FIGURE 4.

Framework for building operational definitions of the double burden of malnutrition (DBM) based on definitions observed in published literature. The framework for building operational definitions of the DBM can be used by analysts, program planners, and policymakers to determine the specific operational definition of DBM that meets their objective(s). The 3 dimensions of the operational definition (level of assessment, target population, and forms of malnutrition to assess) should be chosen with consideration of the country context and public health priorities, and include the purposeful selection of indicators fit to the purpose of the objective(s). ¹Population-level assessment refers to comparisons of national, regional, and subregional populations or smaller populations, such as a population of students within a school or a population of adult women within a community. Household-level assessment refers to comparisons among or across households of all or some specified household members. Dyad-level assessment refers to comparisons among or across mother-child pairs or caregiver-child pairs. Individual-level assessment refers to comparisons of different forms of malnutrition occurring within a single individual. ²Assessment of the target population can include ≥1 age groups. ³Widely used definitions of DBM assess the coexistence of 1 form of “overnutrition” and 1 form of “undernutrition.” This framework can be expanded to assess multiple forms of malnutrition, for example, when assessing a triple burden of malnutrition. Additional forms of “overnutrition” identified in our review included macrosomia. Additional forms of “undernutrition” identified in our review included chronic energy deficiency, low birth weight, low upper-arm circumference, low triceps skinfold measurement, and food insecurity.