Bates, Katie
(2014)
Double or divergent? Stuntingoverweightness among children and the ‘burden’ of malnutrition: a study of Albania.
PhD thesis, London School of Economics and Political Science.
Abstract
Today, researchers and policy makers alike are increasingly concerned about the “double burden of malnutrition” in low and middle income countries (LMICs). This ‘double burden’ is understood to be the coexistence of under- and overnutrition within one population. The definition of a ‘double burden’ relies upon the existence of chronic undernutrition among children (indicated by stunting – where children are shorter than expected for their age) and the existence of overnutrition in children or adults (child overweightness as indicated by a greater weight than expected for a given height and adult overweightness/obesity as indicated by a greater weight than height).
However, research has failed to consider that children can be concurrently stunted and overweight – known here as ‘stuntingoverweightness’. In failing to consider
stuntingoverweightness, the prevalence of stunting and overweightness among children has been overestimated at the population level. Stuntedoverweight children have been ‘double counted’ – once as stunted and once as overweight. This has severe implications for our understanding of malnutrition in LMICs today. The polarisation of malnutrition among children of under- and overnutrition has been exaggerated and a whole group of
children have become hidden – the stuntedoverweight.
This research addresses this issue. Recalculating stunting and overweightness prevalence accounting for stuntingoverweightness this research shows that, today in LMICs, up to 10.42% of children under-five are stuntedoverweight – yet no policies or programmes
exist to understand the determinants of stuntingoverweightness, its effects or how to
alleviate them. An individual level analysis of Albania shows stuntedoverweight children are a separate socioeconomic group and should thus be targeted for
interventions separately from their stunted and overweight peers. Furthermore, failing to recognise stuntingoverweightness has led to overestimations of the burden of stunting by up to 88.54% (in Albania) and of overweight by up to 295.26% (in Benin) and skewing our understanding of the ‘burden of malnutrition’ in LMICs.
The thesis shows that for nutritional strategies to be effective – research needs to consider the diverse burden of malnutrition observed in LMICs today.
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