Increasingly, health systems in many developing countries, including India, are simultaneously confronting “Dual Burden of Malnutrition”. Underweight and overweight are both forms of malnutrition, a term that encompasses either a lack of or excess in energy and/or nutrients. The Dual burden of Malnutrition presents a unique challenge for public health. Programmes should promote nutritious foods and a healthy lifestyle to address both types of malnutrition at the same time.The Health system should be responsible for screening persons for over-nutrition, while ICDS and health programmes should be responsible for screening for undernutrition.

Suggestions

• The ICDS requires strengthening and restructuring, with special focus on pregnant and lactating mothers and children under three years. The ICDS also needs to forge strong institutional convergence with the National Rural Health Mission and the Total Sanitation Campaign particularly at the district and village levels.
• As mandated by the PM’s National Council on India’s Nutrition Challenges, a Multisectoral Nutrition Programme should be implemented. The Multi-sectoral Nutrition Programme is designed to (i) focus action on the critical age groups to prevent and reduce under-nutrition as early as possible, across the life cycle (pregnancy, lactation, infancy and early childhood, adolescence); (ii) address key inter related determinants of malnutrition together by facilitating convergence; (iii) provide local flexibility, support pilots and innovative panchayat led models of convergent action and (iv) to focus on districts with the highest burden of malnutrition, so that reduction in maternal and child under-nutrition is accelerated.
• Despite breastfeeding having numerous recognised advantages, and several initiatives to promote breastfeeding, early and exclusive breastfeeding rates in most states of India are low. There is a need to promote optimal infant and young child feeding (IYCF) practices.
• There is need to have strategies to combat micro- nutrient deficiencies (Iron, Vitamin A and Iodine) in children, women and adolescent girls. A comprehensive approach should be adopted which includes complementary strategies to address micro-nutrient malnutrition including: (i) Infant and Young Child Feeding Practices; (ii) Dietary Diversification; (iii) Horticultural interventions; (iv) Nutrient Supplementation; (v) Food fortification; and (vi) Public Health Measures.
• Nutrition and health education through all available modes of communication should emphasize the need for: (i) eating balanced diets; and (ii) adopting healthy lifestyles with adequate physical activity.
• Health interventions should be carried out by the health system including, (i) screening persons for over-nutrition whenever they access health care; (ii) using of BMI for adults and BMI-for-age in children and adolescents for early detection of over-nutrition; (iii) identification of over-nourished persons and personalised advice regarding modification of dietary intake and life style; and (iv) monitoring the improvement and providing focused care to those who are facing problems in modifying their lifestyles.
• Effective monitoring of national nutrition programmes requires both monitoring and assessment of processes and outcomes. A responsive and dynamic Nutrition Surveillance System (NSS) should be put in place in order to capture nutrition related information. It would help assess the current situation, analyse the causes/reasons of the problem and based on the analysis and available resources, suggest solutions to improve the situation.
• A nation-wide information, education and communication campaign should be launched against malnutrition