Triple Burden What? Talk About Micronutrient Deficiencies

If you thought double burden of malnutrition (coexistence of undernutrition and obesity) was bad, there is even a Triple Burden. Triple burden of malnutrition is the coexistence of three diseases: undernutrition, micronutrient deficiency and obesity. Micronutrient deficiency is also referred as ‘hidden hunger’ which is the lack of vitamins and minerals. 

Compared with the other two diseases, micronutrient deficiency does not necessarily have to be visible from the outside. Undernutrition and micronutrient deficiency together is a problem which often affects individuals, but micronutrient deficiency and obesity is a combination that occurs as well. This happens when an individual eats too many calories a day, but not the right minerals, vitamins etc. The intertwining of all three of these contribute to the triple burden. This burden can be traced back to poverty, a lack of access to adequate diet, poor infant feeding practices, and the sales of unhealthy and cheap processed foods that combined, all lead to undernutrition, micronutrient deficiency, and overweight and obesity! 

There are different symptoms micronutrient deficiency, because there are different micronutrients. Deficiency in iron for example, can cause fatigue, weakness, headaches, and pale skin. It can even cause cravings to items which isn’t food, like clay. Another example of micronutrient deficiency is calcium deficiency. Symptoms are weak hair and nails, memory loss, and seizures. The list is long of the different micronutrient deficiencies and I could go on forever, but the picture is clear that micronutrients are important. So eat your veggies kids.

plaatjeMaybe you noticed, but besides the symptoms of micronutrient deficiencies that may not be very pleasant, they also can vary. So there are not really distinctive symptoms that says “You have a micronutrient deficiency.” For instance in some studies they used mid-upper-arm circumference to detect nutrient deficiency. The smaller the mid-upper-arm circumference, the greater the chance of having a micronutrient deficiency. But think about this– For the combination undernutrition and micronutrient deficiency, this would be a good method, but for the combination of obesity with micronutrient deficiency, this would not work. And also for people with a normal BMI (and thereby normal mid-upper-arm circumference) this method would not be suitable. 

Anyways, going back to Indonesia. A lot of children (and adults) are undernourished and also have a micronutrient deficiency, however, obesity is also a problem that occurs additionally. Therefore, the triple burden of malnutrition is present in Indonesia! 

So by tackling the problem undernourishment, strategies should also take the micronutrient deficiency in consideration, as well as the problem of obesity in Indonesia. The Australian government actually helped to use strategies to combat undernutrition and micronutrient deficiency for Indonesia. The Australian government did not try to just provide food, but also made up for the micronutrient deficiency. However, they did not take into consideration the problem of obesity when implementing the interventions. What can be a good way to implement all three problems into one intervention? Is it possible?

Fun factDid you know you could have micronutrient deficiency which is not food related?

A micronutrient deficiency of vitamin D. You get this vitamin of the sun, but if an individual does not get in a lot of contact with the sun, he or she can not get this vitamin. In Indonesia this problem occur, especially with women. This is because they cover up a lot of there body for their religion.

Written by: Una

The Faces of Malnutrition. (2016, July 20). Retrieved December 1, 2016, from

Hungry behavior

Today, malnutrition is becoming an epidemic. It has a huge effect on the population’s health.  Logically, social outcomes are huge too.  Because we all know: When we’re hungry.. we are not at our best mood.

The effect of malnutrition already starts before birth.  Pregnant women that are suffering from malnutrition tend to have children with behavioral problems later in life. Prenatal malnutrition leads to children with less playful behaviour, whether the children are being malnourished or not. But: Malnourished mothers are more likely to have underweight children. These children will in turn have a higher risk of physical and cognitive impairment. This contributes to the cycle of poverty, because if children do not function well socially, they are less able to work, contribute to local economies, and provide care for their families later in life.

Increased aggressive behavior seems to be a relatively large social consequence of being overweight and malnourished. A high sugar diet seems connected with a high level of hyperactivity within children’s behaviour, while undernourished and underweight children on the other hand show more apathic and nonactive behavior. Malnourished children are known to be less social and less interested in having social relationships with their peers.

