health ,Nutritionally induced diseases ,Children Growth ,

Garrett, James L.

Ruel, Marie T.

English

Research Papers in Economics

 
Discussion Paper 148 
Stunted Child-Overweight Mother Pairs:  
An Emerging Policy Concern? 
James L. Garrett and Marie T. Ruel 
 
ndernutrition is often thought of as reflecting 
conditions that affect all members of the 
household: lack of income, not enough food, and 
unhygienic surroundings. Under this assumption the 
intrafamiliar association of nutritional status should be 
strong. In fact, many development agencies use child 
undernutrition as a key indicator of household poverty 
and deprivation. The coexistence of underweight and 
overweight individuals in the same household presents a 
conundrum that highlights the importance of individual-
level factors. It also complicates efforts to improve 
nutrition. Strategies that once focused only on raising 
incomes, improving water and sanitation, or elevating the 
availability of food for the household must now pay close 
attention to individual factors, addressing multiple and 
perhaps somewhat conflicting causes of over- and 
undernutrition within the same household. 
Background and Overview 
 Poverty continues to exist in developing countries, but 
many of these countries are also confronting health risks 
from diseases associated with excess, such as diabetes and 
obesity. These diseases are associated with increased 
economic development and urbanization, which lead to 
changes in diets, consumption of more processed foods, 
and decreased levels of physical activity. This shift in the 
nature of problems of disease and nutrition in many 
developing countries has been termed 
the nutrition transition. 
Studies now show that this co-
existence of under- and overnutrition 
exists not only at the societal but also 
the household level. This study exam-
ines one particular aspect of this phe-
nomenon: the occurrence of a stunted 
(undernourished) child in the same 
household as an overweight (overnourished) mother. We 
term this pairing of a stunted child with an overweight 
mother SCOWT. The objectives of the study are to 
quantify the global prevalence of SCOWT, explore its 
association with economic development and urbanization, 
and highlight policy directions for the public nutrition 
community. 
Design 
Data from 36 recent Demographic and Health Surveys 
were used (23 in Africa, 8 in Latin America, and 5 in 
Asia). Stunting was defined as height-for-age <-2 SD of 
the reference population and maternal overweight as body 
mass index (BMI) of >25 kg/m
2. World Bank and United 
Nations figures were used for GNP per capita (our 
indicator of economic development) and for level of 
urbanization, respectively. Descriptive statistics were 
derived, and regression analysis was used to model the 
association between economic development, urbanization, 
and the prevalence of SCOWT. 
Results 
The range of overweight mothers is remarkably large, 
even within a region. In Africa, for instance, 4 percent of 
mothers were overweight in Madagascar as compared to 
55 percent in Egypt. Overweight mothers were practically 
nonexistent in the Asian countries of Bangladesh and 
Nepal, but quite common in Latin America. With the 
exception of Haiti, more than 30 percent of mothers in the 
Latin American countries studied were overweight. 
Childhood stunting remained a problem as well, even in 
urban areas and in countries with a high prevalence of 
overweight mothers. For instance, in Egypt and Bolivia, 
the countries with the highest prevalence of overweight 
mothers, more than one-quarter of children 6 to 60 
months old were stunted. 
  Overweight mothers and stunted children do not nec-
essarily occur in the same household, but we also found 
a    range  of  instances 
where they do. Still, the 
prevalence of SCOWT 
was generally below 10 
percent, except for four 
countries. In these coun-
tries (Bolivia, Guate-
mala, Nicaragua, and 
Egypt), the prevalence 
of SCOWT ranged from 10 to 14 percent. Surprisingly, 
SCOWT was not always more prevalent in urban than in 
rural areas. In Latin America, except for Haiti and Peru, 
SCOWT was actually higher in rural areas. 
In addition to associations of SCOWT with economic 
development and urbanization, the regression model 
tested for regional and urban-rural differences. We found 
that the association of SCOWT with development and 
urbanization does not differ between rural and urban 
areas, a conclusion in line with the descriptive statistics 
that  showed  prevalence  was  sometimes  higher  in rural  
U
 
