Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms.

Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms.

A whole system approach to childhood obesity: how a supportive environment was created in the city of Brighton and Hove, United Kingdom.

Childhood obesity is a growing global challenge, and no country has yet reversed the upward trend in prevalence. The causes are multifaceted, spanning individual, societal, environmental, and political spheres. This makes finding solutions complex as traditional linear models of treatment and effect have proven only minimally successful or unfeasible at the population level. There is also a paucity of evidence of what works, and few examples of intervention that operate on a 'whole systems' level. The city of Brighton in the United Kingdom has experienced a downward trend in child obesity rates compared to national figures. The aim of this study was to explore what has led to successful change in the city. This was done through a review of local data, policy and programs, and thirteen key informant interviews with key stakeholders involved in the local food and healthy weight agenda. Our findings highlight key mechanisms that have plausibly contributed to a supportive environment for obesity reduction in Brighton according to key local policy and civil society actors. These mechanisms include; a commitment to early years intervention such as breastfeeding promotion; a supportive local political context; the ability to tailor interventions to community needs; governance structures and capacity that enable cross-sectoral collaboration; and a citywide framing of obesity solutions in the context of a 'whole system' approach. However, substantial inequalities persist in the city. Engaging families in areas of high deprivation and operating in an increasingly difficult context of national austerity are persistent challenges. This case study sheds light on some mechanisms of what a whole systems approach to obesity looks like in practice in a local context. This is of relevance to both policymakers and healthy weight practitioners across a spectrum of sectors who need to be engaged to tackle child obesity. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-023-01361-9.

Stories of change in nutrition: lessons from a new generation of studies from Africa, Asia and Europe.

How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition's upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.

Factors influencing obesogenic behaviours of adolescent girls and women in low- and middle-income countries: A qualitative evidence synthesis.

This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low- and middle-income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10-19 years of age) or women of reproductive age (15-49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty-two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs.