Socio-Ecological Factors and the Double Burden of Malnutrition (DBM) Among Children and Adolescents in Low- and Middle-Income Countries (LMICs)

October 19-20, 2022 (12:30-5:30 p.m.)


Office of Global Health (OGH), Office of the Director (OD), NICHD




Among child populations, DBM has been defined as the coexistence of undernutrition (i.e., micronutrient deficiencies, underweight, and childhood stunting and wasting) and overweight, obesity, and diet-related noncommunicable diseases (NCDs) at the individual, family, and/or community levels.1,2 DBM is becoming particularly problematic in the poorest LMICs, largely due to increases in people affected by overweight and obesity.1

To better understand the factors contributing to these DBM increases, researchers proposed the socio-ecological model (SEM) as a more holistic approach that acknowledges multiple levels of influence (i.e., individual, interpersonal, community, organizational, and policy) that affect health outcomes.3 SEM aims to identify significant correlates and characteristics of target populations most in need of intervention.

This conference will examine the recent etiological and socio-ecological factors contributing to this increased DBM prevalence, and the implications for long-term health outcomes among children and adolescents (ages 3 to 18 years) in LMICs. It also will focus on how to address DBM by examining the following four SEM factors:

  • Behavior changes for healthy eating and lifestyle practices (e.g., nutrition/physical activity)
  • Social determinants of health (e.g., cultural, socioeconomic, environmental, political, etc.)
  • The double-duty approach to interventions, programs, and policies that simultaneously addresses shared drivers for undernutrition and obesity/NCDs4
  • Implementation science to be responsive to complex systems and frameworks5

Participants and presenters will explore evidence-based interventions, identify important research questions, and discuss policy implications toward improving nutrition and health outcomes of youth globally.

Closed captioning will be available through NIH VideoCast. Individuals who need any other reasonable accommodations to participate in this activity should contact Raquel McConnico at or 301-798-5619 at least 5 days in advance.

More Information

Download the following materials:

Presentations and Videocast Recordings

Videocast Recording:

Videocast Recording:


Dr. Jenelle Walker, OGH, OD, NICHD 

Dr. Vesna Kutlesic, OGH, OD, NICHD


  1. Popkin, B. M., Corvalan, C., & Grummer-Strawn, L. M. (2020). Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet, 395(10217), 65-74.
  2. Wells, J. C., Sawaya, A. L., Wibaek, R., Mwangome, M., Poullas, M. S., Yajnik, C. S., & Demaio, A. (2020). The double burden of malnutrition: Aetiological pathways and consequences for health. The Lancet, 395(10217), 75-88.
  3. Mahmudiono, T., Segalita, C., & Rosenkranz, R. R. (2019). Socio-ecological model of correlates of double burden of malnutrition in developing countries: A narrative review. International Journal of Environmental Research and Public Health, 16(19), 3730.
  4. Hawkes, C., Ruel, M. T., Salm, L., Sinclair, B., & Branca, F. (2020). Double-duty actions: Seizing programme and policy opportunities to address malnutrition in all its forms. The Lancet, 395(10218), 142-155.
  5. Perez-Escamilla, R., Bermudez, O., Buccini, G. S., Kumanyika, S., Lutter, C. K., Monsivais, P., & Victora, C. (2018). Nutrition disparities and the global burden of malnutrition. BMJ (Clinical Research Edition), 361, k2252.
Please note: Views expressed during NICHD-sponsored events do not necessarily reflect the opinions or the official positions of NICHD, NIH, or HHS.
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