The double burden of malnutrition: rethinking clinical and policy responses in the era of rising obesity in low- and middle-income countries

OBJECTIVE: To discuss the growing challenge of the double burden of malnutrition (DBM), the co-existence of undernutrition and obesity, and the associated clinical and policy complexities in low- and middle-income countries (LMIC). DESIGN: This commentary synthesises evidence from recent multi-country and country-specific studies in sub-Saharan Africa and other LMIC. Many LMIC are typified by food insecurity, socio-economic inequalities and fragile health systems which drive DBM patterns, as well as informal community structures such as rotating savings groups which influence access to healthier diets. RESULTS: Evidence indicates that DBM disproportionately affects disadvantaged households and complicates obesity management. Current clinical guidelines remain obesity-centric and often overlook contexts where individuals with obesity may also experience stunting or micronutrient deficiencies. CONCLUSIONS: This commentary aligns with global frameworks including WHO’s double-duty actions for nutrition, the UN Decade of Action on Nutrition (2016–2025) and the FAO-WFP food systems agenda. To achieve health equity, a coordinated approach is needed: clinical practice must improve diagnosis of co-existing undernutrition and obesity, while public policy must ensure that efforts to manage obesity are supported by food systems that provide equitable access to affordable, nutritious diets.