Discussion Paper BRIEFS 
Food Consumption and Nutrition Division of the International Food Policy Research Institute 
Policymakers face a serious challenge in 
dealing with conflicting demands of 
dietary excess and deprivation, not only 
within the same population, but also 
within the same household.  
areas. However, we found that SCOWT is associated with 
urbanization, though not urban residence, in Latin 
America (although this does not hold for Asia or Africa). 
Economic development is associated with SCOWT in all 
three regions. 
Discussion 
We expected SCOWT to emerge as part of the nutrition 
transition, but not that SCOWT might be more prevalent 
in rural areas. And in contrast to our expectations, one 
might also think that malnutrition, and SCOWT, would 
decline with economic development and with a higher 
percentage of the population living in the cities. 
  What might lie behind these results? First, the 
prevalence of SCOWT is affected by the rates of 
childhood stunting, which is consistently higher in rural 
than urban areas, and by the prevalence of maternal 
overweight, which is currently escalating in rural areas of 
many countries in the nutrition transition. In addition, the 
results suggest that SCOWT is related to urbanization, 
although not necessarily urban residence. The lack of 
association of SCOWT in Africa and Asia with urbaniza-
tion may be because of relatively low levels of urban-
ization and consequently of the prevalence of factors 
associated with an ￿urban lifestyle￿ and the nutrition 
transition in those regions. 
SCOWT is one expression of a phenomenon observed 
by other authors that intrafamiliar association of 
nutritional status declines with increases in economic 
development. The exact reasons for this dissociation are 
unknown, but we propose some hypotheses. For example, 
in more economically developed societies like those of 
Latin America, the problems of low incomes and lack of 
food are relatively less binding. Undernutrition may be 
associated less with these household factors and more 
with specific diseases or individual characteristics. 
Additionally, in countries undergoing the nutrition 
transition, members of the household are probably not 
experiencing the changes in physical activity and diet 
uniformly, leading to different individual outcomes. On 
the other hand, the poor dietary quality also associated 
with urbanization could provide a common determinant 
for SCOWT. Low dietary quality in children usually 
results in inadequate nutritional intake, causing poor 
growth. In adults, low quality diets may result in 
micronutrient deficiencies and increase the risk of obesity. 
Policy and Program Challenges 
The prevalence of SCOWT at a significant level in Latin 
America and the more economically developed countries 
of Africa and Asia underlines the fact that policymakers 
and programmers can no longer assume that those 
households with malnourished children are simply in need 
of ￿more food.￿ They must tune their antipoverty and 
food and nutrition programs to a more complex reality. 
Policymakers may need to emphasize changes in 
individual dietary and activity patterns and in caring and 
feeding behaviors, including dietary quality, not only 
general household access to food. They face a serious 
challenge in having to deal with conflicting demands of 
dietary excess and deprivation not only in the same 
population but also in the same household. 
Experiences in Brazil, China, and Finland suggest a 
number of elements of successful programs to confront 
increased health risks associated with the nutrition transi-
tion, but there are few examples of programs that simul-
taneously and directly address the other half of the prob-
lem: undernutrition. China￿s development of a diet-quali-
ty index and food guide pagoda is one of the few exam-
ples to do so. The concrete recognition of SCOWT could 
be an important step to delineating public nutrition strate-
gies that explicitly take this dual challenge into account. 
Keywords: DHS (Demographic and Health Surveys), 
malnutrition, nutrition transition, overweight, 
stunting, urbanization 
The full text of this document and other FCND Discussion Papers are available on our Website 
(www.ifpri.org/divs/fcnd/dp.htm) or via B.McClafferty@cgiar.org 
 
 
 
FCND BRIEFS 
 
International 
Food 
Policy 
Research 
Institute 
 
 
2033 K Street, N.W. 
Washington, D.C. 20006 U.S.A. 
 
Policymakers face a serious challenge in dealing with 
conflicting demands of dietary excess and deprivation, not 
only within the same population, but also within the same 
household.￿DP148 

Stunted child - overweight mother pairs

http://www.ifpri.org/sites/default/files/publications/fcnbr148.pdf

Stunted child - overweight mother pairs

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