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:
"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:
The first three sub-studies in Masoud Vaezghasemi doctoral thesis were based on the IFLS dataset. The IFLS is conducted by the RAND Corporation in collaboration with other international and Indonesian partners such as Gadjah Mada University. Two of those sub-studies were conducted in collaboration with Professor SV Subramanian from the Harvard T.H. Chen School of Public Health in Boston, where Masoud spent one semester as a researcher.