Overcoming the ‘Double Burden’ of Malnutrition

by Rachel Borton

August 17, 2018

Despite the fact that obesity is often discussed in this country as though it’s an individual failing, mounting evidence illustrates that the United States’ rising obesity epidemic is more likely a societal problem tied to rising economic inequality. Why? Because one of the primary variables related to obesity is not genes, race, or presence of a raging sweet tooth: it is poverty.

The poverty-obesity link is especially impactful for children, since those who experience obesity early in life are much more likely to be obese as adults. And because children living in low-income neighborhoods are 20 to 60 percent more likely to be obese than those in more affluent areas, poorer children are likely to grow up challenged by many health problems associated with obesity: diabetes, heart disease, osteoarthritis, asthma, and others.

Fortunately, there are ways low-income families can take small yet meaningful steps toward helping their children escape what is known as the “double burden of malnutrition”—that is, obesity that occurs alongside malnutrition.

Obstacles to Healthy Living

There are several reasons why the most nutritious foods may never make it onto the plates of children in low-income homes, and why those preferable foods might be replaced with high-calorie, high-sugar, and low-nutrient alternatives. To begin with, even simple meals built around lean proteins and fruits and vegetables take time and some skill to prepare, and low-wage jobs often require that parents work around the clock, leaving no one at home to turn on a burner or mix up a salad. Left to their own devices, many children and teens will reach for the fastest and easiest alternative—and, as it turns out, this option is often the least nutritious.

Contributing to this problem is the fact that many low-income communities in the U.S. also qualify as “food deserts,” which the USDA defines as a community where at least a third of the population lives greater than one mile from a supermarket or large grocery store. In food deserts, the most accessible food is what can be found for sale at gas stations and convenience stores—businesses where it’s much easier to find a wide variety of prepackaged, high calorie, least nutritious food.

Finally, organic options often come with a higher price tag—which can prove prohibitive for families on a tight budget.

Policy Proposals

The Supplemental Nutrition Assistance Program (SNAP), which provides food assistance to low-income households, could gain importance as an avenue for promoting healthier diets on a national scale. Groups including the Bipartisan Policy Center have recommended expanding financial incentives for SNAP participants who buy fresh fruits and vegetables, as well as for retailers that stock them. Some experts have also called for restrictions on the use of SNAP dollars to purchase unhealthy items like sugary beverages.

Other proposed policy solutions include expanding nutritional counseling services through the federal Medicaid program, imposing taxes on processed foods, and increasing funding for obesity research.

Overcoming Obstacles through Lifestyle Changes

When working with malnourished children who are also obese it is important to confront the weight loss situation one piece at a time. The first step should be to attempt to investigate and understand their lifestyle, diet, and conditions at home. After that foundational work has been completed, the next step is to enable and empower the families to come up with solutions. The following steps can prove vital in improving nutritional standards and overall health outcomes for these children.

  • • Meal preparation is key. The head or heads of household should sit down and figure out the weekly meal budget. Then, they can determine what they can feasibly cook with that amount of money. Beginning the meal-planning process with a cookbook like this one, which promises to help the reader “eat well on $4 a day,” can be a great starting point.
    • Many healthy meals can be repurposed so that one night of meal prep can provide meals for the week. Ingredients can be purchased in bulk when on sale. Intentional meal prepping is critical to successful meal planning in terms of allocating both time and money to purchase and cook the food.
    • Canned and frozen produce is often cheaper than fresh varieties—and money is less likely to be wasted on produce that spoils easily. Canned foods are often easier for older children to cook on their own, so integrating these food staples can be a more manageable step in the right direction.
    • Identify school and community meal programs for children whose parents work early in the morning and/or into the evening can be very beneficial. Organizations that provide such resources include Feeding America, Food Research & Action Center, and many more. Parents can inquire at local public schools about programs in their community.
    • Encourage the entire family to get involved in the conversation. For example, parents can ask children about their activity levels and how they would like to get moving more. Perhaps they have an interest in sports. Many city-based sports programs are quite inexpensive and are subsidized to support wide inclusion.
    • Demonstrate to parents the value of modeling good behavior and encourage a family approach to eating healthy food. Success will be highly dependent on whether everyone is dedicated to unified goals: eating right, staying active and trying not to eat after 7pm—a healthy habit that has been shown to contribute to weight loss.
    • Encourage children of all ages to get involved in meal planning and preparation with age-appropriate tasks. Even children in junior high can be instructed how to have a few simple, healthy meals that they can prepare unassisted.
    • Start with small goals and give children ownership over their choices to make it less daunting. For example, establish a goal of committing to 15 minutes of vigorous activity (walking, running, biking, etc.) at least 5 times a week and then increase from there. Take the time to explain in easy to understand language to parents and children that healthy foods and increased activity will help to prevent against chronic disease such as diabetes and high blood pressure. And remind them that healthy choices now will prevent against childhood as well as adult onset of chronic disease.

Although challenging life situations are unavoidable, it’s possible to take intentional steps toward a better diet. Remember, it’s not enough to just tell someone to lose weight and buy nutritious food—they need actionable items they can take that acclimate and accommodate with their lifestyle.

Author Biography: Rachel Borton is the director of the Family Nurse Practitioner online program at Bradley University. Professor Borton’s advanced practice clinical experience includes urgent care, maternal-child, and family practice. In family practice, Professor Borton is passionate about preventing childhood obesity and educating families about healthy choices that will help prevent obesity in adult

*This is an independent article and does not necessarily reflect the views of WHES.

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