The double burden of malnutrition: coexistence of stunted children and overweight and obese mothers in Sri Lanka

Abstract Objective: Sri Lanka faces a double burden of malnutrition (DBM), characterised by the persistence of child undernutrition alongside rising rates of obesity and non-communicable diseases among women. This study aimed to quantify the prevalence of DBM and identify specific household, maternal, and child-level risk factors associated with stunted child–overweight/obese mother pairs in Sri Lanka. Design: Data from the 2016 Sri Lanka Demographic and Health Survey were used to assess the risk of double burden pairs through multinomial logistic regression, adjusting for individual, socioeconomic, and geographic factors. The primary outcome measures were child stunting, classified according to height-for-age Z-scores, and maternal body mass index. Households with a stunted child and an overweight or obese mother were classified as having a DBM. Setting: A nationally representative sample covering all geographic regions of Sri Lanka. Participants: 5,975 mother-child pairs, comprising children aged 6-59 months and mothers aged 15-49 years with complete anthropometric data. Results: Overall, 8.3% of households had a stunted child with an overweight mother, while 2.8% had a stunted child and an obese mother. Child’s age, low birth weight, maternal age, household size, mode of delivery, wealth status, and province of residence were significantly associated with the double burden among child–mother pairs ( p <0.001). Ethnicity was also significant, with Muslim mothers more likely to reside in households experiencing DBM (p < 0.001). Conclusion: DBM poses a critical nutritional challenge in Sri Lanka, necessitating comprehensive, integrated interventions targeting both child stunting and maternal overweight to improve health outcomes and reduce long-term disease risk at the household and population levels.