Seferidi Paraskevi, Guzman-Abello Laura, Ballard Ellis, Creed-Kanashiro Hilary M, Huicho Luis, Miranda J Jaime, Millett Christopher, Bernabe-Ortiz Antonio
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
Department of Design, School of Architecture and Design, Universidad de los Andes, Bogota, Colombia.
Lancet Reg Health Am. 2025 Apr 21;46:101102. doi: 10.1016/j.lana.2025.101102. eCollection 2025 Jun.
Peru's progress in reducing stunting has stagnated since 2018, while the country is facing increasing levels of overnutrition, leading to a double burden of malnutrition. However, this shift in nutrition burden is not reflected in Peru's nutrition policy agenda. This study aims to identify leverage points for actions against population-level double burden of malnutrition in Peru.
We developed a system dynamics model that simulates changes in overweight and stunting over time in Peru through changes in food system drivers. The model was conceptually informed by policymakers, practitioners and community members in Peru and used quantitative and qualitative data from secondary sources and published literature.
The model indicated that several overnutrition policies, including policies targeting food availability and affordability, may decelerate but not halt the increase of overweight in the country, mainly due to industry resistance. However, in the long term, the reallocation of resources towards overnutrition policies may inadvertently hinder progress towards stunting targets. Transforming nutrition policy governance, from siloed overnutrition and undernutrition policies towards a common policy framework against the double burden of malnutrition was the only modelled scenario that halted the rise in overnutrition, while keeping Peru on course to reach its stunting goals.
Transition away from policy landscapes that focus on single nutrition outcomes towards synergistic actions that target malnutrition in all forms is a long-term solution towards achieving global nutrition goals. Such policy transitions are especially important in low and middle-income countries like Peru, which are affected by the double burden of malnutrition.
This study was supported by a research grant from the Biotechnology and Biological Sciences Research Council (BBSRC) (grant reference: BB/T009004/1).
自2018年以来，秘鲁在减少发育迟缓方面的进展停滞不前，与此同时，该国面临着超重问题日益严重的情况，导致了营养不良的双重负担。然而，这种营养负担的转变并未在秘鲁的营养政策议程中得到体现。本研究旨在确定针对秘鲁人口层面营养不良双重负担采取行动的杠杆点。
我们开发了一个系统动力学模型，该模型通过食品系统驱动因素的变化来模拟秘鲁超重和发育迟缓情况随时间的变化。该模型在概念上得到了秘鲁政策制定者、从业者和社区成员的指导，并使用了来自二手资料和已发表文献的定量和定性数据。
该模型表明，包括针对食品供应和可负担性的政策在内的多项超重政策可能会减缓但无法阻止该国超重情况的增加，主要原因是行业阻力。然而，从长远来看，将资源重新分配到超重政策上可能会无意中阻碍在发育迟缓目标方面取得的进展。将营养政策治理从孤立的超重和营养不良政策转变为针对营养不良双重负担的共同政策框架，是唯一一种能够阻止超重情况上升，同时使秘鲁继续朝着实现发育迟缓目标前进的模拟情景。
从关注单一营养结果的政策格局转向针对各种形式营养不良的协同行动，是实现全球营养目标的长期解决方案。这种政策转变在像秘鲁这样受营养不良双重负担影响的低收入和中等收入国家尤为重要。
本研究得到了生物技术和生物科学研究委员会（BBSRC）的研究资助（资助编号：BB/T009004/1）。
