Table 3.

Suggested factors contributing to double burden of disease worldwide^*

Categories	Examples and related studies	Countries	Number of studies
Lifestyle changes in diets and physical activity	Lack/decreased/low level of physical activity High use of computer/TV; sedentary jobs Diet shifts: high access to high-energy-dense foods, high intake of calories, carbohydrates, and sugar-sweetened beverages; low consumption of fresh fruits/vegetables	China, Bangladesh, Ecuador, Indonesia, Iran, Mexico, Peru	9
Urbanization/Economic development	Labor-saving technology from urbanization Urbanization causing low fruit/vegetable production and poor diet Female schooling increasing incomes Improved economic status and purchasing power used for energy-dense foods intake High maldistribution of food through income inequality: overconsumption by wealthy vs. food insecurity in poor Inadequate coverage/assistance for the poor, along with economic development	Bangladesh, Brazil, China Gambia, India, Indonesia, Peru, Vietnam	11
Policy	Inappropriate government policies and programs on food consumption and food fortification Undesirable healthcare system Lack of educational interventions that stress good nutrition, physical activity, or preventing obesity/overweight Lack of policies/ programs to address the double disease burden, but mainly programs addressing undernutrition, poverty, and/or food insecurity Primary health care services lack nutritionists	Albania, Ecuador Guatemala, Iran, Mexico	6
Other	Low health awareness	India	1

^*Results were based on the 29 studies we reviewed.