female – may grow up to give birth to a low birthweight baby and so on. Adolescent pregnancy is a high risk for perpetuating this cycle.

Efforts to prevent child undernutrition require a multipronged collaboration between a number of development sectors: health, agriculture, water and sanitation, education, women’s empowerment, and family planning.

The global commitment to nutrition is stronger than it has ever been. In 2013, 51 countries, businesses and civil society groups signed an agreement at the Nutrition for Growth Summit in London to make nutrition one of the world’s top development priorities.

Investments to reduce high rates of child undernutrition in Pacific countries may have long-term benefits in adulthood. Department of Foreign Affairs and Trade/Flickr, CC BY

Australia was one of more than 20 donor countries at the summit and subsequently joined the Scaling Up Nutrition (SUN) movement. Established in 2010, the SUN movement aims to unite governments, civil society, the United Nations, donors, researchers, businesses and citizens in a worldwide collective effort to end undernutrition.

Australia’s Department of Foreign Affairs and Trade’s independent review into Australian aid’s contribution to promote nutrition, published in February 2015, found Australia’s investment in nutrition nearly doubled from 2010 to 2012. However, despite a stunting rate in excess of 40% in Papua New Guinea, in the years 2010 and 2012 combined, Australia only allocated 0.1% of total PNG development aid to nutrition.

Back to the obesity epidemic in Pacific Islander adults. A number of studies have found that adults who had a low birthweight or were undernourished as young children are more likely to experience high blood pressure and obesity, and associated chronic diseases including diabetes and heart disease.

Therefore, investments now to reduce high rates of child undernutrition in Pacific countries may have long-term benefits in adulthood. Although Australia’s aid budget has suffered severe cuts in recent years, Foreign Minister Julie Bishop has highlighted the need for innovation in the aid program and allocated funds to a development innovation hub known as innovationXchange.

There could be no better target for innovation than to explore effective ways to reduce the double burden of child malnutrition and adult obesity in our less developed neighbours. This would contribute to significant economic and health benefits in the region.