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The dual burden household and the nutrition transition paradox

Abstract

OBJECTIVE:

The purpose of this study is to document the prevalence of households with underweight and overweight persons (henceforth referred to as dual burden households) and their association with income and urban residence. The explorations by urban residence and income will test whether dual burden households differ from ‘underweight only’ and ‘overweight only’ households, respectively. These comparisons are relevant to differentiating or adapting nutrition-related interventions wherever obesity and undernutrition cluster at the household level.

POPULATION:

Data analysis is based on national surveys conducted in Brazil, China, Indonesia, the Kyrgyz Republic, Russia, Vietnam and the United States.

METHODS:

All persons were first classified into categories for underweight and overweight, using body mass index (BMI) cutoffs, and then all households were categorized into four types: dual burden, overweight, underweight and normal. Income and urban residence were explored as key risk factors for being a dual burden household, with the effects modeled separately for each country. Multiple logistic regression was used to explore income and urban risk factors, controlling for household size, region of residence and either urban residence or income, as appropriate.

RESULTS:

In six of the countries studied, 22–66% of households with an underweight person also had an overweight person. Countries with the highest prevalence of dual burden households were those in the middle range of gross national product (GNP). The dual burden household is easily distinguished from the ‘underweight only’ households in Brazil, China, Indonesia, the United States and Vietnam. In these five countries dual burden households were more likely to be urban and more likely to be among the highest income tertile. There were no significant differences between dual burden and ‘underweight only’ households in Russia and the Kyrgyz Republic. In contrast, dual burden households were not easily distinguished from the ‘overweight only’ households in China, Indonesia, the Kyrgyz Republic, the United States and Vietnam. In Brazil and Russia dual burden households were more likely to be lower income and urban than ‘overweight only’ households.

CONCLUSION:

The prevalence of dual burden households presents a significant public health concern, particularly for those countries in the middle range of GNP. In some countries (China, Indonesia, the Kyrgyz Republic, the United States and Vietnam), dual burden households share sociodemographic profiles with overweight households, raising concerns for underweight individuals who may inadvertently become the focus of obesity prevention initiatives. For this reason, obesity prevention efforts should focus on messages that are beneficial to the good health of all, such as increasing fruit and vegetable intake, improving overall diet quality and increasing physical activity.

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References

  1. Steyn K, Bourne L, Jooste P, Fourie JM, Rossouw K, Lombard C . Anthropometric profile of a black population of the Cape Peninsula in South Africa. East Afr Med J 1998; 75: 35–40.

    CAS  PubMed  Google Scholar 

  2. Bourne LT, Langenhoven ML, Steyn K, Jooste PL, Laubscher JA, Bourne DE . Nutritional status of 3–6 year-old African children in the Cape Peninsula. East Afr Med J 1994; 71: 695–702.

    CAS  PubMed  Google Scholar 

  3. Florencio TM, Ferreira HS, de Franca AP, Cavalcante JC, Sawaya AL . Obesity and undernutrition in a very-low-income population in the city of Maceio, northeastern Brazil. Br J Nutr 2001; 86: 277–284.

    CAS  Article  Google Scholar 

  4. Garrett J, Ruel M . Stunted child–overweight mother pairs: an emerging policy concern? 17th International Congress of Nutrition. Ann Nutr Metab 2001; 45 (Suppl 1): 404.

    Google Scholar 

  5. Doak C, Monteiro C, Adair LS, Bentley ME, Popkin BM . Coexisting overweight and underweight within households is related to the nutrition transition. FASEB 2000; 14: A792.

    Google Scholar 

  6. Popkin BM . The nutrition transition in low-income countries: an emerging crisis. Nutr Rev 1994; 52: 285–298.

    CAS  Article  Google Scholar 

  7. Popkin BM . An overview on the nutrition transition and its health implications: the Bellagio meeting. Public Health Nutr 2002; 5: 93–103.

