For the first time, obesity surpasses underweight as a form of malnutrition among children and adolescents worldwide, according to UNICEF.

For the first time in history, obesity has surpassed underweight as the dominant form of malnutrition worldwide among children and adolescents aged 5 to 19. This is the main conclusion of a UNICEF report published this Wednesday, which also warns of the rapid increase in the prevalence of overweight and obesity in low- and middle-income countries and how diets high in ultra-processed foods are driving this increase. A year ago, a study by The Lancet had warned that this was already the main malnutrition problem among adults and children globally. Now, UNICEF, using its own data, confirms the finding in children and adolescents and projects that the trend will worsen. "From 2030 onwards, this will also occur in children under five years of age, so obesity will continue to be one of the most important challenges in the nutrition of children and adolescents," explains Mauro Brero, senior nutrition advisor at UNICEF and co-author of the report, in a video interview with EL PAÍS.

“When we talk about malnutrition, we are no longer just talking about underweight children,” said UNICEF Executive Director Catherine Russell in a statement, warning that obesity is an “increasingly alarming” problem that can have consequences for children’s health and development . “Ultra-processed foods are increasingly displacing the consumption of fruits, vegetables, and proteins, at a time of life when nutrition is essential for growth, cognitive development, and mental health,” she added.

When we talk about malnutrition, we are no longer referring only to underweight children.

Catherine Russell, Executive Director of UNICEF

The research , "Feeding the Business: How Food Environments Endanger Childhood Well-being," draws on data from more than 190 countries and reveals that, since the beginning of the century, the prevalence of underweight in children aged 5 to 19 has decreased from 13% to 9.2%. This good news contrasts with the rising obesity rate, which has risen from 3% to 9.4%. Today, 188 million children worldwide—one in 10—are obese. This prevalence exceeds underweight in every region except sub-Saharan Africa and South Asia.

Several Pacific island countries have the highest obesity rates worldwide among children aged 5 to 19, with 38% in Niue, 37% in the Cook Islands, and 33% in Nauru. These high levels are primarily due to the shift from traditional diets to those based on cheap, imported, energy-dense foods.

Overall, one in five children and adolescents between the ages of 5 and 19 are overweight. By region, Latin America and the Caribbean, the Middle East and North Africa, and North America are among the three regions with the highest prevalence among children and adolescents aged 0 to 19. According to the most recent data, there are 391 million overweight children and adolescents worldwide, and a large proportion of these suffer from obesity, the chronic phase of overweight that already poses health risks.

Overweight and obesity are growing most rapidly in low- and middle-income countries. Today, 81% of overweight children aged 5 to 19 live in these territories. Between 2000 and 2022 alone, the number of overweight children quadrupled in low-income countries. Afghanistan, Bhutan, the Democratic Republic of the Congo, Indonesia, Liberia, Sri Lanka, the Maldives, Pakistan, and Vietnam are the countries that have experienced the sharpest increase in overweight.

The report highlights that the responsibility for adopting a diet rich in ultra-processed foods is not individual. "It's not children who are failing, nor are it families, but there are environments where these types of products are available," says Brero. She explains that these ultra-processed foods are found in the spaces where children play, live, and learn, are cheaper, and the industry invests in large marketing and advertising campaigns.

To improve food environments and reduce obesity and overweight rates, UNICEF recommends establishing policies that include food labeling, marketing restrictions, and food taxes and subsidies. It is also necessary to ban the sale of ultra-processed foods and their advertising in schools , address interference from the food processing industry, develop initiatives with families and communities to demand healthier food environments, and improve access to nutritious food for vulnerable families.

If children who previously obtained most of their calories from unprocessed grains, vegetables, fruit, eggs, or meat now get them from these foods, this contributes to micronutrient deficiencies and malnutrition.

Mauro Brero, senior nutrition advisor at UNICEF and co-author of the report

Preventing obesity in school cafeterias

In these prevention efforts, school cafeterias play a key role. Carmen Burbano, director of School Feeding and Social Protection at the World Food Programme (WFP), explains that in Latin America, Asia, and Africa, work has begun to ensure that these social programs—which have increased their coverage by 20% in the last four years, according to a report also published this Wednesday—promote better eating habits and a healthy relationship with food. “Countries like Mexico, Chile, Argentina, Peru, Colombia, and Brazil have reformed their programs to address this problem,” Burbano stated in a telephone interview. This is achieved not only by providing healthy menus, but also by teaching about nutrition in the classroom. “With school gardens, for example, we teach children about healthy foods and how to prepare them. This is part of a holistic vision of what the education system can do to address this form of malnutrition.”

The WFP's State of School Feeding 2024 study sees an opportunity to address this and other malnutrition problems with the increase in school meal coverage, which has grown to 60% among children in low-income countries. Africa, which suffers from malnutrition, obesity, and other problems of sedentary living, now provides school meals to 20 million more children than in 2022.

The increase in coverage, reaching a total of 466 million children worldwide, has been achieved thanks to the coordination of the Global School Feeding Coalition, which brings together 108 countries, and government funding, the report highlights. “One hypothesis,” says Burbano, “is that the pandemic was a shock to communities. Schools closed, access to food was suspended, and then governments realized how valuable these programs were.” Global funding for school meals has doubled, from $43 billion in 2020 to $84 billion in 2024 (from about €36.6 billion to €71.5 billion).

However, Burbano acknowledges, there is still a gap to be filled: “Thirty percent of children in low-income countries receive school meals, compared to 80 percent of children in high-income countries. That's when we need international aid.” Currently, only 1 percent of funding for school meals comes from Official Development Assistance, according to the WFP document. Increasing this share in low-income countries would boost coverage and then hand over to governments so they can fund projects with national budgets and make them sustainable.