Doak, Colleen Marie (2002). Explorations in understanding the dual burden of underweight and overweight in households from seven countries. Master's thesis / Doctoral dissertation.
In Cape Town, South Africa, in a community experiencing rapid changes in diet and physical activity, high prevalences of overweight were found among women despite an equally high prevalence of stunting among children (Bourne et al., 1994; Steyn et al., 1998a). Furthermore, in many developing countries experiencing the nutrition transition, overweight among adults is increasing (Delpeuch and Maire, 1997; Popkin and Doak, 1998). Together, these findings led to the hypothesis that under-nutrition and overweight might cluster within households as a consequence of the nutrition transition. Households with an underweight and an overweight person together, the focus of this dissertation, are henceforth referred to as dual burden households. This analysis explores the nutrition transition and its association with the dual burden household in three steps. The first analysis is a broad overview of the urban residence and high household income associated with the dual burden household. These two variables are tested because of their close relationship to the nutrition transition lifestyle. The second analysis uses the China 1993 survey to test the association between nutrition transition related household diet, assets, and other socio-demographic factors and being a dual burden household. The final data analysis is based on national surveys from Brazil, China, Indonesia, the Kyrgyz Republic, Russia, Vietnam and the United States. Significant results from all three studies show high household income is associated with the dual burden phenomenon in many of these countries. The notable exceptions being the Kyrgyz Republic and Russia. Results from China showed household diet, assets related to leisure, and a household head with a low energy occupation were all significantly associated with being a dual burden household. A comparison across the seven countries shows the greatest prevalence of the dual burden household occurred in the countries experiencing the middle stages of the nutrition transition. This result indicates that further longitudinal studies are needed. However, the prevalence of the dual burden household in all seven countries illustrates the importance of finding interventions that are able to simultaneously address both forms of malnutrition.
Doak, Colleen Marie