CHENNAI: A major international study conducted in Tamil Nadu has flagged a worrying nutrition transition among children from low-income urban communities, revealing that under-nutrition and obesity are increasingly coexisting within the same population by middle childhood.
The study, published in the The Lancet Regional Health – Southeast Asia on Wednesday (May 27), tracked 251 children born in urban slum settlements in Vellore between 2010 and 2012 and followed their growth patterns till the age of nine.
Researchers found that while a significant number of children continued to remain undernourished, obesity and overweight levels rose sharply after the age of five. The findings underscored what public health experts had been describing as the ‘double burden of malnutrition’ (DBM), a phenomenon in which thinness, stunting and obesity simultaneously affect vulnerable populations amid rapid dietary and lifestyle changes.
According to the study, nearly 45% of the children were stunted at the age of two. By the age of seven, 26.3% were classified as thin, while 5.2% had already become overweight or obese. At nine, underweight prevalence stood at 21.6%, while overweight and obesity rates climbed steeply to 14.6%.
Researchers said that the nutritional shift had become more visible after the age of five and intensified between seven and nine years, signalling the emergence of a new public health challenge in urban poor communities. “DBM emerged in mid-childhood after five years of age and worsened by nine years,” the researchers said.
The study was led by researchers from Christian Medical College (CMC), Vellore, along with scientists from Tata Institute of Fundamental Research and other institutions. The cohort formed part of the global MAL-ED study examining the impact of early-life nutrition and infections on child growth and development.
Researchers observed that children born with low birth weight remained significantly vulnerable to persistent thinness later in childhood. At the same time, some children born with normal birth weight eventually became overweight or obese, indicating a complex nutritional transition within the same socioeconomic group.
The study also identified a strong link between maternal health and childhood nutritional outcomes. Children born to mothers with low Body Mass Index (BMI) were found to face a substantially higher risk of thinness during later childhood.
“Low maternal BMI had a lasting effect on the BMI trajectory of the offspring,” the paper noted, highlighting the intergenerational dimension of malnutrition.
The report suggested that even as conventional under-nutrition continued among economically weaker sections, obesity was linked to processed food consumption, changing diets and sedentary lifestyles were steadily emerging among children. It warned that obesity could no longer be viewed as a disease confined to affluent populations. They stressed that poor children living in urban settlements were increasingly exposed to calorie-dense but nutrient-poor food environments.
The study called for long-term nutrition monitoring beyond early childhood and urged policymakers to strengthen interventions targeting maternal nutrition, school-age health surveillance and healthier food ecosystems. It said that addressing the worsening double burden of malnutrition would require integrated strategies combining maternal care, child nutrition programmes, physical activity promotion and regulation of unhealthy food environments.
Nearly 45% children stunted at age 2
By age 7:
26.3% thin
5.2% overweight/obese
By age 9:
21.6% underweight
14.6% overweight/obese
Obesity rise became sharper after age 5
Low maternal BMI strongly linked to child thinness
Even as conventional under-nutrition continued among economically weaker sections, obesity was linked to processed food consumption, changing diets and sedentary lifestyles were steadily emerging among children