The absence of secure relationships can affect physical security. Not having good social relationships in child- and adulthood can result in not feeling safe at home(being shut out) and eventually in feelings of anxiety. Malnutrition thereby is known to cause  people to be at risk for staying single. Obese women have more trouble finding a sexual partner than normal-weight women. Also, these women tend to be at risk for getting pregnant unplanned. On the other hand, being married and malnourished causes people to be less happy in the marriage. This can trigger depression, distorted body image and low self-esteem, which can be a real problem in marriage or other social relationship.

Besides that, malnutrition causes other behavior problems. Bullying, but also being bullied are social outcomes that can affect the population.  One possible, but so far untested, hypothesis is that early malnutrition predisposes to antisocial behavior because malnutrition affects neurocognitive functioning. Considered is that malnutrition slows down the process of learning how to make rational decisions.  This makes malnourished children and adolescents even more sensitive. They are also much more influenced by “emotional context”.  Besides, they seem to be even more sensitive to the advertising of advertising of food than people that do not suffer from malnutrition, and in particular to the large amount of junk food available in Indonesia.

There also seems to be a trend in weight and socio-emotional- and behavioral problems. Bullying, but also being bullied can make people feel excluded or shut out and lonely. The more you weigh, more problems appear. Also, the chance of having anxiety and depressive feelings is growing. The same effects are happening with being underweight. These effects not only have impacts on the social life, but you can imagine that it also has impacts on the behavior at school and work too.

As you can see by building up our blog, the facts of the problems linked and caused by malnutrition in Indonesia are adding up. This growing problem affects all kinds of aspects of the life of the Indonesian population. We hope this makes clear that it must really be a priority in Indonesia to address this double burden of disease.

Written by Eline


Hernandes AS, Almeida SS. Postnatal Protein Malnutrition Affects Inhibitory Avoidance and Risk Assessment Behaviors in Two Models of Anxiety in Rats. 2013. Pp. 213-219

Liu, J., Raine, A., Venables, P. H., & Mednick, S. A. (2004). Malnutrition at age 3 years and externalizing behavior problems at ages 8, 11, and 17 years. American Journal of Psychiatry161(11), 2005-2013.

Almeida, S. D. S., Tonkiss, J., & Galler, J. R. (1996). Prenatal protein malnutrition affects the social interactions of juvenile rats. Physiology & behavior60(1), 197-201.

Wester M. (2006) Sociale aspecten van overgewicht bij kinderen.  Rijksuniversiteit Groningen. Available from

Seipel, M. M. (1999). Social consequences of malnutrition. Social Work44(5), 416-425.

Malnourishment: Is It Only Affecting Indonesia?

obese%20womanMalnutrition can affect all areas of health and be detrimental to daily activities. The insidious nature of malnourishment is that eating either too much or too little causes this issue. How can you make sure you’re eating properly?
Though undernourishment predominantly occurs in low and middle-income countries (LMIC), this pervasive health issue burdens high-income countries as well. Overnutrition in the United States affects about 55% of the population and 85% of Americans lack essential vitamins; this is not just an issue in Indonesia1, 2.

Interventions for malnutrition-related issues in Indonesia involve financial support for affected families as well as nutritional education. While you may not have severe financial constraints affecting your nutrition, making healthy choices is difficult when you are surrounded by delicious, cheap food that lacks nutritional value.

So, what are some good ways to prevent malnutrition3?

  1. When making dietary choices, focus on the variety, nutritional value and amount of food chosen.
  2. Make sure to fill your plate with vegetables, fruits, grains and proteins. Additionally, while oils are not technically a food group, health oils should be consumed in moderation.
  3. Choose options lower in saturated fat, sodium and added sugars.
  4. Make sure to read nutrition labels on all prepackaged products. Often times, making recipes from scratch is the easiest way to eat healthy!

You can check out the United States public health initiative, Choose My Plate, in order to build your own nutritious meal plan and learn more about healthy lifestyle choices; there is even a section about eating healthy on a budget! Make an eating plan that is both healthy and nutritious at:

The only potential issue with the website is the recommendation of dairy as a necessity, you can have a healthy lifestyle without the consumption of dairy products, just make sure to get your calcium, vitamin D and potassium elsewhere.

Empower yourself to make the eating choices that are best for your body!


Written by: Devon Boullion


1Chopra, M., Galbraith, S., & Darnton-Hill, I. (2002). A global response to a global problem: the epidemic of overnutrition. Bulletin Of The World Health Organization, 80(12), 952-958.

