Understanding the double burden of malnutrition in Peru

A new study has mapped the drivers of the double-burden of malnutrition in Peru, by capturing the views of different experts.

The double burden of malnutrition occurs when the same populations, households, or individuals face both overnutrition, such as overweight and obesity, and undernutrition, such as stunted growth, at the same time.

This is an important public health concern in Peru. Although stunting has reduced significantly since the early 2000s, it still impacts many communities around the country, especially those living in the jungle and highland regions. At the same time, overweight and obesity has been rapidly increasing over the years, with 61% of Peruvian women being overweight in 2021.

The research was co-led by CRONICAS at Universidad Peruana Cayetano Heredia and Imperial College London, in collaboration with researchers from Washington University in St. Louis, and Universidad de los Andes, Colombia and was published today in BMC Global and Public Health.

The study brought together 36 individuals from Lima and Iquitos, with expertise or lived experience in nutrition issues. They included policymakers, NGO representatives, health practitioners and researchers, and parents of infants and school aged children. The research team conducted 5 different workshops (4 in Lima and 1 in Iquitos), where participants were asked to consider which drivers may contribute to the double burden of malnutrition in Peru.

A method called community-based system dynamics was used to guide the workshops. This method invites participants to think about “what is under the surface”. Instead of only focusing on individual drivers of the double burden of malnutrition, participants were invited to consider how these drivers might change over time, how they might be interconnected, and how people’s beliefs, mindsets, and goals can maintain these interconnections.

Paraskevi Seferidi, Research Fellow at Imperial College London, said: "Community-based system dynamics can bring together people with diverse views to help us untangle complex problems and understand unintended consequences of our policies".

Following various guided activities, workshop participants developed a causal map that describes their understanding of the issue. Workshop participants described how nutrition policy in Peru prioritises actions against undernutrition.

This is mainly the result of Peru’s long-standing and successful efforts to reduce stunting in the last couple of decades. However, with all the efforts concentrated towards undernutrition, there are less resources and political will to act against other types of malnutrition, such as overweight and obesity, which is increasingly becoming a major public health issue in Peru.

Participants identified different ways that nutrition policy may unintentionally impact the double burden of malnutrition, such as the provision of unhealthy foods through food assistance programmes, which are further encouraged by tax incentives associated with food donation by corporations. Experts from Iquitos also described how exports of healthy local products to Lima and abroad, which has been the result of the recent commercialisation of traditional foods, has reduced their availability and increased their prices in regions outside Lima, threatening local diets.

This research emphasises the importance of considering all types of malnutrition when designing nutrition policy in Peru. Antonio Bernabé-Ortiz, CRONICAS researcher, who led this study, said: “Recognising the double burden of malnutrition as a nutrition priority in the country will allow us to effectively monitor and evaluate nutrition policies against malnutrition in all its forms”. He added: “Our study has also highlighted the importance of engaging with stakeholders across different regions to respond to local priorities for nutrition actions”.

This study was supported by a research grant from the Biotechnology and Biological Sciences Research Council (BBSRC) (grant reference: BB/T009004/1).