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Rethinking the Balance Between Future Obesity and Malnutrition with Climate Change

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Funding Year: 2010

Research Areas: Climate, Public Health, Sustainability

Regions: Asia

The goal is to develop a computer model capable of evaluating nutrition-related health policies in India, taking into account the impact of climate change on agricultural production and food availability.


October 25, 2010

By Teal Pennebaker

Obesity is a well-documented problem in the United States and other developed countries. Now, Stanford University researcher Jeremy Goldhaber-Fiebert is turning to an unexpected location to conduct his own obesity research. With support from a Woods Institute Environmental Venture Projects (EVP) grant, Goldhaber-Fiebert has teamed up with colleagues from across campus and worldwide to better understand India's dual health burden of undernutrition and obesity.

"In these places where both undernutrition and obesity are intermingling, the story becomes complicated and the challenges unique," said Goldhaber-Fiebert, an assistant professor of medicine and core faculty member with Stanford Health Policy.

"The image that many people have of India is dominated by the series of pictures we've received for the last 20 years of poorly nourished people," he added. "But obesity and diabetes are increasingly prevalent, affecting cities and rural areas, northern and southern regions, in different ways."

As India's middle class has expanded, the nation's public health concerns have shifted. Obesity rates have risen, coinciding with a surge in diabetes. The number of Indians with type 2 diabetes is expected to double to nearly 80 million by 2030. Meanwhile, 43 percent of children in India are underweight, according to the World Bank.

A chronic condition, type 2 diabetes is characterized by high levels of glucose in the blood. People with type 2 diabetes are at much greater risk of health complications, including problems with the eyes, kidneys and cardiovascular system. The American Heart Association estimates that nearly 75 percent of type 2 diabetics die from some form of heart or blood vessel disease. And the risk of stroke increases more than two-fold within the first five years of being treated for type 2 diabetes.

Public health strategy

Goldhaber-Fiebert is interested in how the rise in India's type 2 diabetes rate will affect a country with 1.1 billion people. He wants to understand how best to attempt a public health strategy that addresses both the undernourished and the obese, who are at greater risk for type 2 diabetes.

"From a public health perspective, I don't think that we can focus solely on undernutrition or on obesity," he said. "Both are important. Their interplay produces complex policy challenges."

Goldhaber-Fiebert is joined in his research by Stanford colleagues David Lobell, assistant professor of environmental Earth system science and Woods Institute center fellow; Walter Falcon, deputy director of the Program on Food Security and the Environment and Woods Institute senior fellow; and Bala Rajaratnam, assistant professor of statistics. In 2010, the Stanford team received a Woods Institute EVP grant for interdisciplinary research to develop a computer model capable of evaluating nutrition-related health policies in India, taking into account the impact of climate change on agricultural production and food availability.

Bringing his own expertise in mathematical modeling, Goldhaber-Fiebert is working with the group to consider the patterns of future illness and death due to undernutrition and obesity. The researchers would like to know how economic and demographic changes will impact these trends. Ultimately, broadly delivered nutrition policies will have to address undernutrition and obesity issues without exacerbating either one.

Global implications

Although currently focused on India, the research will have broad implications for many other countries that face the undernutrition/obesity dual burden. For example, Goldhaber-Fiebert and Karen Eggleston, a Shorenstein APARC Fellow at the Freeman Spogli Institute for International Studies, are examining analogous issues in China.

Goldhaber-Fiebert explained that some Indian families have undernourished and obese members living side-by-side. And studies have shown that public health initiatives aimed at addressing undernutrition end up providing food to older children who are not undernourished. Similarly, efforts to curb obesity might risk inadvertently harming people who are undernourished.

"The next couple of years of our research are going to be largely about how to address both at once," Goldhaber-Fiebert said. "In recent trips to India, we've started conversations with local policymakers and NGOs actively involved in these issues."

Teal Pennebaker is information editor and external relations coordinator for Stanford Health Policy at the Freeman Spogli Institute for International Studies.

Learn more about the Environmental Venture Projects grant program and other funded projects.

Principal Investigators:

Jeremy Goldhaber-Fiebert Associate Professor of Medicine (Primary Care & Outcomes Research) and, by courtesy, of Health Research and Policy

David Lobell Professor of Earth System Science and Senior Fellow at the Freeman Spogli Institute, at the Woods Institute for the Environment and at the Stanford Institute for Economic Policy Research

Walter Falcon Helen C. Farnsworth Professor of International Agricultural Policy, Emeritus

Bala Rajaratnam

Paul Wise Richard E. Behrman Professor in Child Health