2Guardian New and Media Limited, (2015). Hidden hunger: America’s growing malnutrition epidemic. The Guardian. Retrieved from

3U.S. Department of Agriculture. Website. Washington, DC. Build a Healthy Eating Style. Retrieved from

What’s the Deal With Smoking and Malnutrition?

It seems like it is all we hear: Smoking is bad for you!

Yes, we know that by now.. smoking causes a lot of bad health outcomes. High risk of cancer, respiratory problems, heart diseases, etc. appear as consequences to smoking tobacco. But did you know it has a significant effect on  weight and nutrition status too?

Just like alcohol, tobacco smoking promotes malnutrition in two ways:

  1. The smoker’s diet consists of less nutritional value
  2. Smoking holds the body back in taking up the vitamins and antioxidants from food.  Deficits in vitamins C and E are the consequences of just smoking only 1 cigarette a day!!

Adding up to this, smokers frequently show a deficient in vitamin A, which normally protects the body from lung infections, which might lead to cancer later on in life.

Many studies and investigators are prone on this topic, since the population of Indonesia is especially affected. It ranks third in the number of men smokers and 17th for women smokers. The country is the third-largest cigarette consumer in the world. Speaking numbers..  there are approximately 57 million smokers in Indonesia. In comparison, this amount of smokers is almost 20 times larger than in The Netherlands..

Cigarette smoking is widely associated with reduced body weight, an effect which has often been attributed to the nicotine. However, When you smoke tobacco, you can have a reduced feeling of hunger.  This causes smokers to lose weight. According to the findings, Smokers weigh 3 to 5 lbs. less than nonsmokers.

Smoking during pregnancy not only causes Indonesian women to be undernourished, they are known to give birth to babies with a significant lower birth weight. These children are also known to have a high potential of getting undernourished and being obese in the future.

Even worse, smoking among children under 18 is happening there. 41 percent of 13 to 15 year-old boys smoke, according to the World Health organization. This has immense effects on the child’s health in later life. Resulting in reduced height and malnutrition. The effect of child smoking has shown higher risks in both being underweight and overweight. In 2015, a video on youtube caused a lot of commotion. The shocking video (you can find the video below) showed an Indonesian baby boy called Aldi Rizal smoking 40-cigarettes a day when he was just 2 years old.

Smoking does not only have consequences on health.. Investigators found that 68 percent of a family’s money monthly is spent on food, whereas in a nonsmoking family, this percentage was just over 75 percent.  This implies that that 70 percent of the expenditures on tobacco products are financed by a reduction in buying food. This decrease in food-spending has immense nutritional consequences for children whose parents smoke, resulting in a decrease in height (which is often used as a variable in measuring nutrition in children. Besides spending less money on food, smoking families tend to buy food that is lower in quality. This is often because the high-nutrient products such as fruit, vegetables and meat is more expensive.

Written by Eline


Shils M, Shike M, Ross A, Modern nutrition in Health and Disease. 10th edition. Lippincott Williams & Wilkins. New York. Part V  Prevention and management of disease.

World Health organization. Global Adult Tabacco Survey: Indonesia Resport 2011.

Rijksinstituut voor volksgezondheid en Milieu. CBS-Gezondheidsenquête, CBS-GE. 2016.

Perkins, K. A., Sexton, J. E., DiMarco, A., & Fonte, C. (1994). Acute effects of tobacco smoking on hunger and eating in male and female smokers. Appetite, 22(2), 149-158.

Steven A. Block and Patrick Webb. Up in Smoke: Tobacco Use, Expenditure on Food, and Child Malnutrition in Developing Countries. 2009. Economic Development and Cultural Change, 58:1.

How the Trouble Doubled

So what exactly is a double burden of malnutrition?

So what does it mean? The definition of WHO is

The double burden of malnutrition is characterised by the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases, within individuals, households and populations, and across the lifecourse.

Low- and middle-income countries are especially affected by the double burden of malnutrition. The rate of the double burden of malnutrition in low-and middle-income countries is 30% faster than in high income countries. Although the number of undernourished children in Indonesia has overall been decreasing over the past 14 years, more and more children are also becoming overweight. However as the specific number of undernourished children is decreasing throughout the years, there are still 8.4 million children stunted due to undernutrition, which is 37.2% of children under the age of five.

The double burden of malnutrition does not only apply on the national level, but could also be applied on an individual-level.  For example, a child who is undernourished, will have a higher risk of getting non-communicable diseases such as diabetes. Even in the utero – before they are even born – a lower weight (underweight) can lead to diabetes and heart diseases later in life. The double burden of malnutrition could also be practiced in just one household: a mother could be overweight, but her child could be undernourished mainly due to feeding practices.

1975-lHow is the double burden of malnutrition even possible? Undernourishment is understandable. Lack of money and poverty can lead to the lack of food and thereby undernourishment. But somehow a country who deals with this poverty problem, also has to deal with obesity, which can imply that people are consuming too much food or more specifically, an overconsumption of sugary and fatty foods.

Well, as technology and  (food) industries developed throughout the years, lifestyle changed as well. Nowadays, fast food is quite accessible and can be cheap. We all know that too much of this type of food isn’t healthy, because it contains, for example, “bad” saturated fats, too much sugars, too much added salt and so on, which can lead to obesity. Furthermore we are leading a more sedentary lifestyle with our cars, tv’s, mobiles, tablets and computers around us, which also contributes to the obesity problem because of the lack of exercise to live a healthy life. And than we have smoking, drugs and drinking: famous lifestyle habits that influence our health in a negative way and makes the chances of developing non communicable diseases(NCD’s) even higher.

But wait a minute, there is another definition of double burden of disease! Yes, this refers to a country which is tackling NCD’s and communicable diseases (CD’s). To understand this definition, you should understand the epidemiological and demographic transition.

The epidemiological transition refers to a slow shift of a country’s health status from a situation in which the presence of communicable diseases (CD’s) are dominant towards a situation in which the presence of non-communicable diseases (NCD’s) are dominant and the CD’s are reduced. These transitions have already occurred in high income countries. Did you notice that high income countries are more concerned with NCD’s like cancer, diabetes, vascular diseases and so on, instead of infectious diseases? This is because infectious diseases are much better controlled nowadays in the high income countries than it used to be in the 19th century.


So let’s talk about the demographic transition (we are getting to the double burden of disease…). This is a transition that refers to a change of a country’s demographic status from high fertility and high mortality to low fertility and low mortality. Again, just like what happened in the high income countries. This transition is for example due to the introduction of contraceptives, which made family planning possible, but the transition is also closely related to the epidemiological transition, since NCD’s are chronic conditions that most of the time causes a long duration of sickness whilst infectious diseases causes mortality much more rapidly. But there has been other theories as well. Maybe parents would make more offspring if they are uncertain about the survival chances of their kids. According to Fabrice Murtin however, the main contributor to the reduction in fertility was education, primary education in particular. Do you want to read more on that? You can find the source below!

So what about the double burden of disease? As Indonesia is going through both transitions, the country is now facing the double burden of disease. The battle against communicable disease are still on the agenda, but more space on the agenda is needed with the rise of non-communicable diseases due to the changes in lifestyle (which also resulted in the double burden of malnutrition).

It looks like Indonesia has a lot on their plate. Yes, unfortunately this is true. They have to tackle undernutrition, over nutrition (obesity), and non-communicable and communicable diseases. These four seem to be all related, but that doesn’t make it easier to combat the burdens.

Written by: Jessica
Co-editor: Una


Murtin, F. (2013). Long-term determinants of the demographic transition, 1870-200. Review of Economics and Statistics, 95 (2), 617-631.

Skolnik, R (2016). Global Health 101 (3rd edition). Burlington: Jones & Barlett learning.

Mackenback, J.P. Stronk, K. Volksgezondheid en gezondheidszorg. Zesde, geheel herziene druk. Reed Business, Amsterdam. Page 18 – 31.

What the Data Tells Us


So what are the numbers?

Let’s visualize the current situation of undernourishment with an image and graph.




Prevalence of undernourishment in Indonesia

If we look at the FAO Hunger Map 2015, we can see that the prevalence of undernourishment in Indonesia is somewhere between 5% and 14,9%, which is moderately low. However, compared to the majority of the countries in the world, Indonesia still has some work to do. But the good news is, Indonesia is making progress. Was it always like that?


Lets look a bit closer to the prevalence of undernourishment in Indonesia…

Did you know that 7.9% of the Indonesians were undernourished in 2015 and that this number used to be much higher in previous years? Look at that line going down after 2007; There has been a major drop of almost 10% from 2007 to 2015, isn’t that beautiful? This means that the country came from a moderately high to a moderately low status, according to the Hunger Map. However, 7.9% of a population with 258,316,051 inhabitants means that approximately 20,406,986 Indonesians are still undernourished. Which is a lot! So let’s continue to bring that line down!







[Source: The World Bank]

Written by: Jessica

Fast Facts of Malnutrition in Indonesia

Here are some fast statistical facts about the malnutrition situation in Indonesia, just to wrap your brain around the degree of the issue the country is faced with.


  1. 87 million Indonesians are faced with and are vulnerable to food insecurity.
  2. Many people are faced with stunting as a result of malnutrition, and there has been no significant progress in reducing stunting (at 37%).
  3. Indonesia has the 5th highest number of stunted children in the world. 1 of every 3 children in Indonesia are stunted and 9.5 million children under five years old are malnourished.
  4. 12% of children under five years old suffer from wasting (low weight for age) in Indonesia.
  5. 57%, or 2 out of 3 children under two years old, living in rural areas of Indonesia are anemic.
  6. Only 42% of children less than 6 months old are breastfed and only 36% of all children are getting the appropriate complementary food.
  7. 10% of adolescent girls from 15-19 years old are already mothers or pregnant with their first child. Pregnancy during this age creates a greater risk to their nutritional status and their children.
  8. It costs Indonesia more than US$5 billion every year due to malnutrition. This is due to the lost productivity because of poor education standards and decreasing physical capability.
  9. Diarrhea accelerates undernutrition and children suffer from this very frequently. Around 14% of all children in Indonesia suffer from diarrhea.
  10. Overweight and obesity in adults has doubled in the last decade, which increases the risk of non-communicable diseases, otherwise known as the double burden of malnutrition.

(Facts from the World Food Programme, 2014)


Written by Hannah Jin

Winata, J. (2014, December 22). 10 Facts About Malnutrition in Indonesia. Retrieved November 12, 2016, from

More Than Just Skinny

When you think of malnutrition in Indonesia, what do you think of? What kind of image comes to mind? Probably some hungry child that is skinny to the bone, without any food to eat, right? Maybe similar to something that is portrayed in the image above. Before I was educated on this topic, I would’ve thought the same thing.

For many years now, the term “malnutrition” was used only to mean undernutrition, which means that an individual is not receiving the sufficient amount of food intake in their bodies. I personally was familiar with malnutrition as this definition for a long time as well. However, malnutrition actually refers to both the excess and deficiency in nutritional intake, or other words, undernutrition and over nutrition.

Indonesia is mainly referred to as a low, middle-income country, and they continue to struggle with combating malnutrition. With this said, there are many health outcomes and consequences that come with malnutrition in Indonesia. Many instances of malnutrition are seen in maternal and young child undernutrition in Indonesia especially during the infant period where the effects can be very severe and considerable. In childhood undernutrition, it is estimated that it is associated with 1/2- 1/3 of all global child deaths. The thing, however, is that these deaths aren’t just results of undernutrition, but because of the variances of diseases that develop due to the lack of necessary nutrients for the human body. In this specific case, undernutrition contributes to child mortality is the highest for diarrheal diseases at around 73% and around 50% for pneumonia, measles, and severe neonatal infections. Because the child is not receiving the sufficient nutrients to live a healthy and active life, they are prone to developing different kinds of vitamin or micronutrient deficiencies like Vitamin A deficiency, which was commonly found in Indonesia. At least half of the population was considered to be suffering from a deficiency of at least one micronutrient. This can then also lead to stunting, or low height, especially within children. Stunting is a huge problem in Indonesia, which will be discussed in another post.

Anemia, or iron deficiency, is also associated with malnutrition in pregnant women, where it affects around 40% of that specific population. In urban areas, 20% of non-pregnant women over the age of 14, 13% of men, and 10% of children were found to be anemic. Iron deficiency still continues to be a serious problem in Indonesia mainly due to the level of consumption of salt or iodine.

