The coexistence of both undernutrition and overweight/obesity, a phenomenon called double burden of malnutrition, is a global public health challenge existing at all levels from the individual to the population, especially in low-to middle-income countries. Research on malnutrition in Indonesia found that about 20 percent of households exhibit double burden of malnutrition. In his doctoral dissertation, Umeå University researcher Masoud Vaezghasemi emphasizes the importance of social and contextual determinants in fighting against both forms of malnutrition.

"In many ways, Indonesia is a prime example to study these phenomena," says Masoud Vaezghasemi. "As the fourth most populous country in the world, Indonesia is undergoing very fast transitions -- economically, demographically, health-wise and also nutrition-wise. The Indonesian diet transformed very fast from its traditional diets high in cereal and fibre towards Western pattern diets high in sugars, fat, and animal-source foods. This caused a swift increase in the prevalence of overweight and obesity while undernutrition remains a great public health concern."

The researchers started off with exploring the distributions of body mass index (BMI) across different socioeconomic groups in Indonesia using the Indonesian Family Life Survey (IFLS) dataset, which stands out as one of the biggest longitudinal health surveys outside the OECD. According to the results:

Difference in BMI among people from different socioeconomic groups became smaller while people within the same socioeconomic group became more differentiated over time.

Households were identified as a context having a great effect on the variation of BMI.

About 20 percent of all Indonesian households exhibited a double burden of malnutrition.

Households with a higher socioeconomic status had higher odds of double burden of malnutrition with the exception of women-headed households and communities with high social capital.

"At the contextual level, recognition of increased variation among households is important for creating strategies that respond to different needs of individuals within the same household," says Masoud Vaezghasemi.

In a subsequent sub-study, Masoud Vaezghasemi picked up on the findings in regards to gender relations and households' nutritional status. He conducted a qualitative study over two months in 2013 which included focus group discussions among rural and urban community members. The study was done in Indonesia's capital Jakarta, which is the place where the researchers had identified the highest percentage of dual burden of malnutrition, and in Central Java, where said share was the lowest.

The overall results captured the significance of gendered power relations, generational relations, and the emerging obesogenic environment. According to Masoud Vaezghasemi, the findings have three main implications:

Future intervention strategies in Indonesia must recognize that there are often different needs within the same household. When both underweight and overweight individuals live in the same household, interventions must be tailored to that or otherwise will create harm.

Since women-headed households across different socioeconomic groups and communities with high social capital had lower rates of malnutrition, women's empowerment and community social capital should be promoted to reduce inequalities in the double burden of malnutrition.

Community health and nutrition programmes need to address gender empowerment and engage men in the fight against the emerging obesogenic environment and increased malnutrition, especially among children.

Link to doctoral thesis: http://umu.diva-portal.org/smash/record.jsf?pid=diva2%3A1067919&dswid=2985