New report finds 'double burden of malnutrition’ in South East Asia

A joint report from UNICEF, WHO and ASEAN has shed new light on the nutrition situation of children across South East Asia. The report finds that several ASEAN countries are facing simultaneous crises of over and undernutrition, with some children overweight while their peers suffer from stunting and wasting. This ‘double burden of malnutrition’ is happening in middle income countries such Indonesia, Malaysia, the Philippines and Thailand.

In Indonesia, the proportions are exactly the same: 12 percent of children are overweight and 12 percent are wasted. In Thailand, child wasting and overweight are both on the rise: between 2006 and 2012, wasting increased from 5 percent to 7 percent, and overweight from 8 percent to 11 percent.

The causes of overweight and undernutrition are intertwined. A child whose growth was stunted in early childhood is at greater risk of becoming overweight later in life. The risk for being overweight goes up with increased access to junk food and drinks (those with high trans-fat or sugar content and low nutritional value), physical inactivity and sedentary lifestyles.  This is an increasing trend in many countries in the region, and contributes significantly to the growing prevalence of chronic diseases like diabetes and heart conditions.

“Many countries in South East Asia have seen impressive economic gains in the last decade, lifting millions of children out of poverty,” said Christiane Rudert, Regional Nutrition Adviser for UNICEF East Asia and Pacific. “However, at the same time we have seen the rise of conditions like obesity, previously associated with high income countries. Asian children are now at risk of malnutrition from both ends of the spectrum.”

Stunting and wasting is still an issue in most countries in the region, even those that have seen economic gains. In addition to poverty, other contributing factors include traditional diets that lack nutritious foods, poor infant feeding practices, inadequate clean water and sanitation, and farming a limited variety of crops. If children are stunted, this impacts their development in other areas including health and education, affecting their chances in life.

The report finds that stunting prevalence is highest in Cambodia, Lao PDR and Myanmar, as well as in parts of Indonesia and the Philippines.

Child malnutrition also has a significant impact on countries’ economies. It reduces parents’ productivity and creates a burden on health care systems. It can lead to non-communicable diseases, disability and even death, reducing the potential workforce. The economic cost of non-communicable diseases in Indonesia – much of which is diet-related – is estimated at $248 billion USD per year.

Other findings from the report include:

• While overweight is still more common among the richest families in Thailand (15 percent in the richest quintile compared to 9 percent in the poorest), the levels of child wasting is similar in rich and poor families alike (both about 7 percent).
• Close to three quarters, or 12 million, of the 17 million stunted children in ASEAN live in Indonesia and the Philippines.
• Lao PDR has the highest proportion of stunted children in ASEAN, at 44 percent. There is a stark rural/urban divide, with 49 percent of children in rural areas stunted, compared to 27 percent in urban areas.
• Stunting is linked to poverty and is most apparent in the lowest quintile. In Cambodia, for example, 42 percent of children in the lowest quintile are stunted, compared to 19 percent in the highest quintile.
• Conflicts and natural disasters also impact on children’s nutrition by disrupting family’s livelihoods and access to food and water. This in turn can lead to diseases like diarrhea and cholera. The most disaster-hit country in ASEAN is the Philippines.
• Every year, over 4 million children in ASEAN suffer from severe wasting, but less than 2 percent of them receive treatment.
• The countries that lose the highest proportion of their GDP to malnutrition are Cambodia and Lao PDR, both of which lose 2.5 per cent of GDP each year.

What can be done?

UNICEF and the EU recently completed a five-year partnership to tackle nutrition issues in five Asian countries, including Indonesia, Lao PDR and the Philippines.

“The objective of the partnership was to help governments develop a holistic approach to nutrition, looking beyond just the health sector,” UNICEF’s Christiane Rudert said. “For example, we worked to improve maternity leave for mothers, which is a labour issue, and families’ access to nutritious food sources – an agriculture issue.”

Case studies from Indonesia, Lao PDR and the Philippines are available here: http://tinyurl.com/nutritionASEAN

To address the issues raised in the ASEAN report, the authors recommend that:

• Double burden of malnutrition: Governments need to regulate the marketing of junk food and sugary drinks to children and restrict their availability in schools.
• Stunting and wasting: Governments need to do more to help improve infant and young child feeding practices, treat acutely malnourished children, increase agricultural variety, promote better sanitation and hygiene practices, keep girls in school, and work on poverty reduction.
• Natural disasters: Governments need to map the situation of children in the most at-risk areas, including poverty, malnutrition, and geographic vulnerability. They also need to build resilience, including emergency supplies, training and guidelines.
• Economic cost: Governments must consider the cost of child malnutrition and spend more tackling it. Every dollar spent on nutrition in the first 1,000 days of a child’s life saves $45 USD on average. In some cases, it can save up to $166 USD.

“The UNICEF/EU partnership and report on nutrition in ASEAN are good examples of what can be achieved and learned through international partnerships and South-South cooperation,” UNICEF’s Christiane Rudert said. “In light of these findings, we will continue working with ASEAN countries to strengthen their nutrition policies and actions for children. By investing more in childhood nutrition now, governments can secure a better future for their citizens and countries.”