Author : Shoba Suri

Expert Speak Health Express
Published on Jul 30, 2020
Overcoming the triple burden of malnutrition in China This is the 99th article in the series The China Chronicles. Read the articles here.

Globally one-third of the children under the age of 5 are malnourished and many are at risk, owing to hunger or poor-quality diets. The Joint Child Malnutrition 2020 estimate shows high rates of stunting and wasting in Africa and Asia and growing trend of being overweight, with 45% overweight children living in Asia.

The past two decades have witnessed a surge in obesity across countries. Globally 38.3 million children under-5 are overweight (5.6 percent), with Asia contributing to 17.2 million of those, amounting to 4.4 percent overweight children under-five with disparity within sub-regions. Within Asia, Eastern Asia has the highest number of overweight children (5.7 million) followed by South Asia (4.5 million), South East Asia (4.2 million), Western Asia (2.3 million) and Central Asia (0.5 million) in the region.

While countries across the world have faced the dire consequences of the double burden of malnutrition – cha­racterized by the coexistence of undernutrition and obesity – recent statistics show that many countries are now facing the challenges of the Triple Burden of Malnutrition, which is a striking combination of undernutrition and micronutrient deficiencies, and overweight and obesity. The causes are interwoven, complex and often coexist, threatening not only the growth and development in children in the present, but also the future economy, which is dependent on today’s children and adolescents.

According to the Global Nutrition Report 2020, 88 countries are likely to miss the Global Nutrition Targets by 2025. The East Asian  countries currently fall under the list of countries that are not on track to achieving the global nutrition targets for under-five overweight children, adult obesity, low birth weight, and anemia in women of reproductive age. The most populous country of East Asia, China is expected to be on track for meeting the target for stunting and wasting. It is on the other hand, off course on the other indicators.

A closer look at China’s story reveals that undernutrition is on a downward trend in China, but certain pockets still suffer from the triple burden of malnutrition. The stunting, wasting and overweight prevalence in China for children under-five are 8%, 1% and 9% respectively. A recently published study on the geographic variation in prevalence of adult obesity in China indicates an alarming triple-fold increase in obesity in the past decade.

A study on trends in overweight and obesity in 195 countries over 25 years (1990-2015) shows highest number of obese children resided in China and India, but adult obesity was concentrated in United States of America, followed by China. Evidence suggests a disturbing rise in obesity in adolescents from developing middle-income countries including China. This also raises the concern for risk of non-communicable diseases associated with obesity. A review to estimate the medical cost of obesity and overweight related chronic diseases was calculated to be almost US$3 billion and has been estimated to rise exponentially to US$ 7 billion by 2030. The risk of obesity or overweight in China is enormous on the health of a section of its populace and imposes considerable social and economic burdens. This calls for effective measures to be placed in order to control and prevent obesity/overweight as early as 1000 days and through the course of an individual’s life cycle.

The International Obesity Task Force advocated the ‘Sydney Principles’ for the prevention of obesity and non-communicable diseases by banning the sale of junk foods and soft drinks to children aged 16 years and below, and allow for sale of healthy foods. The WHO report of the Commission on Ending Childhood Obesity emphasizes a life style approach (Figure 1) to tackle childhood and adolescent obesity; preconception and pregnancy, infancy and early childhood and older childhood and adolescence. It underscores the importance of the interface between physical activity, sedentary lifestyle and adequate sleep, and its subsequent influence on good health and well-being.

Figure 1: Life Cycle Approach to Ending Childhood Obesity

Source: WHO 2016-Report of the commission on ending childhood obesity

A school based intervention in Beijing found a significant decrease in the prevalence of overweight and obesity in children that were receiving nutrition guidance and were involved in physical activity. An analysis of nutritional status of Chinese school children from 5 national surveys (1995 to 2014) found a strong correlation between socioeconomic indicators (GDP, income spent on food and urbanization ratio) and the prevalence of obesity and overweight, but an inverse relation with stunting and thinness.

China’s National Program for Food and Nutrition (2014-2020) aims to bring down the rate of obesity and overweight by setting clear nutritional goals. It aims to improve nutrition in the first 1000 days after birth, along with providing intervention strategies for student nutrition and physical activity, reducing salt intake and promoting a balanced diet for adults to enhance the nutritional status of the community at large.

The National Nutrition Plan (2017-2020) for China lays out the ‘Outline of "Healthy China 2030" Plan’ for improving the health and nutrition of its people. The plan includes reduction in malnutrition including stunting, wasting, obesity, anemia and improved infant and young child feeding practices among vulnerable sections of the population. China has adopted a coordinated and multi-pronged approach with regard to health, nutrition and related areas to improve the quality and diversity of food produced along with supply chain policy. The availability of nutritious food has led to a reduction in both stunting and wasting. The Government of China is committed and has shown political will in transforming malnutrition in China. In 2019 the ‘Healthy China Action’ (2019-2030) was issued, which lays down goals for the individual, the family and society to promote good health, prevent and treat non-communicable diseases and control infectious diseases.

For China many opportunities exist to overcome the problem of triple burden of malnutrition. There is a need for a comprehensive framework along with a strong monitoring system to closely keep track of childhood stunting and obesity. This calls for scaling up the nutrition programs and implementing the commitments to bring change. The current set of problems call for strong policy interventions with a keen focus on economic growth and strengthened implementation of programs for promotion of healthy eating and physical activity.

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Shoba Suri

Shoba Suri

Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...

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