How a Nation is Battling Two Health Crises at Once
Imagine a nation where obesity rates are skyrocketing while undernutrition remains a persistent threat—not as separate problems, but as simultaneous crises affecting millions. This is Indonesia's "double burden of malnutrition," a complex public health challenge that defies simple solutions.
Indonesian adults studied in landmark research
As Southeast Asia's largest economy undergoes rapid transformation, the health of its population tells a story of two realities: one of progress and prosperity, and another of persistent inequality and emerging disease patterns.
At the forefront of understanding this paradox is the Indonesian Journal of Public Health Nutrition (IJPHN), a scientific publication dedicated to exploring precisely these nutritional challenges. Established in 2020 by the Department of Public Health Nutrition at Universitas Indonesia, this open-access, peer-reviewed journal serves as a crucial platform for researchers investigating Indonesia's evolving nutritional landscape 1 9 .
Indonesia is experiencing what scientists call a "nutrition transition"—a shift away from traditional diets toward more processed foods, combined with decreasing physical activity levels. This transition, driven by rapid urbanization and economic development, has created a unique scenario where both undernutrition and overnutrition coexist within the same communities, sometimes even within the same household .
Source: Scientific Reports (2025)
This dual challenge strains healthcare systems designed to address either one problem or the other, but not both at once. Recent data reveals that between 2007 and 2023, the prevalence of underweight in Indonesian adults declined from 12.3% to 7.5%, while obesity nearly doubled from 19.7% to 38.3% using Asian-specific BMI cutoffs .
One of the most comprehensive examinations of Indonesia's double burden comes from a 2025 study published in Scientific Reports that analyzed data from 2.4 million Indonesian adults aged 20 years and older . This massive repeated cross-sectional analysis utilized data from four waves of Indonesian health surveys (2007, 2013, 2018, and 2023), creating a detailed picture of how malnutrition trends have evolved across different demographic and socioeconomic groups.
The results painted a striking picture of Indonesia's rapid nutritional transition. While underweight prevalence decreased significantly over the 16-year study period, the rise in obesity was far more dramatic, nearly doubling across the adult population .
| Demographic Group | Obesity Prevalence 2007 | Obesity Prevalence 2023 | Increase |
|---|---|---|---|
| Urban Women | 30.1% | 49.9% | +19.8% |
| Highest Income Group | 25.6% | 48.3% | +22.7% |
| Total Population | 19.7% | 38.3% | +18.6% |
Table 2: Socioeconomic Disparities in Malnutrition (2023)
Table 3: Age-Specific Patterns in Malnutrition Prevalence
The socioeconomic patterns revealed by the data follow the "obesity transition" theory proposed by Jaacks et al.—in the early stages of economic development, obesity typically affects higher socioeconomic groups first, before shifting toward lower-income populations as countries develop further . Indonesia currently appears to be in the first stage of this transition.
Understanding nutritional trends at the population level requires specialized methodological approaches. The featured study employed several key research tools that form the foundation of public health nutrition research :
This technique ensures that the study sample accurately represents the broader population by dividing it into subgroups (strata) based on key characteristics like geographic location or socioeconomic status, then randomly selecting participants from each stratum.
Standardized protocols for measuring height, weight, and waist circumference provide objective indicators of nutritional status. The precise equipment and training of field enumerators is crucial for data quality.
Rather than relying solely on income data (which can be unreliable in countries with large informal economies), researchers construct wealth indices based on household asset ownership, housing characteristics, and access to utilities.
Recognizing that health risks occur at lower BMI levels in Asian populations, researchers used region-specific thresholds (BMI ≥ 25 kg/m² for obesity) rather than global standards (BMI ≥ 30 kg/m²).
Development of standardized questionnaires and measurement protocols for national health surveys.
Trained enumerators conduct anthropometric measurements across Indonesia's diverse regions.
Statistical analysis of trends across time, demographics, and socioeconomic groups.
Dissemination of findings through peer-reviewed journals like IJPHN and Scientific Reports.
The Indonesian Journal of Public Health Nutrition showcases research beyond traditional malnutrition metrics, exploring innovative approaches to addressing Indonesia's nutritional challenges. One emerging area focuses on school lunch programs as a strategic intervention point. A 2025 bibliometric analysis highlighted several future trends in this domain, including integrating sustainability considerations, reducing food waste, and incorporating nutrition education directly into school curricula 6 .
Consumer research adds another dimension to understanding Indonesia's nutritional transition. A 2025 NielsenIQ report revealed that:
say emotional and mental health is more important than five years ago
prioritize healthy nutrition
Yet significant barriers persist—48% struggle to access healthy options, while 43% cite high costs as a limiting factor 8 . This consumer insight helps explain why the nutrition transition may be accelerating, even as awareness of healthy eating increases.
Source: NielsenIQ (2025) 8
Indonesia's nutritional paradox represents both a formidable challenge and an opportunity to reimagine public health approaches. The research published in the Indonesian Journal of Public Health Nutrition and other scientific venues points toward several promising directions:
Programs that simultaneously address undernutrition and overnutrition
Meal programs that respect Indonesia's diverse culinary traditions
Digital tools to support individual health goals 8
Cross-sectoral approaches connecting agriculture, education, and healthcare
As Indonesia continues its development journey, the insights from public health nutrition research will be essential for navigating the complex pathway toward a future where all citizens have the opportunity to achieve optimal health, free from the dual burdens of too little nutrition and too much. The work featured in the Indonesian Journal of Public Health Nutrition not only documents this transition but illuminates potential pathways toward a healthier nutritional future for the world's fourth most populous nation .
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