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Double burden or double counting of child malnutrition? The methodological and theoretical implications of stuntingoverweight in low and middle income countries
  1. Katie Bates,
  2. Arjan Gjonça,
  3. Tiziana Leone
  1. Department of Social Policy, London School of Economics and Political Science, London, UK
  1. Correspondence to Dr Katie Bates, Department of Social Policy, London School of Economics, Houghton Street, London WC2A 2AE, UK; k.m.bates{at}lse.ac.uk

Abstract

Background There is increasing concern at research and policy levels about the double burden of child malnutrition (DBCM)—with stunting and overweight found across different groups of children. Despite some case studies suggesting that stunting and overweight can occur concurrently in children, here known as ‘stuntingoverweight’, and major drives to reduce all forms of malnutrition in low and middle income countries (LMICs), stuntingoverweight is continually overlooked. This research evidences the prevalence of stuntingoverweight across LMICs, exploring the theoretical and methodological implications of failing to acknowledge this form of malnutrition.

Methods Prevalence estimates of stuntingoverweight are constructed from 79 LMICs with nationally representative anthropometric survey data. Stunting and overweight estimates are amended to exclude stuntedoverweight children. These estimates are compared with those published in the Joint Child Malnutrition Estimates (JMEs)—evidencing overestimation and double counting of stuntedoverweight children.

Results Children can be concurrently stunted and overweight. Stuntedoverweight children are found in all LMICs, from 0.3% to 11.7% of under-fives and are included in both stunting and overweight rates. Analysed together, this leads to double counting of stuntedoverweight children. This artificial inflation of stunting and overweight rates can give a false impression of a DBCM, obscuring the true diversity of malnutrition present. Over 10 million children are stuntedoverweight in the world.

Conclusions Stuntingoverweight is a newly recognised, understudied phenomenon. Affected children are included in both stunting and overweight prevalence estimates, introducing unobserved heterogeneity to both individual-level and population-level research and double counting to population-level research. Overlooking stuntedoverweight children has great implications for methodology, theory, policies, programmes and the health of affected children.

  • NUTRITION
  • MEASUREMENT
  • OBESITY

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors KB, AG and TL developed the research question and plan. KB conducted the analyses and drafted the manuscript. AG, TL and KB revised the initial draft together.

  • Funding This work was supported by the Economic and Social Research Council (ES/G018006/1 awarded to KB for PhD research, of which this paper formed part).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.