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

objectiveTo 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).

designThis 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.

resultsEvidence 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.

conclusionsThis 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.