With these deficiencies come even more diseases that are developed due to the fact that their bodies are not functioning to its potential and therefore is more prone to other physical complications. It’s mind-blowing how many more diseases that can connected to all of these deficiencies!

On the other hand, malnutrition can also mean over nutrition, where overweight or obesity can be developed. Obesity is associated with energy imbalance and is related to alternations in a person’s metabolic system. An individual may not be receiving the right variance of foods and may only be consuming foods high in fat, sugar, and salt, which then lead to overweight and obesity. This is usually found in adults and in individuals later on in life. Many non-communicable (NCDs), or long-term, diseases can be consequences of malnutrition in Indonesia. Some NCDs that are seen in the country are hypertension, diabetes, cancer, stroke, and ischemic heart disease.

In Indonesia, type 2 diabetes was also strongly associated with central obesity. It was found that 5.7% of the population over 15 years of age had diabetes and 10.2% of the population was pre-diabetic with an impaired glucose tolerance. In addition, as mentioned earlier, hypertension, is also prevalently seen in Indonesia. Hypertension is known as having high blood pressure and around 45.8% of men and 53.4% of women over the age of 45 have hypertension in Indonesia. It is in fact, worse in women than men, and it also increases considerably with age. Hypertension has been found to affect the majority of Indonesian adults over the age of 45, but only 40% of women and 20% of men had any knowledge of their own condition.

A big concern with all of these risks of developing these diseases associated with over nutrition is that the risks are that much more amplified across a person’s life course and even more increasingly over time. Which basically means that the health outcomes can get more and more severe with time, in the case of over nutrition and obesity.

As you can see, there is an innumerable number of diseases and deficiencies that are associated with malnutrition, both within undernutrition and over nutrition, in Indonesia. Who would’ve thought…


Written by Hannah

Caulfield, L.E., de Onis, M., Blössner M., Black, R.E.. (2004). Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. 80(1):193-8.

Shrimpton R. and C. Rokx. (2013). The Double Burden of Malnutrition in Indonesia, World Bank Jakarta, Report 76192-ID. Retrieved from


Gemukness: “Deliberately unspecific term meaning overweight/obesity but in the Indonesian context. Hidden fatness.”

Ever wonder what the Indonesians refer to overweight or obese? Well now you know that it is “gemukness” or “gemuk.”

Now why am I writing about obesity on a blog about malnutrition in Indonesia? Good question. Malnutrition actually incorporates both the aspect of undernutrition and overnutrition– and in this case, obesity is associated with overnutrition.

In Indonesia, undernutrition however is a huge issue and is given more of a priority compared to overweight and obesity, because these are believed to be problems of wealthier countries.

Obesity is not just a problem for the wealthy.

However, obesity is not just seen in wealthy, high income countries or regions of the world where people can afford lavish meals and can afford to eat 10 meals a day. It is true that obesity does in fact increase with income, but that doesn’t mean that lower wealth areas aren’t affected as well. It has been shown that in Indonesia, especially in the outer islands, the rates of adult overweight and obesity are of similar, if not greater, magnitude as undernutrition. In this specific area, the poverty rates are higher than the major cities of the country, and the problem of “gemukness” is actually a greater double burden than undernutrition. Poor nutrition in the younger years and in mothers continue to contribute to the increased risk of obesity later on in life among adults who survive the malnutrition as a child and then end up in environments where they are more prone to be caught in obesity.

Because of this “surprise,” obesity in Indonesia is even more of a problem because of it is a “hidden problem.” Many people are not fully aware of the consequences they are faced with in their particular environments.

The rate of gemuk adult men and women in Indonesia has been significantly increasing over the last few decades, while the rate of malnourished men and women has decreased considerably. This research and information was taken from the Indonesian Family Life Surveys, and it was additionally shown that the proportion of gemuk men and women, of a BMI of greater than 25, almost doubled, and that the greatest increase was found in obese women. We see that undernutrition is actually declining, while overweight and obesity is increasing in Indonesian adults and the risks increase with age.

Of course, genetics was also tested and researched, just to see if it played even a slight role in the gemukness issue. But researchers were left to find that there is no absolute evidence that genetics plays a role in the growing problem of obesity. Rather, it has been found that the obesity problem is mainly caused by consequences seen during childhood like stunting and constrained fetal growth.

