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April 14, 2005

The Nutrition Paradox: Undernutrition and Obesity Co-Existing in the Developing World

New Global Trend Requires a Multifaceted Public Health Response

For many developing countries, the health problems caused by obesity now nearly equal the public health concerns brought on by undernutrition. Benjamin Caballero, MD, PhD, professor and director of the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, analyzes what scientists call the “nutrition transition” in an editorial in the April 14, 2005, issue of the New England Journal of Medicine.

Benjamin Caballero, MD, PhD

Benjamin Caballero, MD, PhD

In the editorial, Dr. Caballero notes that in countries undergoing rapid socioeconomic change, the problems of overweight and underweight frequently co-exist even within the same household. This double burden of disease is more common in countries of intermediate development, including Brazil, Mexico and China; in China, for example, being overweight now ranks fifth among the top ten contributors to the overall disease burden, just below undernutrition.

Caballero mentions some key factors contributing to this combination. In urban areas, increased access to energy-dense processed foods and the adoption of a more sedentary lifestyle and creating an "obesogenic" environment, comparable to that of developed countries. At the same time, socioeconomic disparities and limited access to preventive health care result in a widening gap between rich and poor, affecting primarily infants and children. Caballero says that combating this double burden in developing countries will require not only interventions to reduce risk factors for obesity but also initiatives to eliminate existing economic and health disparities.—Kelly Blake