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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

Bates, Katie, Gjonça, Arjan and Leone, Tiziana ORCID: 0000-0001-9671-5382 (2017) Double burden or double-counting of child malnutrition? The methodological and theoretical implications of stuntingoverweight in low and middle income countries. Journal of Epidemiology and Community Health, 71. pp. 779-785. ISSN 0143-005X

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Identification Number: 10.1136/jech-2017-209008


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 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 to those published in the 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 ten 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- 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.

Item Type: Article
Official URL:
Additional Information: © 2017 The Authors © CC BY 4.0
Divisions: Social Policy
Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Date Deposited: 08 May 2017 14:24
Last Modified: 22 May 2024 16:24
Projects: ES/G018006/1
Funders: Economic and Social Research Council

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