On the other hand, in more areas of the country where income increased, food consumption patterns seemed to suggest increased food intake which contributed to obesity in many people. The greatest increase in food intake was found from meat, fish and eggs, and in prepared foods, where the rates were nearly doubled! Indonesian people be eating lots of animal products!… and processed foods… However, with the scenario with processed foods, many people in low income areas of Indonesia are found to consume more processed foods because they are more affordable than food, say, compared to a farmers market with organic fruits and vegetables. With this said, many of these Indonesian people are found eating instant noodles instead of a good, healthy meal, just because they simply cannot afford it. Instant noodles are good and all, but the constant consumption of these cups of deliciousness are not beneficial for anyone’s health.

And on top of that, much of the physical and built environments in Indonesia are not very friendly in terms of encouraging physical exercise. Instead of bike lanes, pedestrian sidewalks, and parks, there are many many streets where processed foods are sold. Many of the school children purchase snacks from these street vendors and shops, but they do not get the right exercise to burn off the excessive snack consumption.

While undernutrition is a big issue in Indonesia, Gemukness, or obesity, is also just as big of an issue in this region of the world.

Now the questions we are left with are — What other consequences come from obesity? What do we do about it? How can we fix it?… After researching and studying about the obesity problem in Indonesia, I personally believe that one practical way to help control the problem is to continue to educate the people of Indonesia about the extent of the problem and how to change their lifestyle and diet to reduce the risks. This is due to the fact that many Indonesians are not even aware of the severity of the obesity issue in the country!

Written by Hannah

Shrimpton R., & C. Rokx. (2013). The Double Burden of Malnutrition in Indonesia, World Bank Jakarta, Report 76192-ID. Retrieved from

Intervention Innovation in Indonesia

Traditionally, interventions surrounding malnutrition have implemented an educational program and given participants a grocery stipend. This appears to be a good approach until you really look into the portion of the population most affected by the double burden of malnutrition in Indonesia.

Can you guess which socioeconomic group is most at risk?

  1. lowest
  2. middle
  3. highest


Did you make your guess?

If you guessed b.middle, you are correct!

This seems counter-intuitive, wouldn’t those who earned the least be most likely to suffer from malnutrition?

This answer lies in how the double burden of disease is defined. In this case, the double burden of malnutrition is defined as the association between the continued issues of malnutrition and simultaneous increase in obesity rates due to high availability of foods high in Calories and low in micronutrients. While those with moderate income have better food security than low-income groups, they may not have a good nutritional education. Those with moderate income can afford food but may not have the knowledge to make an educated nutritional choice for themselves and their children.

In order to increase efficacy of intervention programs, researchers wanted to implement social cognitive therapy (SCT) in Surabaya City, Indonesia. Essentially, they sought to use the reciprocal determinism along with the interaction between person, environment and behavior in order to help heighten self-efficacy in the mothers.

The new intervention strategy, NEO-MOM added motivational interviews from home visitors as well as hands on nutritional education sessions and role-play experiences from nutrition experts. The comparison group did not receive the interviews or nutrition education. The target behavior was to increase consumption of fruits and vegetables, as well as animal protein (to a lesser degree). Researchers primarily wanted to observe an increase in height of the children but also aimed to achieve a decrease in stunting for children and a decrease in obesity in the mothers.The research suggests that increasing self-efficacy via verbal motivation and bi-weekly goal setting is an effective addition to traditional intervention methods. Success (:!

Due to their high population density and particularly high prevalence of the double burden of malnutrition, urban areas like Surabaya City are ideal location for implementing a more costly program like NEO-MOM.

This motivational, educational method is more than just an intervention, it’s an innovation. They’re doing more than just providing information on how to eat right, they’re performing a service which is needed desperately around the globe… Empowering women to make the right choices for themselves and their children.


Written by: Devon Boullion


Mahmudiono, T., Nindya, T. S., Andrias, D. R., Megatsari, H., & Rosenkranz, R. R. (2016). The effectiveness of nutrition education for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition in Indonesia: study protocol for a randomized controlled trial. BMC Public Health, 16486. doi:10.1186/s12889-016-3155-1