In Pakistan and worldwide, people face the issue of the double burden of malnutrition within the same individuals, households, or regions. It means that people can look overfed yet still have nutritional deficiencies.
Imagine a mother in a middle-income household going through menopause, unexplained weight gain, and random blood pressure spikes. The father checks his sugar level every morning and gets tired by the afternoon. The daughter is anaemic, with pale skin and bones sticking out. The son looks really healthy; however, he has never even tried a vegetable or a fruit. The same food is being eaten in the house, but in different quantities and at separate times.
This isn’t a story of one household but of all households in Pakistan, where excess and scarcity are prevalent for each person and each family.
The Paradox Explained
For decades, the WHO, UNICEF, and other members of the global health community considered malnutrition to be underweight and stunting. It was reported that too little food can lead to infections, diseases, and increased mortality rates. The fact is not that all that’s gone away. The fact is that over the past few decades, overweight and obesity rates worldwide have been added to that list.
In Pakistan alone, stunting (short for age) stands at 150.2 million, wasting (low weight for height) at 42.8 million, and overweight at 35.5 million of the population. After many decades, the prevalence of overnutrition has appeared to surpass that of undernutrition. The reality is that in the same household, one child may be eating junk food and progressing towards diabetes or hypertension, while another child may be eating less than their body requires.
Wealth isn’t even a major factor in overnutrition. Cheap packaged foods filled with preservatives, artificial flavours, and empty calories are worse than fine dining. They release dopamine in our brains, and when children are introduced to it, they keep getting hooked on that feeling of a dopamine rush. These packaged foods are currently more accessible in Pakistan than real fruits and clean water.
It results in a paradox named the “double burden of malnutrition”, meaning a child can be obese, prediabetic, and show signs of nutritional deficiencies simultaneously. Pakistan, like other third-world war countries, is fighting two wars at the same time: against hunger and empty calories from junk foods.
The first 1000 days of a baby’s life are crucial. It starts from the day of conception and goes on till the second birthday. If a mother is not properly nourished during pregnancy, the newborn can bear consequences like low birth weight, which can grow up to be stunted or wasted if not properly nourished after birth. Once that stunted or wasted child starts consuming empty-calorie, nutrient-dense foods, their body can treat the extra calories like an emergency reserve and start storing excess fat quite fast.
Hence, an adolescent who looks short for age can start showing signs of insulin resistance. The problem wasn’t only the food but also the environment, changing faster than the body was accustomed to. The calories become a lot higher than the body used to work on previously.
This cycle, unfortunately, becomes hard to break. When these girls go into adolescence, they face issues like PMOS, iron deficiency anaemia, low haemoglobin, and vitamin C and D deficiencies. This can later cause birth defects in their children. These girls don’t only put their babies’ lives on the line but also their own lives. During pregnancy, the foetus can suck out all the nutrients it needs, leaving the mother to run on almost nothing.
These are the same girls who go through the conflict of achieving the “perfect Instagram bodies” or eating all the delicious foods they see online. This leads to not only NCDs like diabetes but also mental health issues like eating disorders and body dysmorphia.
Breaking this cycle can be hard, but not impossible. Many strategies have been made but not properly implemented to help with these issues. WHO has set up a double duty framework that can help to target both kinds of malnutrition at the same time. The first step has to be taxing sugary drinks, fast food, and packaged foods. Then comes making sure that each child is being given the accurate amount of recommended calories for age, weight, and gender.
To break this cycle, Pakistan needs to establish and work on school feeding programmes, maternal and baby health awareness in rural areas, making fruits and vegetables cheaper for the lower-income communities, and counselling families on balanced diets.
The 2030 plan of Pakistan to achieve Sustainable Development Goals 2.2 (Zero Hunger) and 3.4 (Good Health) is off track and cannot be achieved until proper interventions, monitoring, and evaluation are implemented.