Abstract Objective: To discuss the growing challenge of the double burden of malnutrition (DBM); the co-existence of under-nutrition and obesity and the associated clinical and policy complexities in low- and middle-income countries (LMICs). Design: This commentary synthesizes evidence from recent multi-country and country-specific studies in sub-Saharan Africa and other LMICs. Many LMICs are typified by food insecurity, socioeconomic inequalities, and fragile health systems which drive DBM patterns, as well as informal community structures such as rotating savings groups which influence access to healthier diets. Results: Evidence indicates that DBM disproportionately affects disadvantaged households and complicates obesity management. Current clinical guidelines remain obesity-centric and often overlook contexts where individuals with obesity may also experience stunting or micronutrient deficiencies. Conclusions: This commentary aligns with global frameworks including World Health Organization’s double-duty actions for nutrition, the United Nations Decade of Action on Nutrition (2016–2025), and the FAO-WFP food-systems agenda. To achieve health equity, a coordinated approach is needed: clinical practice must improve diagnosis of co-existing undernutrition and obesity, while public policy must ensure that efforts to manage obesity are supported by food systems that provide equitable access to affordable, nutritious diets.
Lukwa et al. (2026) studied this question.