    PubMed  Google Scholar 

  8. Doak C, Adair LS, Monteiro C, Popkin BM . Overweight and underweight coexist within households in Brazil, China and Russia. J Nutr 2000; 130: 2965–2971.

    CAS  Article  Google Scholar 

  9. Doak C, Adair L, Bentley M, Fengying Z, Popkin B . The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China. Public Health Nutr 2002; 5: 215–221.

    PubMed  Google Scholar 

  10. Carolina Population Center. The China Health and Nutrition Surveys. Chapel Hill, North Carolina, University of North Carolina at Chapel Hill [On line] Available from: http://www.cpc.unc.edu/projects/china/china_home.html (Accessed July 8, 2004).

  11. RAND Corporation. Indonesia Family Life Survey. Santa Monica, California, Rand Corporation. [On line] Available from: www.rand.org/FLS/IFLS (Accessed July 8, 2004).

  12. Ackland R . The 1993 Kygyzstan Multipurpose Poverty Survey: Documentation. Washington, DC, Poverty and Human Resources Division, Policy and Research Department, World Bank. [On line] Available from: http://www.worldbank.org/html/prdph/lsms/country/kyrgyz/docs/kg93.pdf (Accessed July 8, 2004).

  13. Carolina Population Center. The Russia Longitudinal Monitoring Survey. Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, [On line] Available from: http://www.cpc.unc.edu/projects/rlms/rlms_home.html (Accessed July 8, 2004).

  14. Poverty and Human Resources Division, The World Bank. Viet Nam Living Standards Surveys (VNLSS), 1992–93: Basic Information [On line] Available from: Viet Nam Living Standards Survey, published by The World Bank, Poverty and Human Resources Division: 2004 is available on the world bank website: http://www.worldbank.org/html/prdph/lsms/country/vn93/vn93bid.pdf (Accessed July 8, 2004).

  15. US Department of Health and Human Services (DHHS) National Center for Health Statistics. Third National Health and Nutrition Examination Survey 1988–1994. Hyattsville, MD: Centers for Disease Control and Prevention, 1996. (NHANES III) [On line] Available from: http://archive.nlm.nih.gov/proj/dxpnet/nhanes/docs/doc/nhanes3/nhanes3.php (Accessed July 8, 2004).

  16. WHO Expert Committee. Physical status: the use and interpretation of anthropometry. WHO Technical Report Series No. 854. Geneva: WHO; 1995.

  17. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    CAS  Article  Google Scholar 

  18. SAS. Cary, NC, 1999.

  19. Corporation S STATA. College Station, TX, 1999.

  20. Gopalan C . Rising incidence of obesity, coronary heart disease and diabetes in the Indian urban middle class. Possible role of genetic and environmental factors. World Rev Nutr Diet 2001; 90: 127–143.

    CAS  Article  Google Scholar 

  21. Uauy R, Albala C, Kain J . Obesity trends in Latin America: transiting from under- to overweight. J Nutr 2001; 131: 893S–899S.

    CAS  Article  Google Scholar 

  22. Uauy R, Kain J . The epidemiological transition: need to incorporate obesity prevention into nutrition programmes. Public Health Nutr 2002; 5: 223–229.

    Article  Google Scholar 

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Acknowledgements

This research is supported in part by the US National Institutes of Health (NIH) (R01-HD30880 and R01-HD38700). Part of this paper was presented at the Experiment Biology meeting in 2002. We wish to thank Tom Swasey for his assistance with graphics and Frances Dancy for her administrative assistance.

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Correspondence to B M Popkin.

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Doak, C., Adair, L., Bentley, M. et al. The dual burden household and the nutrition transition paradox. Int J Obes 29, 129–136 (2005). https://doi.org/10.1038/sj.ijo.0802824

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  • DOI: https://doi.org/10.1038/sj.ijo.0802824

Keywords

  • dual burden
  • nutrition transition
  • multicountry
  • multiregional
  • household
  • urban

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