By Dinesh Arora and Nina Badgaiyan
FOR THE FIRST TIME in history, childhood obesity worldwide has overtaken the problem of being undernourished.
Among older children and adolescents aged five to 19, overweight and obesity more than doubled between 2000 and 2022, rising from 194 million to 391 million. Low- and middle-income countries now account for more than 80% of these cases.
In Asia and the Pacific, nearly one in 10 children remains underweight even as obesity rates are climbing in East and Southeast Asia, showing how undernutrition and obesity increasingly coexist within the same region.
Food environments are central to this crisis. The number of people consuming fast food and sugary drinks nearly equals those consuming the five recommended food groups, according to the 2024 International Food Policy Research Institute report.
Weak food safety systems add further risks, with unsafe food causing 600 million illnesses and 420,000 deaths every year — many of them children. Marketing of unhealthy products is pervasive: children in some countries see more than 100 online ads for sugary snacks and drinks each week.
A global UNICEF poll of young people found that three out of four had seen such ads in the previous week, and most said these increased their desire to consume the products.
The costs are immense. Malnutrition in all its forms — including undernutrition, micronutrient deficiencies, and obesity — can cut GDP by up to 3% annually. At the household level, obesity drives medical costs for diabetes and heart disease, while undernutrition continues to rob children of growth, learning, and opportunity.
The double burden of malnutrition is not inevitable.
Solutions exist, but they require bold choices. Nutrition guidelines from the World Health Organization and UNICEF stress food diversity and reduced consumption of ultra-processed foods. Yet these diets remain unaffordable for many households, as government subsidies still prioritize cereals over diverse nutrition. This policy paradox leaves families consuming what they can afford, not what is healthiest.
Governments and partners can act decisively to address the double burden of malnutrition by redesigning subsidy models — moving beyond cereal-heavy rations to diversified food baskets, tailoring meals in public programs to local food cultures and nutrition needs.
They can also promote dietary literacy by mainstreaming nutrition guidelines through schools, health centers, and community networks, while mobilizing self-help groups and frontline workers to improve household awareness.
Supporting local food systems is another step, leveraging indigenous crops such as pulses and millets, expanding nutrition-sensitive agriculture, and strengthening logistics to make diverse fresh foods more affordable.
Regulation and food safety can be strengthened by enforcing clear labeling, mandating front-of-pack warnings on sugar, salt, and fat, eliminating harmful trans fats, and ensuring stricter food safety oversight.
Healthier school environments can be created by setting nutrition standards for meals, banning junk food sales, and integrating food literacy programs, as Mexico has done for over 34 million children.
Fiscal measures can be implemented to tax sugary drinks and ultra-processed foods while subsidizing healthy staples. Mexico’s soda tax decreased purchases by 10% in two years, with the strongest impact among low-income households.
Policy should also be safeguarded from industry interference by adopting conflict-of-interest safeguards to ensure public health remains the priority.
Governments and partners can measure what matters by tracking dietary diversity, marketing exposure, and nutrition outcomes to hold systems accountable and inform evidence-based reforms.
The double burden of malnutrition is not inevitable. It is the result of policy choices and weak regulation. With stronger food safety systems, smarter fiscal tools, and regulation that prioritizes health over profit, countries across Asia and the Pacific can reshape food environments to nurture healthier generations.
The stakes are high, but decisive action today can yield lasting returns in education, productivity, and sustainable development.
The views expressed are those of the authors and do not necessarily reflect the views of the Asian Development Bank, its management, its Board of Directors, or its members.
Dinesh Arora is a principal health specialist at ADB’s Sectors Department. Nina Badgaiyan is a senior consultant on Public Health at ADB.
