In 2001, the estimated number of people worldwide suffering from overweight with a body mass index (BMI) of less than 25 kg/m2 equaled those with underweight, less than two standard deviations below the WHO reference. It was estimated there were close to a billion overweight or obese individuals and the corresponding number were underweight. While more of the overnourished are adults in developed countries and more of the malnourished are children in developing countries, the two conditions often exist closely within the same community or even within a given household.
In fact, only the poorest countries, in terms of GDP, have a low rate of intra-household dual burdens as malnutrition would be the most dominant nutritional pathology. However, as incomes rise, extremes of body composition status begin to emerge and co-exist within the same family unit.
For a malnourished young child, there can be a quick transition – over a matter of weeks or a few months – from being wasted (underweight for height) to being overweight or even obese (excess weight for height). Moreover, in many cases, these children remain stunted (low height for age), a legacy of their original condition of chronic malnutrition, making them more vulnerable in an urban setting to obesity and diabetes, both of which are linked to excess body fat resulting from sedentary lifestyles and the consumption of high-energy-dense diets.
Like a malnourished child recovering from extreme hunger, a rapid shift in diet from low- to high-energy-dense food, as well as a progressively sedentary lifestyle, moves stunted populations from underweight to overweight and obesity. Rapid shifts in weight with concurrent gains in height are now recognized as particularly increasing the risk of later diabetes, central obesity and cardiovascular diseases.
In order to tackle malnutrition in all its forms with a common agenda, an agreement on how to define malnutrition must be reached. It should be in clear terms understood not only by experts, but also by key stakeholders, policy makers, politicians and the public at large. With a commonly accepted definition, an integrated common agenda for action at all stages of life can be possible. Providing for good nutrition early in life is an important first step in preventing adult nutrition-related chronic disease.
Strategies that are aimed at promoting healthy diets and lifestyles will affect all sectors of society, from food and agriculture, transport and leisure sectors, not just the health sector. They require intersectoral dialogue and action and may affect the growth of several sectors that contribute to the economies of societies. Hence, the relative costs and the consequences of both the emerging burden and the preventive solutions offered need to be considered if developing societies want to succeed in tackling this rising epidemic of NCDs.
The double burden of global malnutrition is a challenge that needs to be addressed by the food and nutrition community, both in developed and developing societies, and must be addressed together.
A documentary film highlights the double burden of malnutrition in micronesia. | 
