Rachel Nugent POLICY SEMINAR Virtual Event - The New Nutrition Reality: Time to Recognize and Tackle the Double Burden of Malnutrition! DEC 1, 2020 - 09:30 AM TO 11:15 AM EST

1. Economic effects of the double
burden of malnutrition
Rachel Nugent
Vice President, Director, Center for Global NCDs
RTI International
1 December 2020

2. Purpose of Lancet Series Article #4
 Present the challenges of using existing economic models of
malnutrition to estimate impact of DBM
o No models exist that incorporate undernutrition and obesity
with data for common outcomes
 Demonstrate the potential to assess economic costs and benefits
of DBM interventions with an example

3. Methodology
BMI=body-mass index, NCDs=non-communicable diseases.
*Other positive outcomes result from the intervention (eg, school feeding
programmes lead to higher school attendance and health-care savings from
avoiding obesity)

4. Methodology for illustrating impacts of a double-duty
intervention
 Measured stunting and BMI changes in school children receiving
school breakfast
o Jamaica: Measured height change in cm among 407 2nd-5th
grade students
o USA: Measured BMI change for children between grades 1-12
 Simulated the impact of the intervention on those outcomes for 4-
5 year olds in Guatemala, Indonesia, and Nigeria for which we
had stunting and obesity data
o Chose this age range because of a lack of availability of data
for stunting in older children
 Obtained cost of school breakfast programs from multi-country
study (Gelli and Daryanani, 2013)

5. Paper provides two types of findings
 Assesses existing models for
suitability to measure DBM’s
economic impacts
o When measuring stunting,
current models generally
present findings in terms of
GDP loss or benefit-cost
ratios
o When measuring obesity,
current models generally
focus on cost-of-illness from
obesity and related diseases
o There are no existing models
that address DBM with full
distal and proximal risk
factors
 Estimates the economic impact of
an illustrative DBM intervention
o Economic benefits of school
breakfast program to address
DBM outweigh costs in a
simulation using data from
kids who are 4-5 years old in
Guatemala, Indonesia, and
Nigeria
o 54% of the economic benefits
are associated with avoiding
stunting and 46% of benefit
value associated with avoided
obesity

6. Conclusions – to make the case for investment in
preventing DBM
 Need to find a standardized definition of DBM at each level of
society where we wish to measure economic impacts
o Identify a small number of outcomes that can be meaningfully
applied to multiple populations over time (Example: BMI)
 Recommended steps
o Validate modeling tools that can project trends in
undernutrition and obesity for same age groups and time
scales
o Identify cost-effective double duty interventions
o Identify countries rich with epidemiological, health, agriculture,
nutrition, and demographic data in order to populate and
validate models